Serious phlegmonous lesion of the hand following an injury by vegetal thorn: Never forget Pasteurella multocida !

Abstract

Pasteurella multocida can cause serious infections after dog or cat bite. We report here a rare case of hand infection caused by P. multocida consecutive to an injury by a thorn of the prickly pear. It caused an amputation of the distal phalanx of the thumb in a trisomic patient.It is about a 27-year-old man who was admitted to the hospital with swelling and intense pain of the left hand. He reported a sting by a thorn of prickly pear 15 days before. The patient was admitted to proceed with operative irrigation and debridement. The pus was collected for microbiological examination. Microscopic examination after Gram staining revealed small Gram-negative coccobacilli, associated to polymorphonuclear reaction. Culture have objectivated Pasteurella multocida. The isolated strain was susceptible to betalactamins. Patient was treated with ampicillin. Well-conducted antibiotics and repetitive local cares have not prevented local lesions from progressing to necrosis of the soft parts of the thumb and osteitis of the distal phalanx of the thumb. The patient underwent a necrosectomy and an amputation of the distal phalanx. Ampicillin was replaced by amoxicillin/clavulanic acid and after 15 days, progression was clinically and microbiologically favorable.In the case we report, since the patient does not report any exposure or contact with animals, the thorn prick is the source of infection. It was contaminated from the animal reservoir. Taking into account the monomicrobism of the infection, treatment with aminopenicillins was sufficient. Our propositus came to the hospital 15 days after the inoculation of the bacterium. This duration appears to be very late in relation to the acute character of pasteurellosis. This was probably the main reason why the local infection evolved towards osteoarticular complications. That's why, we should consider Pasteurella multocida in case of infection by inoculation, even in the absence of contact with the animals.

Isolation of a T7-Like Lytic Pasteurella Bacteriophage vB_PmuP_PHB01 and Its Potential Use in Therapy against Pasteurella multocida Infections

“…Pasteurella multocida isolates are generally classified into five capsular types (A, B, D, E, and F) [1], and are commonly associated with respiratory diseases and hemorrhagic septicemia in a wide range of domestic and wild animals [2]. While it rarely occurs, P. multocida infections in humans have been continuously reported [3,4,5,6,7], and most of these cases are likely to be transmitted from pets such as dogs and cats [4,8]. It has been reported that the infection of P. multocida isolates displays host predilection; different capsular types are associated with specific types of diseases [2,8,9,10].…”

Isolation of Pasteurella pneumotropica in a Hand Phlegmon Following a Human Bite

“…Gram staining is negative and bipolar staining is common. These bacteria are immobile and they do not form endospores [ 1 , 6 ].…”

“…These symptoms are often accompanied by lymphangitis and satellite lymphadenopathy. In the absence of treatment, subacute forms can lead to arthritis and phlegmons of sheaths [ 1 , 9 ]. Respiratory infections occur in cases of immunosuppression, ethylic, smoking, bronchial dilation, and cancer.…”

“…Respiratory infections occur in cases of immunosuppression, ethylic, smoking, bronchial dilation, and cancer. Sepsis can complicate local infection following a bite or scratch [ 1 , 10 ]. Other, less common manifestations of pasteurellosis include purulent meningitis, most often related to traumatic meningeal or neurosurgical breach [ 11 ].…”

“…Pasteurellosis is primarily an animal infection that can become apparent in humans when transmitted through bites or scratches [1][2][3]. It is uncommon to find this infection in the human oral cavity, and even rarer in cases involving a 'biting mouth' [4].…”