A HAIR OF THE DOG THAT BIT YOU: A CASE OF PASTEURELLA BACTEREMIA

Abstract

SESSION TITLE: Wednesday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM INTRODUCTION: Pasteurella is a Gram-negative coccobacillus that is commonly transmitted from cat and dog bites, and causes a wide spectrum of diseases in humans. With more people keeping pets, there is an increased risk of possible infection with zoonotic organisms. Here, we present a case of septic shock caused by Pasteurella bacteremia. CASE PRESENTATION: A 59 year-old female with no known medical history and no medical follow-up presented with her dog following a motor vehicle accident. Vitals revealed hypotension, atrial fibrillation with rapid ventricular response, fever, and respiratory distress. Physical exam revealed multiple open wounds on her lower extremities with clinical signs of cellulitis. She was intubated for hypoxic respiratory failure and found to have combined distributive and cardiogenic shock, aortic stenosis and insufficiency, and pulmonary edema. The patient was admitted to the Intensive Care Unit where she received intravenous vasopressors, Vancomycin and Piperacillin/Tazobactam. Blood cultures were positive for gram-negative rods, and speciation revealed Pasteurella multocida. She was transitioned to Ceftriaxone and steadily improved. She was eventually weaned off vasopressor support, extubated, and transferred to the general medical floors. DISCUSSION: The most common infections caused by Pasteurella multocida are local wound infections following animal bites or scratches. Cats are the source of infection in 60-80% of cases and dogs in the majority of the remainder. While local skin infections are the most common result of Pasteurella multocida, bacteremia has been shown to occur in 25-50% of patients with pneumonia, meningitis, and septic arthritis. Severe Pasteurella infections are uncommon and appear more frequently in elderly patients and those with underlying chronic diseases such as cardiovascular disease, diabetes mellitus, AIDS, malignancy, cirrhosis and chronic kidney disease. Studies have shown 70% of systemic infections in those greater than 50 years of age and 21% in ages 20-50 years. In our patient’s case, it is suspected that the route of infection was via the skin, as the patient’s dog was witnessed to be licking her lower extremity wounds. Mortality in severe disease (i.e. septicemia) is estimated to be roughly 28%. This case is unique in that our patient had no signs of immunocompromise, but given undiagnosed coronary artery disease, she may have had increased susceptibility to developing severe infection. CONCLUSIONS: Adequate hygiene is essential in preventing transmission from pets. Due to the high mortality of severe Pasteurella infection, and the increasing number of pets, it is important to have a high suspicion for pet-related infections. Reference #1: Fajfar-Whetstone, C. J., et al. "Pasteurella multocida septicemia and subsequent Pasteurella dagmatis septicemia in a diabetic patient.” Journal of clinical microbiology 33.1 (1995): 202-204 DISCLOSURES: No relevant relationships by George Elkomos-Botros, source=Web Response No relevant relationships by Ayelet Hilewitz, source=Web Response No relevant relationships by Sameer Khanijo, source=Web Response