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Pasteurella multocida Respiratory Infection: An Important Cat-Associated Zoonosis

Pasteurella multocida Respiratory Infection: An Important Cat-Associated Zoonosis We read with interest the review by Kravetz and Federman1 concerning the transmission of disease from cats to humans. The article was well written and informative. However, the authors failed to include one infectious process that humans acquire from contact with cats that deserves recognition—Pasteurella multocida lower respiratory tract infection. Following skin infection, pulmonary disease is the second most common human illness caused by P multocida,2 which is thought to contaminate the lower respiratory tract of humans after microaspiration of secretions from a colonized or infected nasopharynx.3,4 Alternatively, human pulmonary infection with this organism may follow direct inhalation of contaminated aerosolized particles.5 The pulmonary manifestations of P multocida infection in humans range from bronchitis and bronchiectasis to pneumonia, abscess formation, and empyema.5-9 As with other inhalation and/or aspiration phenomena, there is a predilection of P multocida for the lower lobes. Respiratory infection with this organism may follow an indolent and chronic course.5 Lower respiratory tract infection with P multocida is most commonly seen in elderly male patients with underlying chronic obstructive pulmonary disease or bronchiectasis.3,4,6,7 Interestingly, an outbreak of P multocida pneumonia occurred in a hospital ward housing patients with chronic underlying pulmonary disease.10 Although an extensive investigation failed to uncover the source of the organism, a mouth swab culture from the house pet of a respiratory therapist on duty in the hospital ward grew the same serotype of P multocida that was isolated from the affected patients. This occurrence should alert physicians to the possibility of a nosocomial spread of this organism. Pasteurella multocida may also act as an opportunistic pulmonary pathogen in patients with altered immune systems.3 It is often difficult to isolate P multocida from sputum or from bronchial aspirates obtained at flexible fiberoptic bronchoscopy.6 However, growth of P multocida may be facilitated by using blood or serum agar under increased carbon dioxide tension. The bipolar staining characteristics of these organisms on gram stain can lead to a presumptive diagnosis. However, this staining property is shared with Haemophilus influenzae, Neisseria species, and Actinobacter species and can, therefore, cause confusion. Pasteurella multocida can be positively identified by deoxyribonucleic acid and fatty acid analysis.3 Once P multocida is identified as the causative agent of the patient's respiratory tract infection, it is important to establish the organism's antibiotic sensitivities. Pasteurella multocida is generally sensitive to β-lactam antibiotics and tetracycline derivatives. However, reports have identified strains of P multocida that are resistant to multiple antibiotics. It is also suggested that antibiotic therapy be continued for at least 2 weeks, since treatment failures have been documented with shorter therapy despite susceptibility of the organism.8 We hope that this letter will serve as a complement to the review article by Kravetz and Federman1 and a reminder to the clinician that P multocida can cause pulmonary disease, especially in elderly patients with underlying lung disease. While the diagnosis of pulmonary infection from this organism may be elusive, once the organism is identified, care must be observed in the selection and duration of the antibiotics chosen to treat these patients. References 1. Kravetz JDFederman DG Cat-associated zoonoses. Arch Intern Med. 2002;1621945- 1952Google ScholarCrossref 2. Escande FLion C Epidemiology of human infection by Pasteurella and related groups in France. Zentralbl Bakteriol. 1993;279131- 139Google ScholarCrossref 3. Drabick JJGasser RA JrSaunders NB et al. Pasteurella multocida in a man with AIDS and nontraumatic feline exposure. Chest. 1993;1037- 11Google ScholarCrossref 4. Blaine HGeorge MYJeanel C Exposure to domestic cats and dogs: risk for Pasteurella multocida pneumonia in older people? J Am Geriatr Soc. 1998;461329- 1330Google Scholar 5. Mathai MGEbeo CTByrd RP JrFields CLRoy TM Cat cuddler's cough. Tenn Med. 2001;9498- 99Google Scholar 6. Weber DJWolfson JSSwartz MNHooper DC Pasteurella multocida infections: report of 34 cases and review of the literature. Medicine (Baltimore). 1984;63133- 154Google ScholarCrossref 7. Klein NCCunha BA Pasteurella multocida pneumonia. Semin Respir Infect. 1997;1254- 56Google Scholar 8. Machiels PHaxhe JTrigaux JDelos MShoevaerdts JCVandenplas O Chronic lung abscess due to Pasteurella multocida. Thorax. 1995;501017- 1018Google ScholarCrossref 9. Steyer BJSobonya RE Pasteurella multocida lung abscess: a case report and review of the literature. Arch Intern Med. 1984;1441081- 1082Google ScholarCrossref 10. Itoh MTierno PM JrMilstoc MBerger AR A unique outbreak of Pasteurella multocida in a chronic disease hospital. Am J Public Health. 1980;701170- 1173Google ScholarCrossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Pasteurella multocida Respiratory Infection: An Important Cat-Associated Zoonosis

Archives of Internal Medicine , Volume 163 (10) – May 26, 2003

Pasteurella multocida Respiratory Infection: An Important Cat-Associated Zoonosis

Abstract

We read with interest the review by Kravetz and Federman1 concerning the transmission of disease from cats to humans. The article was well written and informative. However, the authors failed to include one infectious process that humans acquire from contact with cats that deserves recognition—Pasteurella multocida lower respiratory tract infection. Following skin infection, pulmonary disease is the second most common human illness caused by P multocida,2 which is thought to contaminate...
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Publisher
American Medical Association
Copyright
Copyright © 2003 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.163.10.1239-a
Publisher site
See Article on Publisher Site

Abstract

We read with interest the review by Kravetz and Federman1 concerning the transmission of disease from cats to humans. The article was well written and informative. However, the authors failed to include one infectious process that humans acquire from contact with cats that deserves recognition—Pasteurella multocida lower respiratory tract infection. Following skin infection, pulmonary disease is the second most common human illness caused by P multocida,2 which is thought to contaminate the lower respiratory tract of humans after microaspiration of secretions from a colonized or infected nasopharynx.3,4 Alternatively, human pulmonary infection with this organism may follow direct inhalation of contaminated aerosolized particles.5 The pulmonary manifestations of P multocida infection in humans range from bronchitis and bronchiectasis to pneumonia, abscess formation, and empyema.5-9 As with other inhalation and/or aspiration phenomena, there is a predilection of P multocida for the lower lobes. Respiratory infection with this organism may follow an indolent and chronic course.5 Lower respiratory tract infection with P multocida is most commonly seen in elderly male patients with underlying chronic obstructive pulmonary disease or bronchiectasis.3,4,6,7 Interestingly, an outbreak of P multocida pneumonia occurred in a hospital ward housing patients with chronic underlying pulmonary disease.10 Although an extensive investigation failed to uncover the source of the organism, a mouth swab culture from the house pet of a respiratory therapist on duty in the hospital ward grew the same serotype of P multocida that was isolated from the affected patients. This occurrence should alert physicians to the possibility of a nosocomial spread of this organism. Pasteurella multocida may also act as an opportunistic pulmonary pathogen in patients with altered immune systems.3 It is often difficult to isolate P multocida from sputum or from bronchial aspirates obtained at flexible fiberoptic bronchoscopy.6 However, growth of P multocida may be facilitated by using blood or serum agar under increased carbon dioxide tension. The bipolar staining characteristics of these organisms on gram stain can lead to a presumptive diagnosis. However, this staining property is shared with Haemophilus influenzae, Neisseria species, and Actinobacter species and can, therefore, cause confusion. Pasteurella multocida can be positively identified by deoxyribonucleic acid and fatty acid analysis.3 Once P multocida is identified as the causative agent of the patient's respiratory tract infection, it is important to establish the organism's antibiotic sensitivities. Pasteurella multocida is generally sensitive to β-lactam antibiotics and tetracycline derivatives. However, reports have identified strains of P multocida that are resistant to multiple antibiotics. It is also suggested that antibiotic therapy be continued for at least 2 weeks, since treatment failures have been documented with shorter therapy despite susceptibility of the organism.8 We hope that this letter will serve as a complement to the review article by Kravetz and Federman1 and a reminder to the clinician that P multocida can cause pulmonary disease, especially in elderly patients with underlying lung disease. While the diagnosis of pulmonary infection from this organism may be elusive, once the organism is identified, care must be observed in the selection and duration of the antibiotics chosen to treat these patients. References 1. Kravetz JDFederman DG Cat-associated zoonoses. Arch Intern Med. 2002;1621945- 1952Google ScholarCrossref 2. Escande FLion C Epidemiology of human infection by Pasteurella and related groups in France. Zentralbl Bakteriol. 1993;279131- 139Google ScholarCrossref 3. Drabick JJGasser RA JrSaunders NB et al. Pasteurella multocida in a man with AIDS and nontraumatic feline exposure. Chest. 1993;1037- 11Google ScholarCrossref 4. Blaine HGeorge MYJeanel C Exposure to domestic cats and dogs: risk for Pasteurella multocida pneumonia in older people? J Am Geriatr Soc. 1998;461329- 1330Google Scholar 5. Mathai MGEbeo CTByrd RP JrFields CLRoy TM Cat cuddler's cough. Tenn Med. 2001;9498- 99Google Scholar 6. Weber DJWolfson JSSwartz MNHooper DC Pasteurella multocida infections: report of 34 cases and review of the literature. Medicine (Baltimore). 1984;63133- 154Google ScholarCrossref 7. Klein NCCunha BA Pasteurella multocida pneumonia. Semin Respir Infect. 1997;1254- 56Google Scholar 8. Machiels PHaxhe JTrigaux JDelos MShoevaerdts JCVandenplas O Chronic lung abscess due to Pasteurella multocida. Thorax. 1995;501017- 1018Google ScholarCrossref 9. Steyer BJSobonya RE Pasteurella multocida lung abscess: a case report and review of the literature. Arch Intern Med. 1984;1441081- 1082Google ScholarCrossref 10. Itoh MTierno PM JrMilstoc MBerger AR A unique outbreak of Pasteurella multocida in a chronic disease hospital. Am J Public Health. 1980;701170- 1173Google ScholarCrossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: May 26, 2003

Keywords: cats,pasteurella multocida,respiratory tract infections,zoonoses

References