Pasteurella multocida meningitis with disseminated intravascular coagulation and multi-organ failure in an adult with no bite history
Abstract
A 70-year-old woman with an extensive past medical history presented to the emergency
center with two weeks of generalized weakness, fatigue, resting shortness of breath, and
abdominal pain. The patient was bradycardic and hypotensive and was admitted to the
intensive care unit. Within a few hours of admission, she developed worsening lethargy and
respiratory acidosis and required intubation and vasopressor support. Laboratory results were
remarkable for azotemia, anemia, and thrombocytopenia. Magnetic resonance imaging of the
brain was unremarkable; an EEG reported mildly generalized slowing and no epileptiform
waves. Cerebrospinal fluid culture was positive for Pasteurella multocida. The patient later
developed acute hepatic injury, acute kidney injury, and an elevated D-Dimer with a decreased
fibrinogen consistent with disseminated intravascular coagulation. After twelve days her family
decided for comfort care only; the patient was extubated and died.
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References
Duran ML, Calderwood SB, Weber DJ, Miller SI, Southwick
FS et al. Acute bacterial meningitis in adults. A review of 493
episodes. N Engl J Med 1993 Jan 7; 328(1):21-8.
Kuhnert P, Christensen H. Pasteurellaceae: Biology, Genomics
and molecular aspects. Cais Academ Press. 2008.
Ryan KJ, Ray CG (Editors) 2004. Sherris Med Biol 4th Ed.
Mc Graw Hill. Columbus, OH.
Christidou A, Maraki S, Gitti Z, Magurean-Zervaki K, Tselentis
Y. Human Infections due to Pasteurella multocida in
a tertiary care hospital. A 12 year review. Proceeding of the
th European congress of clinical microbiology and infectious
disease. 2006.
Bardou M, Honorat E, Dobourg G, Couderc C, Fournier PE,
et all. Meningitis caused by Pasteurella multocida in a dog
owner, without a dog bite: clonal lineage identification by
MALDI-TOF mass spectrometry. BMC Res Notes 2015 Dec
; 8:826.
Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella
multocida infections. Report of 34 cases and review of literature.
Medicine (Baltimore) 1984 May; 63(3):133-54.
Wilson BA, Ho M. Pasteurella multocida: from zoonosis
to cellular microbiology. Clin Microbiol Rev 2013 Jul;
(3):631-55.
Giordanno A, Dincman T, Clyburn BE, Steed LL, Rockey
DC. Clinical features and outcomes of Pasteurella multocida
infection. Medicine (Baltimore) 2015 Sep; 94(36): e1285.
San Millan A, Escudero JA, Gutierrez B, Hidalgo L, Garcia
N, Llagostera M, Dominguez L, Gonzalez-Zorn B. Multiresistance
in Pasteurella multocida is mediated by coexistence
of small plasmids. Antimicrob Agents Chemother 2009 Aug;
(8):3399-404.
