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The Deadly Meowwwww: A Case of Pasturella Induced ARDS
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A5304 - The Deadly Meowwwww: A Case of Pasturella Induced ARDS
Author Block: J. R. Heffernan1, I. Turk1, Z. Iskenderian1, K. Leung2; 1Internal Medicine, St. John Providence Hospital, Southfield, MI, United States, 2Pulmonary Critical Care, St. John Providence Hospital, Southfield, MI, United States.
Pasteurella are small gram-negative coccobacilli that are pathogens of small animals. Pasteurella multocida can cause disease in patients with impaired immune defenses. Felines and Canines have the highest carriage rate. Patients most commonly present with cellulitis at the site of the trauma. On occasion, Pasteurella can cause severe respiratory tract infections.
A 56-year-old female with a complicated past medical history highlighted by morbid obesity, insulin-dependent type 2 diabetes mellitus and sarcoidosis presented to hospital with fever and dyspnea. She was scratched by her cat 1-week prior to admission. Physical examination indicated the presence of cellulitis on her left lower leg. Blood cultures were positive for Pasteurella Multocida. The patient developed severe sepsis with worsening respiratory status in spite of IV ampicillin-sulbactam and IV fluid support. CT thorax demonstrated patchy bilateral opacities likely representing multifocal pneumonia. On the second day, the patient developed severe ARDS and she was transferred to the ICU for intubation. A pronator bed was utilized, however was not effective due to body habitus and she was subsequently switched to high-frequency oscillation. The patient responded well to ventilatory support with oscillation therapy and continued IV antibiotics and was successfully extubated.
Pneumonia is a common infection caused by Pasteurella Multocida, however it is rare to find bactermia manifesting into severe ARDS. When this occurs, it is associated with rapid and severe inflammatory reactions associated with a mortality of approximately 30%. It is vital therefore, to consider this organism whenever trauma is inflicted by a dog or cat. Diagnosis is made by isolation of the organism in culture. The susceptibility to antibiotics is quite broad with ampicillin-sulbactam and amoxicillin-clavulanate being the main stay of treatment.
Author Block: J. R. Heffernan1, I. Turk1, Z. Iskenderian1, K. Leung2; 1Internal Medicine, St. John Providence Hospital, Southfield, MI, United States, 2Pulmonary Critical Care, St. John Providence Hospital, Southfield, MI, United States.
Pasteurella are small gram-negative coccobacilli that are pathogens of small animals. Pasteurella multocida can cause disease in patients with impaired immune defenses. Felines and Canines have the highest carriage rate. Patients most commonly present with cellulitis at the site of the trauma. On occasion, Pasteurella can cause severe respiratory tract infections.
A 56-year-old female with a complicated past medical history highlighted by morbid obesity, insulin-dependent type 2 diabetes mellitus and sarcoidosis presented to hospital with fever and dyspnea. She was scratched by her cat 1-week prior to admission. Physical examination indicated the presence of cellulitis on her left lower leg. Blood cultures were positive for Pasteurella Multocida. The patient developed severe sepsis with worsening respiratory status in spite of IV ampicillin-sulbactam and IV fluid support. CT thorax demonstrated patchy bilateral opacities likely representing multifocal pneumonia. On the second day, the patient developed severe ARDS and she was transferred to the ICU for intubation. A pronator bed was utilized, however was not effective due to body habitus and she was subsequently switched to high-frequency oscillation. The patient responded well to ventilatory support with oscillation therapy and continued IV antibiotics and was successfully extubated.
Pneumonia is a common infection caused by Pasteurella Multocida, however it is rare to find bactermia manifesting into severe ARDS. When this occurs, it is associated with rapid and severe inflammatory reactions associated with a mortality of approximately 30%. It is vital therefore, to consider this organism whenever trauma is inflicted by a dog or cat. Diagnosis is made by isolation of the organism in culture. The susceptibility to antibiotics is quite broad with ampicillin-sulbactam and amoxicillin-clavulanate being the main stay of treatment.
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