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==Overview== | ==Overview== | ||
'''Pasteurellosis''' is an infection with a species of the bacterial genus ''[[Pasteurella]]'',<ref name="KuhnertChristensen">{{cite book | author = Kuhnert P; Christensen H (editors). | title = Pasteurellaceae: Biology, Genomics and Molecular Aspects | publisher = Caister Academic Press | year = 2008 | url=http://www.horizonpress.com/past | id = [http://www.horizonpress.com/past | isbn = 978-1-904455-34-9}}</ref> which is found in humans and other [[animal]]s. | '''Pasteurellosis''' is an infection with a species of the bacterial genus ''[[Pasteurella]]'',<ref name="KuhnertChristensen">{{cite book | author = Kuhnert P; Christensen H (editors). | title = Pasteurellaceae: Biology, Genomics and Molecular Aspects | publisher = Caister Academic Press | year = 2008 | url=http://www.horizonpress.com/past | id = [http://www.horizonpress.com/past | isbn = 978-1-904455-34-9}}</ref> which is found in humans and other [[animal]]s. ''[[Pasteurella multocida]]'' ([[subsp]]. ''septica'' and subsp. ''multocida'') is carried in the mouth and respiratory tract of various animals, including pigs.<ref name="Hunt GerardoCitron2001">{{cite journal|last1=Hunt Gerardo|first1=S.|last2=Citron|first2=D. M.|last3=Claros|first3=M. C.|last4=Fernandez|first4=H. T.|last5=Goldstein|first5=E. J. C.|title=Pasteurella multocida subsp. multocida and P. multocida subsp. septica Differentiation by PCR Fingerprinting and -Glucosidase Activity|journal=Journal of Clinical Microbiology|volume=39|issue=7|year=2001|pages=2558–2564|issn=0095-1137|doi=10.1128/JCM.39.7.2558-2564.2001|pmid=11427568}}</ref> It is a small Gram negative bacillus with bipolar staining by [[Wayson stain]].The mechanisms of pathogenesis of ''[[Pasteurella]]'' infection in its natural host species and in humans are still not completely understood, and further studies are needed. ''[[Pasteurella]]'' is usually transmitted via the cutaneous route to the human host.''[[Pasteurella]]'' uses a number of mechanisms for avoiding or suppressing bactericidal responses such as lipopolysaccharides (LPS) and the bacterias capsule.<ref name="pmid226439163">{{cite journal| author=Wilkie IW, Harper M, Boyce JD, Adler B| title=Pasteurella multocida: diseases and pathogenesis. | journal=Curr Top Microbiol Immunol | year= 2012 | volume= 361 | issue= | pages= 1-22 | pmid=22643916 | doi=10.1007/82_2012_216 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22643916 }} </ref><ref name="b">Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella Accessed on February 10, 2016 </ref> It is difficult to establish the true prevalence and incidence of pasteurellosis because disease reporting is not required. In the USA, the annual incidence of dog and cat bites has been reported as 300 bites per 100,000 individuals.<ref name="pmid11897069">{{cite journal| author=Kaiser RM, Garman RL, Bruce MG, Weyant RS, Ashford DA| title=Clinical significance and epidemiology of NO-1, an unusual bacterium associated with dog and cat bites. | journal=Emerg Infect Dis | year= 2002 | volume= 8 | issue= 2 | pages= 171-4 | pmid=11897069 | doi=10.3201/eid0802.010139 | pmc=PMC2732450 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11897069 }} </ref><ref name="pmid23824375">{{cite journal| author=Wilson BA, Ho M| title=Pasteurella multocida: from zoonosis to cellular microbiology. | journal=Clin Microbiol Rev | year= 2013 | volume= 26 | issue= 3 | pages= 631-55 | pmid=23824375 | doi=10.1128/CMR.00024-13 | pmc=PMC3719492 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23824375 }} </ref> Common risk factors in the development of pasteurellosis are animal exposure, children, and inmunosuppressed individuals.<ref name="pmid23824375">{{cite journal| author=Wilson BA, Ho M| title=Pasteurella multocida: from zoonosis to cellular microbiology. | journal=Clin Microbiol Rev | year= 2013 | volume= 26 | issue= 3 | pages= 631-55 | pmid=23824375 | doi=10.1128/CMR.00024-13 | pmc=PMC3719492 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23824375 }} </ref><ref name="c">Dog Bite Prevention. CDC. http://www.cdc.gov/features/dog-bite-prevention/ Accessed on February 10, 2016 </ref><ref name="d">Kristinsson G. Pasteurella multocida Infections. ''Pediatr Rev''. 2007; 28(12): 472-473 </ref> If left untreated, patients with pasteurellosis may progress to develop soft tissue inflammation. Common complications of pasteurellosis include cellulitis, septic arthritis, and osteomyelitis. Patients with cutaneous infection have the most favorable prognosis with adequate treatment.<ref name="pmid3719492">{{cite journal| author=Stewart PJ| title=Counselling on smoking. | journal=CMAJ | year= 1986 | volume= 135 | issue= 2 | pages= 105-6 | pmid=3719492 | doi= | pmc=PMC1491194 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3719492 }} </ref><ref name="b">Pasteurella multocida. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella_multocida Accessed on February 10, 2016 </ref><ref name="pmid6371440">{{cite journal| author=Weber DJ, Wolfson JS, Swartz MN, Hooper DC| title=Pasteurella multocida infections. Report of 34 cases and review of the literature. | journal=Medicine (Baltimore) | year= 1984 | volume= 63 | issue= 3 | pages= 133-54 | pmid=6371440 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6371440 }} </ref><ref name="pmid23824375">{{cite journal| author=Wilson BA, Ho M| title=Pasteurella multocida: from zoonosis to cellular microbiology. | journal=Clin Microbiol Rev | year= 2013 | volume= 26 | issue= 3 | pages= 631-55 | pmid=23824375 | doi=10.1128/CMR.00024-13 | pmc=PMC3719492 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23824375 }} </ref> Physical examination of patients with pasteurellosis is usually remarkable for redness, warmth, swelling and pain in the affected area. | ||
''[[Pasteurella multocida]]'' ([[subsp]]. ''septica'' and subsp. ''multocida'') is carried in the mouth and respiratory tract of various animals, including pigs.<ref name="Hunt GerardoCitron2001">{{cite journal|last1=Hunt Gerardo|first1=S.|last2=Citron|first2=D. M.|last3=Claros|first3=M. C.|last4=Fernandez|first4=H. T.|last5=Goldstein|first5=E. J. C.|title=Pasteurella multocida subsp. multocida and P. multocida subsp. septica Differentiation by PCR Fingerprinting and -Glucosidase Activity|journal=Journal of Clinical Microbiology|volume=39|issue=7|year=2001|pages=2558–2564|issn=0095-1137|doi=10.1128/JCM.39.7.2558-2564.2001|pmid=11427568}}</ref> It is a small Gram negative bacillus with bipolar staining by [[Wayson stain]]. | |||
==Historical Perspective== | ==Historical Perspective== | ||
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*[[Pasteurella multocida|''P. multocida'']] oral cavity colonization in cats, dogs and other animals is common worldwide.<ref name="abc">Zoonoses and Communicable Diseases common to Man and Animals. PAHO (2001). http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=19187&Itemid= Accessed on February 10, 2016 </ref> | *[[Pasteurella multocida|''P. multocida'']] oral cavity colonization in cats, dogs and other animals is common worldwide.<ref name="abc">Zoonoses and Communicable Diseases common to Man and Animals. PAHO (2001). http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=19187&Itemid= Accessed on February 10, 2016 </ref> | ||
*An estimated 4.4 million animal bites occur each year in the United States | *An estimated 4.4 million animal bites occur each year in the United States | ||
* | *In the USA, the annual incidence of dog and cat bites has been reported as 300 bites per 100,000 individuals | ||
*The mortality rate of pasteurellosis is approximately 25-30% | *The mortality rate of pasteurellosis is approximately 25-30% | ||
*The mortality rate of pasteurellosis patients with meningitis and neurological manifestations is approximately 17-29% | *The mortality rate of pasteurellosis patients with meningitis and neurological manifestations is approximately 17-29% | ||
*The mortality rate of pasteurellosis patients with bacteremia is approximately 40-63% | *The mortality rate of pasteurellosis patients with bacteremia is approximately 40-63%<ref name="pmid11897069">{{cite journal| author=Kaiser RM, Garman RL, Bruce MG, Weyant RS, Ashford DA| title=Clinical significance and epidemiology of NO-1, an unusual bacterium associated with dog and cat bites. | journal=Emerg Infect Dis | year= 2002 | volume= 8 | issue= 2 | pages= 171-4 | pmid=11897069 | doi=10.3201/eid0802.010139 | pmc=PMC2732450 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11897069 }} </ref><ref name="pmid23824375">{{cite journal| author=Wilson BA, Ho M| title=Pasteurella multocida: from zoonosis to cellular microbiology. | journal=Clin Microbiol Rev | year= 2013 | volume= 26 | issue= 3 | pages= 631-55 | pmid=23824375 | doi=10.1128/CMR.00024-13 | pmc=PMC3719492 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=23824375 }} </ref> | ||
==Risk Factors== | ==Risk Factors== | ||
| Line 82: | Line 80: | ||
==Natural History, Complications and Prognosis== | ==Natural History, Complications and Prognosis== | ||
===Natural History=== | ===Natural History=== | ||
*Pasteurellosis incubation period occurs within 24 hours. | *Pasteurellosis incubation period occurs within 24 hours. | ||
| Line 107: | Line 104: | ||
*Patients with pasteurellosis most commonly report contact with pets, including sharing a bed, being licked by, or kissing the pets | *Patients with pasteurellosis most commonly report contact with pets, including sharing a bed, being licked by, or kissing the pets | ||
===Symptoms=== | ===Symptoms=== | ||
==== '''Symptoms related to cellulitis (most common) include:''' ==== | ==== '''Symptoms related to cellulitis (most common) include:''' ==== | ||
*[[Fever]] | *[[Fever]] | ||
| Line 190: | Line 186: | ||
==Treatment== | ==Treatment== | ||
As the infection is usually transmitted into humans through animal bites, antibiotics usually treat the infection, but medical attention should be sought if the wound is severely swelling. Pasteurellosis is usually treated with high-dose [[penicillin]] if severe. Either [[tetracycline]] or [[chloramphenicol]] provides an alternative in beta-lactam intolerant patients. However, it is most important to treat the wound. | As the infection is usually transmitted into humans through animal bites, antibiotics usually treat the infection, but medical attention should be sought if the wound is severely swelling. Pasteurellosis is usually treated with high-dose [[penicillin]] if severe. Either [[tetracycline]] or [[chloramphenicol]] provides an alternative in beta-lactam intolerant patients. However, it is most important to treat the wound. | ||
==Prevention== | ==Prevention== | ||
Revision as of 20:36, 11 February 2016
This page is about clinical aspects of the disease. For microbiologic aspects of the causative organism(s), see Pasteurella multocida.
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Danitza Lukac
Synonyms and keywords: Shipping fever; bovine respiratory disease complex; fibrinous pneumonia; pasteurella pneumonia; hemorrhagic septicemia; fowl cholera; snuffles
Overview
Pasteurellosis is an infection with a species of the bacterial genus Pasteurella,[1] which is found in humans and other animals. Pasteurella multocida (subsp. septica and subsp. multocida) is carried in the mouth and respiratory tract of various animals, including pigs.[2] It is a small Gram negative bacillus with bipolar staining by Wayson stain.The mechanisms of pathogenesis of Pasteurella infection in its natural host species and in humans are still not completely understood, and further studies are needed. Pasteurella is usually transmitted via the cutaneous route to the human host.Pasteurella uses a number of mechanisms for avoiding or suppressing bactericidal responses such as lipopolysaccharides (LPS) and the bacterias capsule.[3][4] It is difficult to establish the true prevalence and incidence of pasteurellosis because disease reporting is not required. In the USA, the annual incidence of dog and cat bites has been reported as 300 bites per 100,000 individuals.[5][6] Common risk factors in the development of pasteurellosis are animal exposure, children, and inmunosuppressed individuals.[6][7][8] If left untreated, patients with pasteurellosis may progress to develop soft tissue inflammation. Common complications of pasteurellosis include cellulitis, septic arthritis, and osteomyelitis. Patients with cutaneous infection have the most favorable prognosis with adequate treatment.[9][4][10][6] Physical examination of patients with pasteurellosis is usually remarkable for redness, warmth, swelling and pain in the affected area.
Historical Perspective
- The genus Pasteurella is named after the French chemist and microbiologist, Louis Pasteur, who first identified the bacteria now known as Pasteurella multocida as the agent of chicken cholera.[11]
Pathophysiology
- The mechanisms of pathogenesis of Pasteurella infection in its natural host species and in humans are still not completely understood, and further studies are needed.
- Pasteurella is usually transmitted via the cutaneous route to the human host.
- Pasteurella uses a number of mechanisms for avoiding or suppressing bactericidal responses:
- Lipopolysaccharides (LPS) and the bacterias capsule probably play a substantial role in intracellular survival
- P. multocida capsule has been shown in strains belonging to serogroups A and B to help resist phagocytosis by host immune cells and capsule type A has also been shown to help resist complement-mediated lysis
- The LPS produced by P. multocida consists of a hydrophobic lipid A molecule (that anchors the LPS to the outer membrane), an inner core, and an outer core, both consisting of a series of sugars linked in a specific way
- A study in a serovar 1 strain showed that a full-length LPS molecule was essential for the bacteria to be fully virulent in chickens
- Strains that cause atrophic rhinitis in pigs are unique as they also have P. multocida toxin (PMT) residing on a bacteriophage. PMT is responsible for the twisted snouts observed in pigs infected with the bacteria. This toxin activates Rho GTPases, which bind and hydrolyze GTP, and are important in actin stress fiber formation
- Formation of stress fibers may aid in the endocytosis of P. multocida
- The host cell cycle is also modulated by the toxin, which can act as an intracellularmitogen
- Pasteurella needs iron to grow.
- P. multocida has developed mechanisms acquire iron from hemoglobin, ferritin, lactoferrin and transferrin.[3][4]
Causes
- Pasteurellosis is caused by an infection with Pasteurella spp.
- Pasteurella is a gram-negative, facultatively anaerobic bacteria.
- Pasteurella species are nonmotile and pleomorphic.
- Most Pasteurella species are catalase- and oxidase-positive.
- P. multocida is the most frequent causative agent in human.
- Pasteurella cells occur in many cats mouths, a large percentage of dogs mouths, and frequently in rabbits. This is in perfectly normal and otherwise healthy animals.
- Cats oral cavity colonization of P. multocida is between 70%–90%
- Dogs oral cavity colonization of P. multocida is between 50%–60%
- Several reports describe human infections by Pasteurella spp. that were acquired after close contact with pets, including sharing a bed, being licked by, kissing the pets, animal scratches or bites.
- Less commonly, pasteurellosis can be acquired by inhalating the bacteria, human-to human transmission or with non known source of infection.
- Pasteurella can be transmitted when exposed to animals that have been exposed directly or indirectly to the animals oropharyngeal secretions through licking or sniffing.[4][12][13][14][6]
Differentiating Pasteurellosis from other Diseases
Pasteurellosis must be differentiated from:
- Cat scratch disease
- Abscesses:
- Abdominal
- Brain
- Liver
- Lung
- Perinephric
- Due tu amebas, streptococcus, staphylococcus, and anaerobic bacteria
- Cellulitis
- Animal Bites
- Pneumonia:
- Abdominal Sepsis
- Haemophilus spp. infections
- Actinobacillus actinomycetemcomitans infection
- Cardiobacterium hominis infection
- Eikenella corrodens infection
- Kingella spp infection
- Peritonitis
- Meningitis
Epidemiology and Demographics
- It is difficult to establish the true prevalence and incidence of pasteurellosis because disease reporting is not required.
- P. multocida oral cavity colonization in cats, dogs and other animals is common worldwide.[13]
- An estimated 4.4 million animal bites occur each year in the United States
- In the USA, the annual incidence of dog and cat bites has been reported as 300 bites per 100,000 individuals
- The mortality rate of pasteurellosis is approximately 25-30%
- The mortality rate of pasteurellosis patients with meningitis and neurological manifestations is approximately 17-29%
- The mortality rate of pasteurellosis patients with bacteremia is approximately 40-63%[5][6]
Risk Factors
- Animal exposure
- Children: Among children, the rate of dog-bite–related injuries is highest for those 5 to 9 years old. Children are more likely than adults to receive medical attention for dog bites.
- Men: Men are more likely than women to be bitten by a dog.
- Elderly
- Pregnant women
- Immunosuppressed individuals[6][7][8]
Natural History, Complications and Prognosis
Natural History
- Pasteurellosis incubation period occurs within 24 hours.
- Initial presentation usually shows as soft tissue inflammation.
- If left untreated, patients with pasteurellosis progress to develop complications.[9][4]
Complications
- Pasteurellosis complications include:[10]
- Cellulitis
- Subcutaneous abscesses
- Septic arthritis
- Lower respiratory tract infections
- Upper respiratory tract infections
- Osteomyelitis
- Bacteremia
- Endocarditis
- Meningitis
- Peritonitis
Prognosis
- The prognosis varies with the type of infection; cutaneous infections have the most favorable prognosis with adequate treatment.
- Prognosis is generally poor for patients who develop bacteremia, endocarditis and meningitis.[6]
History and Symptoms
History
- Patients with pasteurellosis most commonly report contact with pets, including sharing a bed, being licked by, or kissing the pets
Symptoms
- Fever
- Pain or tenderness in the affected area
- Skin redness or inflammation that gets bigger as the infection spreads
- Skin sore or rash that starts suddenly, and grows quickly in the first 24 hours
- Tight, glossy, "stretched" appearance of the skin
- Warm skin in the the area of redness
- Dyspnea
- Productive cough (greenish or yellow sputum)
- Fever (high grade) with sweating, chills, and rigor
Physical Examination
Skin
- Redness, warmth, and swelling
- Possible drainage, if there is an infection
- Swollen lymph nodes near the affected area
Vital Signs
Lungs
- Palpation
- Increased tactile fremitus
- Percussion
- Dullness on percussion
- Auscultation
Vital Signs
- Hypotension
- Sepsis is considered present if infection is highly suspected or proven and two or more of the following systemic inflammatory response syndrome (SIRS) criteria are met:
- Heart rate > 90 beats per minute
- Temperature < 36 (96.8 °F) or > 38 °C (100.4 °F)
- Tachypnea > 20 breaths per minute or, on blood gas, a PaCO2 < 32 mm Hg
Skin
Extremities
- Decreased peripheral pulses
Neurologic
Diagnosis
- Diagnosis is made with isolation of Pasteurella multocida in a normally sterile site (blood, pus or CSF)
- P. multocida has been observed invading and replicating inside host amoebae, causing lysis in the host. P. multocida will grow at 37 °C on blood or chocolate agar
- Colony growth is accompanied by a characteristic "mousy" odor due to metabolic products
- Being a facultative anaerobe, it is oxidase-positive and catalase-positive, and can also ferment a large number carbohydrates in anaerobic conditions[4]
Treatment
As the infection is usually transmitted into humans through animal bites, antibiotics usually treat the infection, but medical attention should be sought if the wound is severely swelling. Pasteurellosis is usually treated with high-dose penicillin if severe. Either tetracycline or chloramphenicol provides an alternative in beta-lactam intolerant patients. However, it is most important to treat the wound.
Prevention
Preventing dog bites:
- Do:
- Remain motionless (e.g., "be still like a tree") when approached by an unfamiliar dog.
- Curl into a ball with your head tucked and your hands over your ears and neck if a dog knocks you over.
- Don't:
- Approach an unfamiliar dog.
- Run from a dog.
- Panic or make loud noises.
- Disturb a dog that is sleeping, eating, or caring for puppies.
- Pet a dog without allowing it to see and sniff you first.
- Encourage your dog to play aggressively.
- Let small children play with a dog unsupervised. [7]
See also
References
- ↑ Kuhnert P; Christensen H (editors). (2008). Pasteurellaceae: Biology, Genomics and Molecular Aspects. Caister Academic Press. ISBN 978-1-904455-34-9. [http://www.horizonpress.com/past.
- ↑ Hunt Gerardo, S.; Citron, D. M.; Claros, M. C.; Fernandez, H. T.; Goldstein, E. J. C. (2001). "Pasteurella multocida subsp. multocida and P. multocida subsp. septica Differentiation by PCR Fingerprinting and -Glucosidase Activity". Journal of Clinical Microbiology. 39 (7): 2558–2564. doi:10.1128/JCM.39.7.2558-2564.2001. ISSN 0095-1137. PMID 11427568.
- ↑ 3.0 3.1 Wilkie IW, Harper M, Boyce JD, Adler B (2012). "Pasteurella multocida: diseases and pathogenesis". Curr Top Microbiol Immunol. 361: 1–22. doi:10.1007/82_2012_216. PMID 22643916.
- ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella Accessed on February 10, 2016
- ↑ 5.0 5.1 Kaiser RM, Garman RL, Bruce MG, Weyant RS, Ashford DA (2002). "Clinical significance and epidemiology of NO-1, an unusual bacterium associated with dog and cat bites". Emerg Infect Dis. 8 (2): 171–4. doi:10.3201/eid0802.010139. PMC 2732450. PMID 11897069.
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 6.6 Wilson BA, Ho M (2013). "Pasteurella multocida: from zoonosis to cellular microbiology". Clin Microbiol Rev. 26 (3): 631–55. doi:10.1128/CMR.00024-13. PMC 3719492. PMID 23824375.
- ↑ 7.0 7.1 7.2 Dog Bite Prevention. CDC. http://www.cdc.gov/features/dog-bite-prevention/ Accessed on February 10, 2016
- ↑ 8.0 8.1 Kristinsson G. Pasteurella multocida Infections. Pediatr Rev. 2007; 28(12): 472-473
- ↑ 9.0 9.1 Stewart PJ (1986). "Counselling on smoking". CMAJ. 135 (2): 105–6. PMC 1491194. PMID 3719492.
- ↑ 10.0 10.1 Weber DJ, Wolfson JS, Swartz MN, Hooper DC (1984). "Pasteurella multocida infections. Report of 34 cases and review of the literature". Medicine (Baltimore). 63 (3): 133–54. PMID 6371440.
- ↑ Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella. Accessed on February 9, 2016
- ↑ Chomel BB, Sun B (2011). "Zoonoses in the bedroom". Emerg Infect Dis. 17 (2): 167–72. doi:10.3201/eid1702.101070. PMC 3298380. PMID 21291584.
- ↑ 13.0 13.1 Zoonoses and Communicable Diseases common to Man and Animals. PAHO (2001). http://www.paho.org/hq/index.php?option=com_docman&task=doc_view&gid=19187&Itemid= Accessed on February 10, 2016
- ↑ Kimura R, Hayashi Y, Takeuchi T, Shimizu M, Iwata M, Tanahashi J; et al. (2004). "Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review". J Infect Chemother. 10 (4): 250–2. doi:10.1007/s10156-004-0331-5. PMID 15365869.