An abscess due to Pasteurella multocida after a cat scratch: Case report

Abstract

Pasteurella multocida has been isolated from 50% to 70% of healthy cats and most commonly associated with acute skin and soft tissue infections following an animal bite or scratch. As the zone and depth of injury can lead to more serious infections such as deep tissue infections, septic arthritis, osteomyelitis. However, no predictive factor showing which wound would be infected. In our case, patient whom applied with abscess after a cat scratch and P. multocida was found as a causative agent. This situation has caused to review us, once more, that which cases should be taken antibiotic pro­phylaxis in addition to immunoprophylaxis (for rabies post-exposure prophylaxis, and anti-tetanus prophylaxis) in the first admission. Antibiotic prophylaxis should be used for 3-5 days in selected cases if they include; moderate to severe crushing injuries especially edematous form, less than 8 hours old, bone or joint penetration, hand wounds, especially emphasizes the importance of hand injuries and deep penetrations.

Keywords

• Pasteurella multocida

An abscess due to Pasteurella multocida after a cat scratch: Case report

Öz

Sağlıklı kedilerin %50 ile %70’inde Pasteurella multocida izole edilmekte ve hayvanın tırmalaması ya da ısırmasını takiben gelişen deri ve yumuşak doku infeksiyonlarına sıklıkla neden olabilmektedir. Yaralanmanın olduğu bölge ve derinliği itibariyle derin doku infeksiyonları, septik artrit, osteomyelit gibi çok daha ciddi infeksiyonlara yol açabilmektedir. Buna rağmen hangi yaranın infekte olacağını gösteren prediktif faktör yoktur. Bizim olgumuz kedi tırmalaması sonrası oluşan abse nedeniyle başvurdu ve etken olarak P. multocida saptandı. Bu durum, ‘‘ilk başvuruda immünoprofilaksiye (temas sonrası kuduz ve tetanoz profilaksisi) ilaveten antibiyoprofilaksi hangi vakalara uygulanmalı?’’ sorusunu bir kez daha gözden geçirmemize neden oldu. Seçilmiş vakalarda; orta ve şiddetli ezilme şeklinde yaralanmalarda özellikle ödematöz formda, yaralanmanın üzerinden sekiz saatten az bir zaman geçmişse, kemik veya eklem penetrasyonu ihtimali varsa, el yaralanmalarında, 3-5 gün süre ile antibiyoterapi önerilmekte ve özellikle el yaralanmaları ve derin penetrasyonlarda antibiyoterapinin önemi vurgulanmaktadır

Anahtar Kelimeler

• Pasteurella multocida, kedi tırmalaması, antibiyotik profilaksisi

Kaynakça

1. Mitnovetski S, Kimble F. Cat bites of the hand. ANZ J of Surg 2004;74: 859-862.
2. Goldstein EJC. Bites. In: Mandell GL, Bennett JE, Dolin R eds. Mandell, Douglas, and Bennett’s Principles and prac- tice of Infectious Diseases 7th edn. Vol 2: Philadelphia, PA: Churchill Livingstone Elsevier, 2010:3911-3915.
3. Philipsen TE, Molderez C, Gys T. Cat and dog bites. What to do? Guidelines for the treatment of cat and dog bites in humans. Acta Chir Belg 2006;106:692-695.
4. Zong ZY, Gao YY, Wang XH. Subcutaneous abscess caused by Pasteurella multocida in a patient due to a cat bite. Chin Med J 2005; 118:1045-1046.
5. Benson LS, Edwards SL, Schiff AP, et al. Dog and cat bites to the hand: treatment and cost assessment. J Hand Surg Am 2006;31:468-473.
6. Kimura R, Hayashi Y, Takeuchi T, et al. Pasteurella multo- cida septicemia caused by close contact with a domestic cat: case report and literature review. J Infect Chemother 2004;10:250-252.
7. Mat O, Moenens F, Beauwens R, et al. Indolent Pasteurella multocida peritonitis in a CCPD patient. 25 years of “cat-bite peritonitis”: a review. Perit Dial Int 2005;25:88-90.
8. Rondon Berrios H, Trevejo Nunez GJ. Pets or pest: peritoneal dialysis-related peritonitis due to Pasteurella multocida. J Mi- crobiol Immunol Infect 2010; 43:155-158.

9. Kobayaa H, Souki RR, Trust S, Domachowske JB. Pasteurella multocida meningitis in newborns after incidental animal ex- posure. Pediatr Infect Dis J 2009;28:928-929.
10. Kofteridis DP, Christofaki M, Mantadakis E, et al. Bacteremic community-acquired pneumonia due to Pasteurella multo- cida. Int J Infect Dis 2009;13:81-83.
11. Rada N, Arrad B, Draiss G, et al. Pasteurella multocida: a rare cause of cerebral abscess. Med Mal Infect 2012;42:525- 526.
12. Mugambi SM, Ullian ME. Bacteremia, sepsis, and peritonitis with Pasteurella multocida in a peritoneal dialysis patient. Perit Dial Int 2010;30:381-383.
13. Brook I. Management of human and animal bite wound infec- tion: an overview. Curr Infect Dis Rep 2009; 11:389-395.
14. Yokose N, Dan K. Pasteurella multocida sepsis, due to a scratch from a pet cat, in a post-chemotherapy neutropenic patient with non-Hodgkin lymphoma. Int J Hematol 2007 ;85:146-148.
15. Goldstein EJ, Citron DM, Merriam CV, Tyrrell KL. Ceftaroline versus Isolates from Animal Bite Wounds: Comparative In Vitro Activities against 243 Isolates, Including 156 Pasteu- rella Species Isolates. Antimicrob Agents Chemother 2012; 56:6319–6323.
16. Stevens DL, Bisno AL, Chambers HF, et al. Practice guide- lines for the diagnosis and management of skin and soft-tis- sue infections. Clin Infect Dis 2005; 41: 1373–1406.
17. Winner JS, Gentry CA, Machado LJ, Cornea P. Aztreonam treatment of Pasteurella multocida cellulitis and bacteremia. Ann Pharmacother 2003; 37:392-394.