Pericardite purulenta e Pasteurella multocida: uma associação raríssima

Abstract

Purulent pericarditis is a rare entity, defined as the presence of neutrophilic pericardial effusion which is infected by a bacterial, fungus or parasite agent. The diagnosis can be challenging, especially if patients have taken previous antibiotic therapy; on the other hand the recognition of this pathology is often made late, with the onset of severe symptoms or signs of cardiac tamponade or even only at the autopsy. The authors describe the case of a 82-year-old woman with history of extensive laceration of the right lower limb from a dog bite in July 2016, admitted to the Cardiology Department one month later for Acute Pericarditis. During hospitalization she maintained recurrent fever peaks despite the treatment with non-steroidal anti-inflammatory drugs and colchicine. She collected blood cultures and repeated echocardiogram showed increased pericardial effusion with no signs of hemodynamic compromise. Blood cultures revealed the presence of Pasteurella multocida. Due to clinical suspicion of purulent pericarditis, pericardiocentesis was performed with drainage of liquid compatible with exudate and the patient was presented to the Cardiothoracic Surgery Department for pericardiotomy and adequate drainage of the liquid. Histological examination confirmed the diagnosis of Acute Pericarditis. It should be noted that Pasteurella is a very frequent agent (50-90%) in the gastrointestinal tract and nasopharynx of many domestic animals, namely dogs. The authors emphasize the need to aggressively treat this pathology, since untreated death is inevitable.

Occurrence of Pasteurella multocida in Dogs Being Trained for Animal-Assisted Therapy

“…Although cases of P. multocida infection have been reported more often in people from risk categories, such as young children, the elderly, pregnant women, or immunocompromised individuals [ 22 ], case reports of infection have also been reported in immunocompetent subjects [ 23 , 24 , 25 , 26 ]. In humans, P. multocida can cause serious infections, both invasive and localized, in the oral cavity, respiratory tract, and soft tissue, including pharyngitis, sinusitis, meningitis, tracheobronchitis, pneumonia, empyema, and abscess [ 10 , 18 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ].…”

“Cat got your lung?”: Case of a trapped lung following cat bite

“…Humans usually acquire soft tissue infections through bites by animals with oropharyngeal colonization. The prevalence of P. multocida infection is unclear, but reported annual incidence of emergency departments in the U.S. attributed to animal bites exceeds 300,000 and 20–30 deaths are credited to P. multocida infection annually worldwide [3]. Infections of the lungs and pleural space are rarely reported with P. multocida [1].…”