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A5440 - The Hazards of Being a Cat Lady: A Case of Pasteurella Pneumonia
Author Block: S. A. Mahmood1, C. Kloefkorn2, S. Gandotra3, J. M. Bishop4; 1Internal Medicine, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States, 2Pulmonary, Critical Care, Wake Forest Baptist Medical Center, Winston-Salem, NC, United States, 3Wake Forest Baptist Medical Center, Winston-Salem, NC, United States, 4IM-Pulmonary, Wake Forest Baptist Health, Winston Salem, NC, United States.
Introduction: Pasteurella multocida is a gram-negative coccobacillus that is normal oral flora in cats and dogs. Although most commonly seen in skin and soft tissue infections, in rare cases it can cause respiratory tract infections. We present a case of a 49-year-old female diagnosed with Pasteurella multocida pneumonia and discuss the importance of considering pasteurella infection in patients with significant cat exposure. This case is also atypical in that the patient’s infection persisted despite appropriate antibiotic therapy.
Case: A 49-year-old female never smoker with moderate persistent asthma, severe obstructive sleep apnea managed with CPAP, subglottic stenosis status post tracheal dilation, and chronic bronchiectasis presented with chronic cough and dyspnea. She owned 10 cats and a dog and denied other exposures. She appeared frail, poorly kempt, had decreased breath sounds bilaterally with bibasilar rales. Computed tomography revealed dense right lower lobe consolidation and diffuse micro-nodularity. Sputum cultures grew Methicillin-sensitive staphylococcus aureus and E. coli which were attributed to chronic aspiration. Symptoms and radiographic abnormalities persisted despite courses of amoxicillin-clavulanate and trimethoprim-sulfamethoxazole. Bronchoscopy with bronchial alveolar lavage was performed. Cultures grew greater than 100,000 colony forming units of beta-lactamase negative Pasteurella multocida. The procedure was complicated by pneumothorax, which resolved after placement of an 18 French chest tube. Symptoms improved with ampicillin therapy. Despite clinical improvement from pasteurella pneumonia, in the subsequent week, this patient succumbed to fatal polymicrobial gram negative shock.
Discussion: There is limited literature to document severe pasteurella respiratory infection; however, it seems that underlying lung disease is a significant risk factor. Her pets were the likely source of her infection. The susceptibility data from BAL showed sensitivity to penicillins including amoxicillin-clavulanate, although duration of therapy is not well established in the literature. Prior cases have shown rapid response to penicillins, making this case particularly unique. We suspect that her underlying structural lung disease may have required a longer initial antibiotic course. The patient’s continued exposure to cats in her home and her history of aspiration may have also put her at risk for re-infection.
Pasteurella pneumonia should be a consideration in patients with severe underlying lung disease and significant exposure to cats and dogs. The optimal duration of therapy in patients with bronchiectasis should be further elucidated. The etiology for this patient’s pneumothorax from mere BAL remains unclear as does the trigger for her rapid demise despite initial clinical improvement.