<i>Pasteurella</i><i> </i><i>multocida</i><i> </i>Bacteremia and Osteomyelitis from a Diabetic Foot Ulcer

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.

Pasteurella multocida vertebral osteomyelitis, myositis and epidural abscess in a diabetic cirrhotic patient

“…Sixty-two cases of osteomyelitis have been reported in the English literature [3,[11], [12], [13], [14],[16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27], [28], [29], [30], [31], [32], [33], [34], [35], [36], [37]]. Of these, 50 cases were related to direct inoculation of the organism or by contiguity.…”

A Case of Recurrent Pasteurella Bacteremia in an Immunocompetent Patient with No Animal Bite

“…Usually these diseases have been documented in immunocompromised patients like patients with active cancer, HIV positive, cirrhotic, chronic kidney diseases, or patients after chemotherapy and radiotherapy [ 8 , 9 ]. In this case, the patient was completely immunocompetent and there was no pet bite.…”