Septicemia hemorrágica y empiema pleural por Pasteurella canis

Abstract

Pasteurella canis hemorragic sepsis and empyemaWe report the case of a 56-year-old female patient, with a three-day history of hematemesis, melena, abdominal wall hematoma and epistaxis associated with thrombocytopenia and anemia. Idiopathic thrombocytopenic purpura was diagnosed and she was treated with dexamethasone for four days. The patient developed acute respiratory failure with signs of systemic inflammatory response. Blood and pleural fluid cultures grew Pasteurella canis. This is the first case, to our knowledge, of P. canis empyema associated with hemorrhagic septicemia without epidemiological background and the third case of septicemia caused by P. canis reported in the literature.Key words: Pasteurella, empyema, sepsis.Palabras clave: Pasteurella canis, empiema, septicemia hemorrágica. IntroducciónE l género Pasteurella está conformado por bacterias aerobias-microaerofílicas o anaerobias facultativas que se describen morfológicamente como cocobacilos gramnegativos pleomórficos. En la tinción de Gram se pueden observar como formas cocoides, bacilos cortos o filamentosos con una típica tinción bipolar 1-3 . Habitan en la cavidad oral y tracto gastrointestinal de diversos animales y en el ser humano pueden ser parte de la microbiota del tracto respiratorio superior. Los factores de virulencia están dados por la adherencia al epitelio del tracto respiratorio superior mediada por fimbrias, producción de leucotoxinas que alteran la respuesta celular en el tejido pulmonar, una cápsula de polisacáridos antifagocítica resistente al complemento 4 y la unión a la transferrina garantizando la suplencia de hierro necesaria para el crecimiento bacteriano 1 . El cuadro clínico más común es la infección de piel y tejidos blandos posterior a una mordedura animal, seguido por infecciones del tracto respiratorio, que afecta en la mayoría de los casos a personas con una enfermedad pulmonar subyacente como la enfermedad pulmonar obstructiva crónica (EPOC) y bronquiectasias, o en ancianos e individuos inmunocomprometidos. Se han descrito infecciones secundarias a diseminación hematógena (osteomielitis y artritis séptica) en pacientes con enfermedades de base como artritis reumatoide y en quienes reciben tratamientos con corticoesteroides 2,5,6 . Se han reportado casos infrecuentes de septicemia, endocarditis y meningitis, con mayor frecuencia en personas mayores de 50 años de edad 7 .A continuación, comunicamos el primer caso de una septicemia hemorrágica asociada a un empiema pleural por Pasteurella canis.

Unusual Etiology of Pasteurella canis Biovar 2 Causing Dacryocystitis in HIV Patient: A Case Report and Review of Literature

“…We found the susceptibility of the isolate to ampicillin, gentamycin, cefuroxime, cefotaxime, ciprofloxacin, amoxycillin-clavulanic acid, piperacillin and tetracycline supporting the notion that Pasteurella spp are not great resistance exhibiting organism [3][4][5][6][7][8][9]. Several decades of clinical experiences with Pasteurella and numerous in vitro studies including ours suggested, penicillin as the best antimicrobial agent for the treatment of virtually all forms of infection [17].…”

“…The second category describes infection occurring after other animal exposure while third category included infection with no known animal contact history [4,17]. P.canis have been infrequently implicated in wound infection, cellulitis, bacteraemia, peritonitis, conjunctivitis, empyema, osteoarticular and lower respiratory tract infection mainly during two extremities of age but never been reported in HIV patients [2][3][4][5][6][7][8][9]. In fact, P.bettaye has exclusively been reported in HIV patients [18].…”

“…Majority of these cases were from extreme of the ages either children or old age people and predominantly suffering with some underlying disease, although not always true. All the cases showed sufficient sensitivity of P.canis to various anti-microbial with complete recovery of their patients and amoxicillin-clavulanate was the drug of choice in majority of the reported cases [2][3][4][5][6][7][8][9][10][11][12][13][14].…”

“…Among non-β-lactam antibiotics, trimethoprim-sulfamethoxazole, fluoroquinolones and tetracyline showed good invitro activity [17]. However, occasional clinical failures have been documented to P.multocida against various anti-microbials including oral macrolides (e.g., erythromycin), semisynthetic penicillins (e.g., oxacillin, dicloxacillin), first generation cephalosporins (e.g., cephalothin, cephalexin, cefadroxil) and clindamycin [3][4][5][6][7][8][9].…”

“…Fifty three (53) studies restricted to animals and six (06) with characterisation of P.canis were excluded. Only 13 case studies were found relevant for review [2][3][4][5][6][7][8][9][10][11][12][13][14].…”