Pasteurella multocida meningitis caused by kissing animals: a case report and review of the literature

Abstract

Pasteurella multocida is a rare cause of meningitis. It is a Gram-negative coccobacillus that is a normal inhabitant of the nasopharynx or gastrointestinal tracts in animals. In humans, P. multocida has been reportedly responsible for secondary infections via domestic animals. Although it generally shows low pathogenicity in healthy individuals, exposure to domestic animals may increase the risk of infection. P. multocida should be considered as a potential cause of meningitis when a patient has experienced close contact with animals. A 44 year-old female complained of severe headache with nausea. Physical examination showed high-grade fever but no infectious symptoms and no signs of scratch wounds. She was alert and focal neurological signs were absent, but she complained of neck stiffness. Laboratory examination revealed a white blood cell count of 14,200/ mm (89.6% neutorophils), 4.2% HbA1c, and a negative HIV-1 serology. Chest X-ray and brain computed tomography findings were also normal. An initial cerebrospinal fluid (CSF) examination showed 2,880 cells/ll, an elevated protein level (156 mg/dl), and reduced glucose (51 mg/dl). Gram-negative rods were detected in the CSF by Gramstaining. The patient was therefore diagnosed with bacterial meningitis. Empiric therapy was started immediately with antibiotics, including high-dose meropenem (4 g/day) and vancomycin (2 g/day). P. multocida was isolated from blood and CSF. Based on the results of antibiotic susceptibility tests, meropenem treatment was continued for a week. Closer inspection revealed no underlying disease causing the bacterial meningitis. Her condition improved, with no neurological sequelae. On interview, she was found to have a habit of kissing her dog’s face and feeding it by transferring food mouth-to-mouth. The current case shows the typical symptoms and CSF findings of bacterial meningitis. Pasteurella multocida was isolated as the causative microorganism. Pasteurella multocida very occasionally produces infectious disease in humans, but its carriage rate in dogs, especially in the oral cavity, is high (12–75%) [3]. There have been some reports of animal bites resulting in symptoms of P. multocida infection in humans, including sepsis and cellulitis [5]. An overview of the literature on P. multocida meningitis between 1989 and 2009 suggests that animal kissing, as well as animal bites, can also cause this type of meningitis in healthy adults (Table 1) [1, 2, 6–10]. Patients with P. multocida meningitis occasionally have other, concomitant neurological diseases, such as epidural empyema and/ or encephalitis (Table 1) [2, 6–10]. Green et al. [2] reported that neurological complications were present in 17% (5/17 cases) of patients of P. multocida meningitis, based on an overview of case reports between 1989 and 1999. Analysis of a further 36 cases, in addition to the seven cases from 2000 to 2009, suggested a prevalence of neurological complications in patients with P. multocida of 22.2% (8/36 cases), which is similar to the reported prevalence in patients with bacterial meningitis caused by common bacteria. Penicillin was the most frequently used therapy in patients with P. multocida meningitis (Table 1) [2, 6–10]. However, penicillin-resistant P. multocida have been reported in rare cases [4]. We used meropenem and vancomycin as empiric antibiotics, to provide initial, broadspectrum coverage. S. Kawashima N. Matsukawa (&) Y. Ueki M. Hattori K. Ojika Department of Neurology, Nagoya City University, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya 467-8601, Japan e-mail: norim@med.nagoya-cu.ac.jp