Volume 182 - Issue 3
An unusual neonatal zoonosis
Authors: Emma J Best, Monica M Lahra and Pam Palasanthiran
Med J Aust 2005; 182 (3): 137. || doi: 10.5694/j.1326-5377.2005.tb06619.x
Published online: 7 February 2005
Published online: 7 February 2005
Emma J Best,* Monica M Lahra,† Pam Palasanthiran‡
* Paediatric Infectious Diseases Fellow, † Microbiology Registrar, Neonatal Medicine, Royal Prince Alfred Hospital, Sydney, NSW. ‡ Infectious Diseases Physician, Sydney Children’s Hospital, Level 4, High Street, Randwick, NSW 2031; PalasanthiranpATsesahs.nsw.gov.au
To the Editor: Pasteurella multocida is an oral commensal of domestic pets known to be an opportunistic human pathogen after traumatic animal contact. The most common infections in humans are skin and pulmonary infections. This report outlines a case of P. multocida meningitis, which has not previously been reported in Australia.
A 19-day-old girl presented with a 12-hour history of fever and poor feeding. Her temperature was 39.5°C, and she was irritable, with no localising signs or skin lesions. A full septic screen was performed. Cerebrospinal fluid (CSF) showed a neutrophilic pleocytosis and gram-negative coccobacilli. She was treated with intravenous cefotaxime and gentamicin. Within 24 hours both CSF and blood cultures showed growth of gram-negative bacilli. The initial Gram stain, growth on chocolate agar and positive oxidase and catalase tests were suggestive of a Haemophilus species. However, further biochemical tests revealed the organism to be P. multocida. The infant made an excellent clinical recovery, with normal neurological and growth assessments at 6 and 12 months.
The family owned two cats but reported no contact between their baby and the pets. A single tonsillar swab performed on each cat by a veterinarian 10 days after the baby’s presentation failed to isolate Pasteurella species. The family elected to keep the pets.
Pasteurella meningitis occurs at extremes of age, in the immunocompromised (associated with liver cirrhosis, renal disease and haematological malignancies) and after traumatic head injury.1 Infants aged under 1 year account for almost half the cases of P. multocida meningitis.
On review of the literature, we found 37 reported cases of P. multocida infection in infants (Box).1-5 In more than three-quarters of these cases, there was known contact with household animals — in more than half of these contact was non-traumatic (licking or presumed handling of the pet). Molecular studies in one of the cases with no history of traumatic contact confirmed that P. multocida isolates from pet and infected child were indistinguishable.2
This infection is unusual, and, given the popularity of household pets, the risk appears low. However, this case highlights the relative immunocompromise of newborn infants, and is a reminder of the importance of hand hygiene and preventing contact between newborn infants and pets.
Details of 38 case reports of invasive Pasteurella multocida infection in infants (including current case)1-5
Mean age (range) |
2.6 months (1 day– 11 months) |
Type of infection |
|
Meningitis |
30 (79%) |
Puerperal sepsis, chorioamnionitis |
7 (18%) |
Bacteraemia (postnatal) |
1 (3%) |
Nature of animal contact |
|
Traumatic (scratch, bite) |
9 (24%) |
Non-traumatic |
22 (58%) |
Unknown |
7 (18%) |
Type of animal (n = 31) |
|
Cat |
16 (52%) |
Dog |
11 (35%) |
Both |
4 (13%) |
References
- Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore) 1984; 63: 133-154.
- Boerlin P, Siegrist HH, Burnens AP, et al. Molecular identification and epidemiological tracing of Pasteurella multocida meningitis in a baby. J Clin Microbiol 2000; 38: 1235-1237. i1085725
- Thompson CM Jr, Levkoff AH. Pasteurella multocida meningitis in infancy. Am J Dis Child 1986; 140: 1216.
- Voss A, van Zwam YH, Meis JF, et al. Sepsis puerperalis caused by a genotypically proven cat-derived Pasteurella multocida strain. Eur J Obstet Gynecol Reprod Biol 1998; 76: 71-73.
- Wade T, Booy R, Teare EL, Kroll S. Pasteurella multocida meningitis in infancy (a lick may be as bad as a bite). Eur J Pediatr 1999; 158: 875-878. i1085729