&lt;i&gt;Pasteurella&lt;/i&gt;&lt;i&gt; &lt;/i&gt;&lt;i&gt;multocida&lt;/i&gt;&lt;i&gt; &lt;/i&gt;Bacteremia and Osteomyelitis from a Diabetic Foot Ulcer

Ekamjeet Randhawa,Benjamin Bluen,Sara Schultz,John R Woytanowski

doi:10.12691/ajmcr-5-8-7

Pasteurella multocida Bacteremia and Osteomyelitis from a Diabetic Foot Ulcer

Ekamjeet Randhawa, Benjamin Bluen + Show 2 more

Open Access

https://doi.org/10.12691/ajmcr-5-8-7

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Abstract

Pasteurella multocida is a gram-negative coccobacillus that causes a spectrum of illnesses. P multocida lives as commensal bacteria in the upper respiratory tracts of fowl and mammals. Infections most commonly result from cat or dog bites; however, direct inoculation via saliva has been reported. Although the majority of P. multocida infections manifest in skin and soft tissue, it may cause bacteremia with disseminated infection in an immunocompromised host. Dissemination is responsive to treatment but carries a significant mortality risk of about 30%. We present a case of a 46 year old male with type 2 diabetes mellitus, coronary artery disease and chronic kidney disease with stage 4 neuropathic heel ulcer who presented with hypothermia and chills. One day into admission, 4/4 blood culture bottles were positive for Pasteurella multocida. MRI of the foot was concerning for osteomyelitis which was confirmed via I&D. The patient did report having a dog and a cat at home, but adamantly denied any bites from either animal. Examination of his boot used for support with his foot containing the ulcer revealed extensive animal hair stuck to the boot. It was deemed likely that the route of inoculation occurred from contamination of his neuropathic ulcer from his dog’s saliva, likely from a lick, for which his diabetic neuropathy may have impaired initial sensation of the contamination. The patient was treated with ampicillin-sulbactam while admitted and discharged with oral levofloxacin 6 week course for residual osteomyelitis.

Highlights

Pasteurella multocida is a gram-negative coccobacillus that causes a spectrum of illnesses
A 46-year-old male with history of coronary artery disease, chronic kidney disease stage IV and type II diabetes mellitus complicated by neuropathy and chronic heel ulcer with tracking to bone presented to the emergency department in our inner city university hospital after he was found to be lethargic in his work office
The patient had a temperature of 101.9 deg F, had a heart rate of 95 beats/minute, and a blood pressure of 166/75. His physical examination was notable for warmth, erythema, and tenderness to palpation in the area surrounding his left lower extremity heel ulcer

Summary

Introduction

Pasteurella multocida is a gram-negative coccobacillus that causes a spectrum of illnesses. P multocida lives as commensal bacteria in the upper respiratory tracts of fowl and mammals [1]. An estimated 70-90% of cats and 20-50% of dogs carry the microbe. Infections most commonly result from cat or dog bites; direct inoculation via contaminated saliva has been reported [2,5,6]. The majority of P. multocida infections manifest in skin and soft tissue, many complications have been identified especially in immunocompromised patients [1,3,4]. Associated bacteremia is rare but carries a significant mortality rate [3]

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