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The genus Pasteurella is part of the normal oral flora of many animals, including domestic cats and dogs. In humans, Pasteurella may cause complications ranging from cellulitis to septicemia but rarely causes osteomyelitis or septic arthritis after bites and/or scratches by cats and dogs. Although Pasteurella multocida is a common cause of infection, other Pasteurella species have also been cultured from wounds in humans. We describe here, a case of a cutaneous abscess and acute osteomyelitis associated with P canis after a domestic dog bite. To our knowledge, no previous case of P canis has been reported as the cause of acute osteomyelitis in humans.

An unusual case of meningitis and pericardial tamponade caused by Pasteurella multocida after a cat bite is reported. The patient was successfully treated by antibiotics and pericardiocentesis and made an uneventful recovery from a life threatening condition. This case illustrates the potential dangers that can arise from a seemingly trivial and commonplace injury.

Cat bite infections are one of the most common infectious diseases presenting to veterinary practices and to emergency rooms at human hospitals. This review describes the disease in humans and cats, the origin of organisms involved in cat bite abscesses and the importance of selected organisms such as members of the genus Porphyromonas in the disease. It also discusses future directions, the importance of identifying significant organisms and why an understanding of antimicrobial susceptibility patterns is of consequence to the outcome of the disease in humans and cats.

Although bite wounds are common injuries in the pediatric population, most are minor. Dog bites are the most common animal bite wound. Children are more likely to have head and face injuries and share a disproportionate number of fatal wound injuries. Cat bites have a twofold higher risk of infection than dog wounds, with the most frequent and important pathogen being P multocida. Both cat and dog bite wounds are associated with a wide range of aerobic and anaerobic pathogens. Principles of wound management include copious irrigation, cautious debridement, appropriate antibiotics, elevation, and immobilization. The patient should have follow-up contact and usually a visit within 24 to 48 hours after the initiation of therapy.

Pasteurella aerogenes is rarely isolated from human specimens. The species is found in the digestive tract of pigs. From 1976 to 1994 7 strains were cultured in Denmark from wounds or ulcers. Five patients were bitten by pigs and 2 patients with ulcers were employed in pig farming. A mixture of bacterial species was often found. All 7 strains of P. aerogenes were susceptible to ampicillin, cephalosporins and ciprofloxacin. Ability to hydrolyse urea, to produce oxidase and catalase, to decarboxylate ornithine and to produce gas from glucose and inability to produce indole was characteristic for P. aerogenes. Most bite wounds were located on the lower lateral part of the thigh. Foul smelling pus and abscess formation was the rule. Incision, drainage and antibiotic treatment were usually necessary.

Annually 50,000 to 100,000 animal bites are seen by physicians in the Netherlands. Infections of these bite wounds frequently occur. Pasteurella multocida is one of the main causes of these infections and many serious complications may occur. We present 3 patients with disturbances in wound healing after animal bites or scratches due to infection with P. multocida. In view of the high infection ratio after cat bites we advise giving amoxicillin/clavulanic acid (Augmentin) for 5 days as prophylaxis. According to the literature prophylaxis for dog bites is not necessary. However, fatal complications after dog bites due to infections with Capnocytophaga canimorsus (DF-2) support those who prefer to give antibiotics after these bites also.

Pasteurella multocida is a common cause of infection following bites or scratches caused by dogs and (especially) cats. It is rarely reported, however, and apparently often overlooked as a pathogen. The typical clinical manifestation is a rapidly developing cellulitis at the site of injury. The infection is potentially dangerous and can cause a chronic local infection of deep tissues and osteomyelitis. It responds well to several antimicrobials, with penicillin being drug of choice. Fifty-five patients are reported--72% with cat bites and/or scratches and 28% with dog bites. Ninety-two percent of the wounds went deeply through the skin. All patients presented for treatment 12 to 72 hours after receiving the animal wounds to their hands. Drainage from all wounds was serosanguineous or purulent, and cultures taken were positive for P. multocida. All of the wounds responded to surgical drainage and penicillin. One patient developed osteomyelitis. The acute onset of cellulitis, lymphangitis, and serosanguineous or purulent drainage from hand wounds 12 to 24 hours after cat or dog bites should suggest P. multocida as the predominant etiologic agent. Immediate surgical drainage and penicillin therapy is the treatment of choice.

Catbite or scratch injuries frequently contain mixed organisms, and penicillin or erythromycin alone may not give adequate coverage, as shown in the cases described. Incision and drainage should not be neglected or deferred when a deep infectious process is present or bones, joints, or tendon sheaths are involved. Finally, a catbite injury is a deep penetration injury with potentially virulent organisms that require close followup and awareness of potential problems.

We have discussed 13 patients with Pasteurella multocida infection of the hand, six of whom developed chronic hand impairment as a result of the infection. It is thus apparent that chronic morbidity following Pasteurella infection of the hand is nearly 50 percent. Despite a fairly wide antibiotic susceptibility pattern of this organism, the infection may have long-term consequences such as osteomyelitis, or small joint stiffness due to paraarticular infection. We wish to emphasize the rapid evolution of the clinical picture following inoculation and the need for vigorous antibiotic therapy supplemented by rest, elevation immobilization, and occasional surgical decompression or drainage. At this time, the preferred antibiotic for initial care would appear to be on of the cephalosporins changed to penicillin for the culture-proven infection.

A previously healthy 15-year-old girl was bitten by a cat in her left thumb. Despite initial treatment with penicillin she developed osteomyelitis after a period of four months. Pasteurella multocida was cultured from the necrotic bone. The infection showed low activity and was successfully treated with surgery combined with penicillin.