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Updated: Oct 24 2022

Pasteurella multocida

Images bite.jpg
  • Snapshot
    • A 40-year-old woman presents to the emergency room after being bitten by a cat. She had been visiting her boyfriend, who has 5 cats, when one of them was wary of strangers and bit her on the thumb. She cleaned it with some water and soap. On physical exam, she has a normal range of motion and sensation in her thumb. Her pulses are 2+ bilaterally. The wound is irrigated with sterile saline and wound is examined for any foreign bodies. She is started on empiric antibiotics to cover bacteria associated with cat bites.
  • Introduction
    • Classification
      • Pasteurella multocida
        • an facultative anaerobic gram-negative coccobacillus
        • encapsulated
        • can cause cellulitis at the site of inoculation
        • can also cause osteomyelitis
    • Epidemiology
      • incidence
        • high in cat bites
      • demographics
        • male > female
        • more common in those < 20 years of age
      • risk factors
        • cat bites > dog bites
        • bites in the hand
        • deep penetrating wounds
        • immunosuppression
    • Pathogenesis
      • direct inoculation of oral pathogens from animal bites into the wound, leading to infection
      • cats have narrow and sharp teeth, which can inflict deep penetrating wounds with tiny wound openings that prevent good drainage
  • Presentation
    • Symptoms
      • fevers
      • chills
    • Physical exam
      • wound with signs of cellulitis
        • purulence
        • surrounding erythema
        • edema
      • osteomyelitis
        • deep penetrating wound with bone involvement
      • may have a foreign body in the wound
  • Imaging
    • Radiography
      • indication
        • to rule out fracture
      • findings
        • fracture of bone
        • early signs of osteomyelitis
          • soft tissue swelling
          • focal bony lysis or cortical loss
          • blurring of normal fat planes
  • Labs
    • Labs
      • wound culture
      • blood cultures if a systemic infection is suspected
      • catalase positive
      • oxidase positive
      • grows on 5% sheep's blood
    • Making the diagnosis
      • based on clinical presentation
  • Differential
    • Tularemia
      • distinguishing factors
        • associated with rabbits and ticks not with an animal bite
        • presents with skin ulcer and lymphadenopathy
  • Treatment
    • Management approach
      • wounds are not typically closed due to the risk of infection
    • Conservative
      • wound care
        • indication
          • all patients
        • modalities
          • sterile saline irrigation
          • removal of any foreign bodies
    • Medical
      • amoxicillin/clavulanate
        • indication
          • all patients
      • post-exposure prophylaxis
        • indication
          • patients with exposure risk
        • prophylaxis for
          • tetanus
          • rabies
  • Complications
    • Abscess
      • more common with cat bites
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