Septic Arthritis Due to Pasteurella Multocida Complicating Rheumatoid Arthritis

Abstract

HIS REPORT describes 2 patients with T rheumatoid arthritis in whom septic arthritis of the knee followed a relatively minor cat scratch of the lower leg. Pasturella multocidu was the causative organism in both cases and was found in the saliva of one of the pets involved. The clinical manifestations of infection by this unusual organism will be discussed, and distinguishing features of the bacteriology and epidemiology will be presented. CASE STUDIES Case Number 1A 53-year-old white secretary with rheumatoid arthritis was admitted to the Clinical Center for the first time on May 16, 1966 with complaints of fever, chills, nausea and vomiting of three days' duration. Rheumatoid arthritis involving symmetrically both small and large joints had been present for 18 years. She had been on continuous steroid therapy for 15 years with a current dosage of 9 mg. prednisone per day.Five weeks earlier she had been scratched on her right leg by her cat. A week later one of the scratches became reddened, angry and drained pus. She received a broad spectrum antibiotic for 5 days; the exact drug could not be recalled. DrainageFrom the Arthritis and Rheumatism Branch, National lnstitute of Arthritis and Metabolic Diseases,

Septic arthritis due to Pasteurella multocida complicating rheumatoid arthritis.

“…The organism's usual sensitivity to penicillin has led to suggestions that this is the drug of choice and should be given prophylactically after animal bites (Tindall and Harrison, 1972;Barth et al, 1968). However, the organism found in our patient was resistent to penicillin.…”

“…Infections are often of a minor and local nature, but may produce regional lymphadenopathy or rarely systemic toxicity. Four similar reports have been found in which septic arthritis occurred other than by direct inoculation into the joint (Barth et al, 1968;British Medical Journal, 1972;Griffin and Barber, 1975;Maurer et al, 1975). Apart from 1 unspecified case all patients were known to have rheumatoid arthritis and to be taking corticosteroids.…”

“…However, the organism found in our patient was resistent to penicillin. The decision to give prolonged antibiotic therapy is supported by a reported relapse which occurred after only 3 weeks of treatment (Barth et al, 1968). Eradication of the organ-394 ism from the healthy cat was not attempted, since the expectation was that early recolonisation would occur.…”

Septic sternoclavicular arthritis with pasteurella multocida and streptococcus sanguis

“…Although both P rnultocida and S sanguis were grown from the joint tissues from this patient, we believe that the primary infective agent was probably P multocida and that S sanguis was introduced secondarily at the time of injection of corticosteroids 10 days before admission to Scripps. This belief is based on the fact that there have been no previous reports of septic arthritis due to S sanguis, but there have been 14 cases due to P multocida (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16). The first case was reported in 1944 (4) in a patient with a P multocida bacteremia.…”

“…The first case was reported in 1944 (4) in a patient with a P multocida bacteremia. In the subsequent 13 reported cases, 7 had rheumatoid arthritis (7,8,(10)(11)(12)15), and 5 of these were receiving regular corticosteroid therapy (7,11,12,15). Altogether, 9 patients had knee involvement (4,5,7,11-15), 3 of whom had prosthetic joints (1 1,12,14).…”