Pasteurella arthritis in a nonsurgical joint
Mrad A, Curtis R, and Wilson L. Pasteurella arthritis in a nonsurgical joint. Crit Care Med 2019; 47(1).
Crit Care Med
Learning Objectives: Human infections with Pasteurella are not uncommon, with Pasteurella multocida being the most prevalent isolate observed in human infections. Transmission to humans occurs primarily through animal bites, scratches, licks of skin with abrasions, or contact with mucous secretions derived from pets. The classic presentation is an abscess formation at the site of an animal bite, typically cats. Bacteremia, Osteomyelitis, Endocarditis, Meningitis, and Pneumonia in chronic pulmonary diseases have been reported. We report a case of oligoarticular septic arthritis including non-prosthetic joint in an immunocompromised patient. Methods: A 74-year-old woman with a history of Gout and Rheumatoid Arthritis status post bilateral Total Knee Replacement and on long-term Methotrexate and Prednisone, who presented with left toe and right knee pain with erythema, swelling and inability to bare weight. She has one cat at home but denies any recent bites or scratches. The patient had a normal White Blood Count. Right knee x-ray shows small air collection with soft tissue swelling. Left foot x-ray was negative for any acute process. As the left toe swelling initially thought to be a gout attack, and the patient was started on Colchicine and Indomethacin. Right knee aspiration and synovial fluid analysis revealed WBC of 149632 /cu mm, with no crystals, suggesting septic arthritis. Blood Culture was positive for Pasteurella Multicida. She was started on Cefepime. She went to the Operation Room for joint debridement and antibiotic beads placement. Wound swab culture was negative. Fluid Culture from aspiration was positive for Pasteurella Multicida. Results: This case is pointing up the invasive potential of Pasteurella Multicida in an immunocompromised host, which led to septic oligoarthritis, without direct penetrating injury to the joint or skin, history of wounds or lacerations. The hematogenous mechanism appears to be the most common method of dissemination. High suspicion of Pasteurella Arthritis should be warranted in immunocompromised patients who are in frequent contact with animals. In those patients, thorough history taking is required in order to increase suspicion for Pasteurella infection, besides comprehensive workup and early initiation of empiric antibiotics. Such an approach can lead to early identification of the pathogen and is crucial to the outcome.