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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. ''[[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. The mainstay of therapy for pasteurellosis is cleaning the wound and antibiotics such as penicillin and beta lactamase inhibitors.<ref name=e>Warrell D, Cox TM, Firth J et al. Oxford Textbook of Medicine: Infection. OUP Oxford; 2012.</ref>
'''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]]. ''[[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. Complications of pasteurellosis include [[cellulitis]], [[pneumonia]], and [[bacteremia]]. Patients with cutaneous infection have the most favorable prognosis with adequate treatment.<ref name="b">Pasteurella multocida. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella_multocida Accessed on February 10, 2016  </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><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="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> Physical examination of patients with pasteurellosis is usually remarkable for redness, warmth, swelling and pain in the affected area. The mainstay of therapy for pasteurellosis is cleaning the wound and antibiotics such as [[penicillin]] and beta lactamase inhibitors.<ref name="e">Warrell D, Cox TM, Firth J et al. Oxford Textbook of Medicine: Infection. OUP Oxford; 2012.</ref>


==Historical Perspective==
==Historical Perspective==
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**[[Pasteurella multocida|''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
**[[Pasteurella multocida|''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 [[Pasteurella multocida|''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  
**The LPS produced by [[Pasteurella multocida|''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 [[Pasteurella multocida|''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 [[Pasteurella multocida|''P. multocida'']]
**Formation of stress fibers may aid in the endocytosis of [[Pasteurella multocida|''P. multocida'']]
**The host cell cycle is also modulated by the toxin, which can act as an intracellularmitogen
**The host cell cycle is modulated by the [[Pasteurella multocida|''P. multocida'']] toxin, which can act as an intracellularmitogen
*''[[Pasteurella]]'' needs iron to grow.  
*''[[Pasteurella]]'' needs iron to grow.  
**[[Pasteurella multocida|''P. multocida'']] has developed mechanisms acquire iron from hemoglobin, ferritin, lactoferrin and transferrin.<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>
**[[Pasteurella multocida|''P. multocida'']] has developed mechanisms acquire iron from hemoglobin, ferritin, lactoferrin and transferrin.<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>
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*Pasteurellosis is caused by an infection with ''[[Pasteurella]]'' [[Pasteurella|''spp''.]]
*Pasteurellosis is caused by an infection with ''[[Pasteurella]]'' [[Pasteurella|''spp''.]]
*''[[Pasteurella]]'' is a gram-negative, facultatively anaerobic bacteria.
*''[[Pasteurella]]'' is a gram-negative, facultatively anaerobic bacteria.
*''[[Pasteurella]]'' species are nonmotile and pleomorphic.
*Most ''[[Pasteurella]]'' species are catalase- and oxidase-positive.
*Most ''[[Pasteurella]]'' species are catalase- and oxidase-positive.
*[[Pasteurella multocida|''P. multocida'']] is the most frequent causative agent in human.
*[[Pasteurella multocida|''P. multocida'']] is the most frequent causative agent in human.
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*Several reports describe human infections by ''[[Pasteurella]]'' [[Pasteurella|''spp''.]] that were acquired after '''close contact with pets''', including sharing a bed, being licked by, kissing the pets, animal scratches or bites.
*Several reports describe human infections by ''[[Pasteurella]]'' [[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.
*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.<ref name="b">Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella Accessed on February 10, 2016  </ref><ref name="pmid21291584">{{cite journal| author=Chomel BB, Sun B| title=Zoonoses in the bedroom. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 2 | pages= 167-72 | pmid=21291584 | doi=10.3201/eid1702.101070 | pmc=PMC3298380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21291584  }} </ref><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><ref name="pmid15365869">{{cite journal| author=Kimura R, Hayashi Y, Takeuchi T, Shimizu M, Iwata M, Tanahashi J et al.| title=Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review. | journal=J Infect Chemother | year= 2004 | volume= 10 | issue= 4 | pages= 250-2 | pmid=15365869 | doi=10.1007/s10156-004-0331-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15365869 }} </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>
*''[[Pasteurella]]'' can be transmitted when exposed to animals that have been exposed directly or indirectly to the animals oropharyngeal secretions through licking or sniffing.<ref name="b">Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella Accessed on February 10, 2016  </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><ref name="pmid21291584">{{cite journal| author=Chomel BB, Sun B| title=Zoonoses in the bedroom. | journal=Emerg Infect Dis | year= 2011 | volume= 17 | issue= 2 | pages= 167-72 | pmid=21291584 | doi=10.3201/eid1702.101070 | pmc=PMC3298380 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21291584  }} </ref><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><ref name="pmid15365869">{{cite journal| author=Kimura R, Hayashi Y, Takeuchi T, Shimizu M, Iwata M, Tanahashi J et al.| title=Pasteurella multocida septicemia caused by close contact with a domestic cat: case report and literature review. | journal=J Infect Chemother | year= 2004 | volume= 10 | issue= 4 | pages= 250-2 | pmid=15365869 | doi=10.1007/s10156-004-0331-5 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15365869  }} </ref>
==Differentiating Pasteurellosis from other Diseases==
==Differentiating Pasteurellosis from other Diseases==
Pasteurellosis must be differentiated from:
Pasteurellosis must be differentiated from:
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==Epidemiology and Demographics==
==Epidemiology and Demographics==
*It is difficult to establish the true prevalence and incidence of pasteurellosis because disease reporting is not required.
*It is difficult to establish the true prevalence and incidence of pasteurellosis because disease reporting is not required
*[[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
*In the USA, the annual incidence of dog and cat bites has been reported as 300 bites per 100,000 individuals
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==Risk Factors==
==Risk Factors==
*Animal exposure
*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.
*Children: Among children, the rate of dog bite related injuries is highest for those 5 to 9 years old
*Men: Men are more likely than women to be bitten by a dog.
*Men: Men are more likely than women to be bitten by a dog
*Elderly
*Elderly
*Pregnant women
*Pregnant women
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*Pasteurellosis incubation period occurs within 24 hours.
*Pasteurellosis incubation period occurs within 24 hours.
*Initial presentation usually shows as soft tissue inflammation.
*Initial presentation usually shows as soft tissue inflammation.
*If left untreated, patients with pasteurellosis progress to develop complications.<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>
*If left untreated, patients with pasteurellosis progress to develop complications.<ref name="b">Pasteurella multocida. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella_multocida Accessed on February 10, 2016  </ref><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>
===Complications===
===Complications===
*Pasteurellosis complications include:<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>
*Pasteurellosis complications include:<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>
**Cellulitis
**[[Cellulitis]]
**Subcutaneous abscesses
**Subcutaneous [[abscesses]]
**Septic arthritis
**[[Septic arthritis]]
**Lower respiratory tract infections
**[[Respiratory tract infection|Lower respiratory tract infections]]
**Upper respiratory tract infections
**[[Respiratory tract infection|Upper respiratory tract infections]]
**Osteomyelitis
**[[Osteomyelitis]]
**Bacteremia
**[[Bacteremia]]
**Endocarditis
**[[Endocarditis]]
**Meningitis
**[[Meningitis]]
**Peritonitis
**[[Peritonitis]]
===Prognosis===
===Prognosis===
*The prognosis varies with the type of infection; cutaneous infections have the most favorable prognosis with adequate treatment.
*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.<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>
*Prognosis is generally poor for patients who develop [[bacteremia]], [[endocarditis]] and [[meningitis]].<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>


==History and Symptoms==
==History and Symptoms==
Line 179: Line 176:


==Diagnosis==
==Diagnosis==
*Diagnosis is made with isolation of ''Pasteurella multocida'' in a normally sterile site (blood, pus or CSF)
*Diagnosis is made with isolation of ''[[Pasteurella multocida]]'' in a normally sterile site (blood, pus or cerebrospinal fluid)
*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
*''[[Pasteurella multocida|P. multocida]]''  has been observed invading and replicating inside host amoebae, causing lysis in the host. ''[[Pasteurella multocida|P. multocida]]''  will grow at 37 °C on [[Blood agar|blood]] or [[chocolate agar]]
**Colony growth is accompanied by a characteristic "mousy" odor due to metabolic products
**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<ref name="b">Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella Accessed on February 10, 2016  </ref>
*Being a facultative anaerobe, it is oxidase-positive and catalase-positive, and can also ferment a large number carbohydrates in anaerobic conditions<ref name="b">Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella Accessed on February 10, 2016  </ref>


==Treatment==
==Treatment==
*As the infection is usually transmitted into humans through animal bites, cleaning the wound and antibiotics usually treat the infection.
*As the infection is usually transmitted into humans through animal bites, cleaning the wound and antibiotics usually treat the infection  
*Pasteurellosis is usually treated with [[penicillin]] {{and}} beta lactamase inhibitor.
*Pasteurellosis is usually treated with [[penicillin]] {{and}} beta lactamase inhibitor
*Patients with penicillin allergies or resistant to beta lactamase inhibitor should be treated with doxycycline, levofloxacin or moxifloxacin.
*Patients with [[penicillin]] allergies or resistant to beta lactamase inhibitor should be treated with [[doxycycline]], [[levofloxacin]] or [[moxifloxacin]]
*Therapy for patients with soft-tissue infection last approximately 10 days.
*Therapy for patients with [[cellulitis]] infection last approximately 10 days
*Therapy for patients with tenosynovitis infection last approximately 3 weeks.
*Therapy for patients with [[tenosynovitis]] infection last approximately 3 weeks
*Therapy for patients with septic arthritis infection last approximately 4 weeks.
*Therapy for patients with [[septic arthritis]] infection last approximately 4 weeks
*Therapy for patients with osteomyelitis infection last approximately 6 weeks.<ref name=e>Warrell D, Cox TM, Firth J et al. Oxford Textbook of Medicine: Infection. OUP Oxford; 2012.</ref>
*Therapy for patients with [[osteomyelitis]] infection last approximately 6 weeks<ref name="e">Warrell D, Cox TM, Firth J et al. Oxford Textbook of Medicine: Infection. OUP Oxford; 2012.</ref>
==Prevention==


 
==== Preventing dog bites ====
==Prevention==
Preventing dog bites:
*Do:
*Do:
**Remain motionless (e.g., "be still like a tree") when approached by an unfamiliar dog.
**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.
**Curl into a ball with your head tucked and your hands over your ears and neck if a dog knocks you over
*Don't:
*Don't:
**Approach an unfamiliar dog.
**Approach an unfamiliar dog
**Run from a dog.
**Run from a dog
**Panic or make loud noises.
**Panic or make loud noises
**Disturb a dog that is sleeping, eating, or caring for puppies.
**Disturb a dog that is sleeping, eating, or caring for puppies
**Pet a dog without allowing it to see and sniff you first.
**Pet a dog without allowing it to see and sniff you first
**Encourage your dog to play aggressively.
**Encourage your dog to play aggressively
**Let small children play with a dog unsupervised. <ref name="c">Dog Bite Prevention. CDC. http://www.cdc.gov/features/dog-bite-prevention/ Accessed on February 10, 2016  </ref>
**Let small children play with a dog unsupervised<ref name="c">Dog Bite Prevention. CDC. http://www.cdc.gov/features/dog-bite-prevention/ Accessed on February 10, 2016  </ref>


==See also==
==See also==

Revision as of 13:59, 12 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. 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. Complications of pasteurellosis include cellulitis, pneumonia, and bacteremia. Patients with cutaneous infection have the most favorable prognosis with adequate treatment.[4][6][9][10] Physical examination of patients with pasteurellosis is usually remarkable for redness, warmth, swelling and pain in the affected area. The mainstay of therapy for pasteurellosis is cleaning the wound and antibiotics such as penicillin and beta lactamase inhibitors.[11]

Historical Perspective

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
    • Formation of stress fibers may aid in the endocytosis of P. multocida
    • The host cell cycle is modulated by the P. multocida 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.
  • 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][6][13][14][15]

Differentiating Pasteurellosis from other Diseases

Pasteurellosis must be differentiated from:

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[14]
  • 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
  • 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.[4][9]

Complications

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

Symptoms related to cellulitis (most common) include:

  • 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

Symptoms related to pneumonia include:

Symptoms related to septicaemia include:

Physical Examination

Physical examination related to cellulitis (most common) include:

Skin

Physical examination related to pneumonia include:

Vital Signs

Lungs

  • Percussion
    • Dullness on percussion

Physical examination related to septicaemia include:

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:

Skin

Extremities

  • Decreased peripheral pulses

Neurologic

Diagnosis

  • Diagnosis is made with isolation of Pasteurella multocida in a normally sterile site (blood, pus or cerebrospinal fluid)
  • 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, cleaning the wound and antibiotics usually treat the infection
  • Pasteurellosis is usually treated with penicillin AND beta lactamase inhibitor
  • Patients with penicillin allergies or resistant to beta lactamase inhibitor should be treated with doxycycline, levofloxacin or moxifloxacin
  • Therapy for patients with cellulitis infection last approximately 10 days
  • Therapy for patients with tenosynovitis infection last approximately 3 weeks
  • Therapy for patients with septic arthritis infection last approximately 4 weeks
  • Therapy for patients with osteomyelitis infection last approximately 6 weeks[11]

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

  1. ↑ 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.
  2. ↑ 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. ↑ 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. ↑ 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. ↑ 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. ↑ 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. ↑ 7.0 7.1 7.2 Dog Bite Prevention. CDC. http://www.cdc.gov/features/dog-bite-prevention/ Accessed on February 10, 2016
  8. ↑ 8.0 8.1 Kristinsson G. Pasteurella multocida Infections. Pediatr Rev. 2007; 28(12): 472-473
  9. ↑ 9.0 9.1 Stewart PJ (1986). "Counselling on smoking". CMAJ. 135 (2): 105–6. PMC 1491194. PMID 3719492.
  10. ↑ 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.
  11. ↑ 11.0 11.1 Warrell D, Cox TM, Firth J et al. Oxford Textbook of Medicine: Infection. OUP Oxford; 2012.
  12. ↑ Pasteurella. Wikipedia. https://en.wikipedia.org/wiki/Pasteurella. Accessed on February 9, 2016
  13. ↑ 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.
  14. ↑ 14.0 14.1 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
  15. ↑ 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.

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