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Case report

Erysipelas in a cat-bite victim caused by pasteurella multocida - case report

Eleonora Gvozdenović1, Jovan Malinić2,3, Nataša Nikolić2,3, Nataša Katanić3,4, Milica Jovanović3, Olga Dulović1
  • Medigroup Hospital, Belgrade, Serbia
  • University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • University Clinical Center of Serbia, Clinic for Infectious and Tropical Diseases, Belgrade, Serbia
  • University of Priština with a temporary seat in Kosovska Mitrovica, Faculty of Medicine, Kosovska Mitrovica, Serbia

ABSTRACT

Introduction: Erysipelas is a characteristic form of acute superficial streptococcal cellulitis, usually treated in outpatient service, primarily with penicillin, or erythromycin, in cases where the patient is allergic to penicillin. We are reporting the case of a patient who was preventively treated with erythromycin, after a cat bite, but during treatment developed erysipelas, which, after a swab sample from the wound was analyzed, proved to be caused by Pasteurella multocida, resistant to erythromycin.

Case report: A 53-year-old woman came to the outpatient clinic with clinical signs of erysipelas cruris. Seven days before, she had been bitten by her own cat. The wound was surgically treated, and erythromycin, 500 mg qid, was prescribed as prophylaxis of wound infection. There were no signs of infection. On the 5th day following the bite, the patient was running a very high fever (39.2°C), but she was without other symptoms, thus the fever was considered to be a symptom of the flu. On the following day, prominent erythematous swelling appeared around the site of the wound, with localized lymphangitis and regional lymphadenitis, and discharge from the wound. The diagnosis of erysipelas was made. The peripheral blood test results were as follows: WBC = 13.9 x 109 /l; NE = 82%, CRP = 43 IU. A swab sample was collected from the wound and the patient was started on penicillin. On the 7th day of penicillin administration, there were no signs of inflammation, while the blood test results were as follows: WBC = 5.1 x 109 /l; NE = 52%; CRP = 24 IU. Pasteurella multocida, resistant to erythromycin but sensitive to penicillin was isolated from the swab sample.

Conclusion: Erysipelas, although an easily recognized clinical entity, can be caused by other microorganisms, besides streptococcus. It is very important to consider this in order to make an accurate diagnosis and prescribe the appropriate therapy.


INTRODUCTION

Erysipelas

Erysipelas is a type of superficial cellulitis with systemic manifestations, caused by group A β-hemolytic streptococcus, less frequently by group C and G β-hemolytic streptococci, and by group B β-hemolytic streptococcus, only in newborns. The disease is sporadic in character. Infection is transmitted through direct contact. The source of infection is most commonly the upper respiratory tract of the infected person, i.e., patient themselves, less frequently the upper respiratory tract of a person providing care for the patient (asymptomatic carrier).

The onset of erysipelas is sudden, with high fever, chills, shivering, weakness, nausea, sometimes vomiting, and pain at the site where it will apear, where characteristic changes occur, in the form of a clearly delineated red swelling with raised edges, most commonly with regional lymphadenitis and lymphangitis. Systemic manifestations are of short duration, while localized changes have a different evolution, depending on the intensity of the inflammation [1],[2],[3],[4],[5].

The diagnosis of erysipelas is a clinical one, it is established on the basis of the anamnesis and examination of the patient. Laboratory findings indicate bacterial infection.

Erysipelas can be contracted year-round by persons of both sexes. It usually affects persons of older age [3],[5],[6],[7],[8]. After the patient recovers from the disease, discreet changes on collecting lymph vessels remain, obstructing microcirculation, thus providing the substrate for the return of the same disease in the same location, i.e., after a person has had erysipelas, a predisposition towards the disease remains [2],[9],[10].

Before the advent of antibiotics, erysipelas had a self-limiting (mild to moderately severe form of the disease) or lethal character (severe disease). In rare cases, the migrating from of the disease appeared, wherein erythematous plaques extended one upon the other. While the previous plaques faded, new ones formed. This form of the disease had a distinctly malignant character [5]. In the pre-antiseptic era, the form of erysipelas developing after surgical procedures and in maternity hospitals or wards was also a malignant variant of the disease; it broke out in the form of epidemics, taking many lives, since the gate for the entry of the infections was wide open, and the source of the infection was ever-present, in the form of the hospital staff.

In the mid 1900s, erysipelas started to become a less serious disease. The belief is that this was partially the result of a change in the streptococcus itself, but also the result of the advent of antibiotics, towards which the streptococcus did not show resistance. Since that time, erysipelas has most commonly been encountered as a disease treated in outpatient care. Penicillin and penicillin-based medication is most commonly used for its treatment, or erythromycin, in patients allergic to penicillin [6].

Procedure with an animal-inflicted wound

Any wound requires proper treatment, and for wounds inflicted by animals it is additionally required that they are reported, primarily for the purpose of rabies control. Due to the dedicated work of Louis Pasteur on rabies prevention, a network of outpatient clinics was formed, led by the Pasteur Institute in Paris, as the central institution for rabies control. In Belgrade, the Pasteur Unit operates within the Clinic for Infectious and Tropical Diseases of the University Clinical Center of Serbia (UCCS). Injured persons should first be examined by a surgeon, who needs to provide the description of the wound and prescribe therapy. After this, at the Pasteur Unit, a record is made of the circumstances of the injury, of the assessment of the vaccination status of the animal who had inflicted the wound, as well as of the injured individual, upon which post-exposure prophylaxis is prescribed, and, if needed, a directive is issued to the City Veterinary Service to examine the animal who had inflicted the wound [11].

Pasteurella multocida

Pasteurella multocida is a microorganism of the Mannheimia genus. These bacteria can be seen under the microscope as coccobacilli. They give a negative result on the Gram stain test. They are aerobes and facultative anaerobes. They have a capsule and are nonmotile and asporogenic. Pasteurella multocida was first described in 1878, in fowl cholera [12]. It lives as a saprophyte in the oral cavities of many animals; in domesticated animals and pets. Cats and dogs are the primary carriers [13].

This bacterium is sensitive to penicillin. Its invasiveness depends on different virulence factors, such as the structure of the capsule, lipopolysaccharides, surface adhesins, and many other elements which have as yet not been identified [14]. Although a saprophyte, this bacterium can cause different animal diseases, primarily of the respiratory tract. It plays a significant role in bovine and swine mortality, in collective breeding [15],[16],[17],[18],[19].

People primarily contract pasteurellosis as the result of direct contact with animals, in the sense of the infection of a bite wound, although being licked by an animal may also be dangerous. The outcome of the disease is most commonly favorable, although it may be lethal, primarily in immunocompromised patients and when data on the animal bite is lacking [20],[21]. In addition to the infection of the bite wound, in people, this disease can also cause sepsis, empyema, meningitis, endocarditis, and infection of other organs. When treating this infection, one must bear in mind that this bacterium is resistant to certain antibiotics, and that treatment should primarily be based on those antibiotics which this bacterium is known not be resistant to, while the treatment needs to be adjusted according to the antibiogram [22],[23],[24],[25],[26],[27],[28],[29]. The drug of first choice is still penicillin G, followed by amoxicillin, piperacillin, cephalosporines, and new-generation antibiotics [30],[31],[32].

We present an erysipelas (surface cellulitis) case, resistant to erythromycin, which developed following the bite of a house cat, wherein pasteurella multocida was isolated from the swab sample of the wound.

Case report

A 53-year-old woman came in for an examination due to complaints which matched the clinical diagnosis of erysipelas cruris. Seven days before, she had been examined at the Pasteur Unit of the Clinic for Infectious and Tropical Diseases, following a bite inflicted by her own cat. The bite was minor, anti-tetanus post-exposure prophylaxis was prescribed, as well as antibiotic prophylaxis of wound infection with erythromycin. In the first few days, the surrounding area of the wound was without signs of inflammation. Anti-tetanus protection was carried out, as prescribed, and the patient took the prescribed antibiotic therapy. On the fifth day following the cat bite, the patient developed a fever of 39.2°C, with no other symptoms. At that point, the wound was covered with a scab, with minor inflammation surrounding the wound, but which exuded serosanguinous content. The fever was attributed to the flu, while the slight hyperemia surrounding the wound was disregarded. On the following day, the fever persisted, while the area surrounding the scab showed signs of marked inflammation; lymphangitis and inguinal lymphadenitis also developed. The diagnosis of erysipelas was established at this point, a swab sample was collected from the wound, and penicillin (1,600,000 IU) was prescribed. Laboratory tests were performed, with the following results: WBC = 13.9 x 109/l; NE = 82%, fibrinogen = 6.2 g/l; CRP = 43 IU; SE = 30. After three days of treatment, lymphangitis and lymphadenitis subsided, there was no more exudation from underneath the scab, the erythema of the surrounding area decreased, however the edema of the surrounding tissue persisted. Pasteurella multocida, resistant to erythromycin but sensitive to penicillin, was isolated from the swab sample of the wound.

On the seventh day of treatment, the scab was delineated with mild infiltrate, there were no remaining signs of inflammation, and the laboratory test results clearly showed a drop in the inflammatory syndrome markers (WBC = 5.1 x 109 /l; NE = 52%; CRP = 24 IU; fibrinogen = 5.2 g/l; SE = 32).

CONCLUSION

Erysipelas is a well-known disease. Its etiology and pathogenesis are well understood, as is the method of treatment, with penicillin being the medication of choice. High fever with systemic manifestations does not last long and is not a cause for concern. Primarily, the cause for concern are cases with markedly elevated levels of inflammatory syndrome markers, which must be monitored. However, both in monitoring and in treatment of the patient, one must be led by the clinical presentation.

It is necessary to treat animal-inflicted wounds with special care and with the notion that an animal bite may transfer bacteria that can cause invasive infections, depending on the virulence of the bacterium itself.

In our everyday clinical practice, when the appropriate treatment of the wound is carried out, we rarely see infection of wounds inflicted by animals. Considering the sites of the wounds clean, after professional treatment, we regard infections of these wounds as secondary infections caused by streptococci or staphylococci, less frequently by other bacteria, in this way practically excluding the possibility that the wound had been primarily infected.

In Serbia, Pasteurella multocida is discussed only in publications pertaining to veterinary medicine. Reports of this pathogen being isolated in the domain of human medicine are rare, although reports can be found. In addition to bite wound infection, this bacterium can cause severe disease of different organs, as well as sepsis. These facts must motivate us to seek etiological confirmation, regardless of the recognizable clinical presentation. In the above-described case, the clinical presentation matched erysipelas, but the initial nausea and vomiting were absent, which, indeed, do not necessarily occur in all patients.

Just like many other microorganisms, Pasteurella multocida is characteristic of veterinary medicine. It is prone to change with respect to its sensitivity to antibiotics, which is why its resistance needs to be constantly monitored. In this case, had penicillin or a cephalosporin been prescribed as preventive treatment, the infection would not have developed. This is why we suggest that, for the purpose of preventing the infection of animal-inflicted wounds (bite or scratch), penicillin or cephalosporin medication should be prescribed in the usual therapeutic doses.

  • Conflict of interest:
    None declared.

Informations

Volume 3 No 1

Volume 3 No 1

March 2022

Pages 113-118
  • Received:
    22 February 2021
  • Revised:
    18 May 2021
  • Accepted:
    15 February 2022
  • Online first:
    25 March 2022
  • DOI:
Corresponding author

Eleonora Gvozdenović
Medigroup Hospital, Belgrade, Serbia
3 Milutina Milankovića Street, 11070 Belgrade, Serbia
E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.


  • 1. Connor DH, Chandler FW, Schwartz DA, Manz HJ, Lack EE. Pathology of Infectious Diseases. Stamford: Appleton & Lange; 1997. p. 819-820.

    2. Crickx B, Chevron F, Sigal-Nahum M, Bilet S, Fraucher F, Picard C, et al. Erysipelas: epidemiological, clinical and therapeutic data (111 cases). Ann Dermatol Venereol. 1991;118:545-6.[HTTP]

    3. Hansmann Y. De quelles données a-t-on besoin aujourd'hui pour prendre en charge un érysipèle? [What data is needed today to deal with erysipelas?]. Ann Dermatol Venereol. 2001 Mar;128(3 Pt 2):419-28. French.

    4. Kosanović-Ćetković D i sar. Erizipel. U: Kosanović-Ćetković D. Akutne infektivne bolesti. Beograd: Zavod za izdavanje udžbenika; 1998. p. 98-99

    5. Todorović K. Akutne infektivne bolesti. Beograd: Prosveta; 1947. p. 707-727.

    6. Gvozdenović E. Crveni vetar-erizipel. U: Božić M, Brmbolić B, Delić D i sar. Infektivne bolesti: udžbenik za studente medicine. Beograd: Medicinski fakultet; 2019. p. 229-234

    7. Brue C, Chosidow O. Pasteurella multocida wound infection and cellulitis. Int J Dermatol. 1994 Jul;33(7):471-3. doi: 10.1111/j.1365-4362.[CROSSREF]

    8. Heydemann J, Heydemann JS, Antony S. Acute infection of a total knee arthroplasty caused by Pasteurella multocida: a case report and a comprehensive review of the literature in the last 10 years. Int J Infect Dis. 2010 Sep;14 Suppl 3:e242-5. doi: 10.1016/j.ijid.2009.09.007.[CROSSREF]

    9. Lindberg J, Frederiksen W, Gahrn-Hansen B, Bruun B. Problems of identification in clinical microbiology exemplified by pig bite wound infections. Zentralbl Bakteriol. 1998 Dec;288(4):491-9. doi: 10.1016/s0934-8840(98)80067-4.[CROSSREF]

    10. Suvajdžić Lj, Mrđa E, Džambas Lj, Bogavac M. Isolation of Pasteurella Multocida subspec. Multocida from chronic periapical lesion. Zbornik Matice srpske za prirodne nauke. 2006;111:29-34.[CROSSREF]

    11. Pravilnik o imunizaciji i načinu zaštite lekovima. Službeni glasnik RS, br. 52/2021.[HTTP]

    12. Boyce JM. Pasteurella species. In: Mandell GL, Bennett JE, Dolin R. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th ed. London: Churchill Livingstone; 1994. p. 2068-2070.

    13. Lloret A, Egberink H, Addie D, Belák S, Boucraut-Baralon C, Frymus T, et al. Pasteurella multocida infection in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013 Jul;15(7):570-2. doi: 10.1177/1098612X13489215.[CROSSREF]

    14. Harper M, Boyce JD, Adler B. Pasteurella multocida pathogenesis: 125 years after Pasteur. FEMS Microbiol Lett. 2006 Dec;265(1):1-10. doi: 10.1111/j.1574- 6968.2006.00442.x.[CROSSREF]

    15. Zhu W, Fan Z, Qiu R, Chen L, Wei H, Hu B, et al. Characterization of Pasteurella multocida isolates from rabbits in China. Vet Microbiol. 2020 May;244:108649. doi: 10.1016/j.vetmic.2020.108649.[CROSSREF]

    16. Cid D, Fernández-Garayzábal JF, Pinto C, Domínguez L, Vela AI. Antimicrobial susceptibility of Pasteurella multocida isolated from sheep and pigs in Spain - Short communication. Acta Vet Hung. 2019 Dec;67(4):489-498. doi: 10.1556/004.2019.048.[CROSSREF]

    17. Savić B, Ivetić V, Milošević B, Valter D i sar. Reproduktivni i respiratorni sindrom svinja (PRRS): sa posebnim osvrtom na respiratornu formu kod zalučene prasadi. Zbornik referata i kratkih sadržaja simpozijuma “V epizootiološki dani” sa međunarodnim učešćem. 2003 april 2-5; Subotica. p. 316-321.

    18. Žutić M, Ivetić V, Drezga J, Markić Z, Mrenoški S. Pleuropneumonia in pigs in farm conditions. Mac Vet Rev 1999;28(1):51-56. doi: 619.636.4].616.24-002- 02.579.943.96.

    19. Banu A, Lax AJ, Grigoriadis AE. In Vivo Targets of Pasteurella Multocida Toxin. Int J Mol Sci. 2020 Apr 15;21(8):2739. doi: 10.3390/ijms21082739.[CROSSREF]

    20. Giordano A, Dincman T, Clyburn BE, Steed LL, Rockey DC. Clinical Features and Outcomes of Pasteurella multocida Infection. Medicine (Baltimore). 2015 Sep;94(36):e1285. doi: 10.1097/MD.0000000000001285.[CROSSREF]

    21. Wade T, Booy R, Teare EL, Kroll S. Pasteurella multocida meningitis in infancy - (a lick may be as bad as a bite). Eur J Pediatr. 1999 Nov;158(11):875-8. doi: 10.1007/s004310051232.[CROSSREF]

    22. Ujvári B, Weiczner R, Deim Z, Terhes G, Urbán E, Tóth AR, et al. Characterization of Pasteurella multocida strains isolated from human infections. Comp Immunol Microbiol Infect Dis. 2019 Apr;63:37-43. doi: 10.1016/j.cimid.2018.12.008.[CROSSREF]

    23. Cuevas I, Carbonero A, Cano D, García-Bocanegra I, Amaro MÁ, Borge C. Antimicrobial resistance of Pasteurella multocida type B isolates associated with acute septicemia in pigs and cattle in Spain. BMC Vet Res. 2020 Jun 30;16(1):222. doi: 10.1186/s12917-020-02442-z.[CROSSREF]

    24. Fukumoto Y, Moriyama Y, Iguro Y, Toda R, Taira A. Pasteurella multocida endocarditis: report of a case. Surg Today. 2002;32(6):513-5. doi: 10.1007/ s005950200087.[CROSSREF]

    25. Rukma P, Sunil M. Antimicrobial Therapy for Pasteurella multocida Empyema in Immunocompetent Adults. Am J Ther. 2018 Mar/Apr;25(2):e278-e279. doi: 10.1097/MJT.0000000000000577.[CROSSREF]

    26. Arons MS, Fernando L, Polayes IM. Pasteurella multocida--the major cause of hand infections following domestic animal bites. J Hand Surg Am. 1982 Jan;7(1):47-52. doi: 10.1016/s0363-5023(82)80013-0.[CROSSREF]

    27. Jankovic J, Vesovic R, Djurdjevic N, Mitic J. Hemoptysis. Is it caused by Pasteurella multocida infection or congenital pulmonary artery anomalies? Germs. 2019 Dec 2;9(4):193-197. doi: 10.18683/germs.2019.1177.[CROSSREF]

    28. Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore). 1984 May;63(3):133-54.

    29. Pak S, Valencia D, Decker J, Valencia V, Askaroglu Y. Pasteurella multocida pneumonia in an immunocompetent patient: Case report and systematic review of literature. Lung India. 2018 May-Jun;35(3):237-240. doi: 10.4103/ lungindia.lungindia_482_17.[CROSSREF]

    30. Bilić V, Žutić M. Osetljivost prema antibioticima i kemofarmaceutskim preparatima bakterija izdvojenih iz organa svinja. Praxis Vet. 1982;30:61-65.

    31. Singer RS, Case JT, Carpenter TE, Walker RL, Hirsh DC. Assessment of spatial and temporal clustering of ampicillin- and tetracycline-resistant strains of Pasteurella multocida and P haemolytica isolated from cattle in California. J Am Vet Med Assoc. 1998 Apr 1;212(7):1001-5. PMID: 9540872.[HTTP]

    32. Van Driessche L, Bokma J, Gille L, Ceyssens PJ, Sparbier K, Haesebrouck F, et al. Rapid detection of tetracycline resistance in bovine Pasteurella multocida isolates by MALDI Biotyper antibiotic susceptibility test rapid assay (MBT-ASTRA). Sci Rep. 2018 Sep 11;8(1):13599. doi: 10.1038/s41598-018-31562-8.[CROSSREF]


References

1. Connor DH, Chandler FW, Schwartz DA, Manz HJ, Lack EE. Pathology of Infectious Diseases. Stamford: Appleton & Lange; 1997. p. 819-820.

2. Crickx B, Chevron F, Sigal-Nahum M, Bilet S, Fraucher F, Picard C, et al. Erysipelas: epidemiological, clinical and therapeutic data (111 cases). Ann Dermatol Venereol. 1991;118:545-6.[HTTP]

3. Hansmann Y. De quelles données a-t-on besoin aujourd'hui pour prendre en charge un érysipèle? [What data is needed today to deal with erysipelas?]. Ann Dermatol Venereol. 2001 Mar;128(3 Pt 2):419-28. French.

4. Kosanović-Ćetković D i sar. Erizipel. U: Kosanović-Ćetković D. Akutne infektivne bolesti. Beograd: Zavod za izdavanje udžbenika; 1998. p. 98-99

5. Todorović K. Akutne infektivne bolesti. Beograd: Prosveta; 1947. p. 707-727.

6. Gvozdenović E. Crveni vetar-erizipel. U: Božić M, Brmbolić B, Delić D i sar. Infektivne bolesti: udžbenik za studente medicine. Beograd: Medicinski fakultet; 2019. p. 229-234

7. Brue C, Chosidow O. Pasteurella multocida wound infection and cellulitis. Int J Dermatol. 1994 Jul;33(7):471-3. doi: 10.1111/j.1365-4362.[CROSSREF]

8. Heydemann J, Heydemann JS, Antony S. Acute infection of a total knee arthroplasty caused by Pasteurella multocida: a case report and a comprehensive review of the literature in the last 10 years. Int J Infect Dis. 2010 Sep;14 Suppl 3:e242-5. doi: 10.1016/j.ijid.2009.09.007.[CROSSREF]

9. Lindberg J, Frederiksen W, Gahrn-Hansen B, Bruun B. Problems of identification in clinical microbiology exemplified by pig bite wound infections. Zentralbl Bakteriol. 1998 Dec;288(4):491-9. doi: 10.1016/s0934-8840(98)80067-4.[CROSSREF]

10. Suvajdžić Lj, Mrđa E, Džambas Lj, Bogavac M. Isolation of Pasteurella Multocida subspec. Multocida from chronic periapical lesion. Zbornik Matice srpske za prirodne nauke. 2006;111:29-34.[CROSSREF]

11. Pravilnik o imunizaciji i načinu zaštite lekovima. Službeni glasnik RS, br. 52/2021.[HTTP]

12. Boyce JM. Pasteurella species. In: Mandell GL, Bennett JE, Dolin R. Mandell, Douglas and Bennett’s Principles and Practice of Infectious Diseases. 4th ed. London: Churchill Livingstone; 1994. p. 2068-2070.

13. Lloret A, Egberink H, Addie D, Belák S, Boucraut-Baralon C, Frymus T, et al. Pasteurella multocida infection in cats: ABCD guidelines on prevention and management. J Feline Med Surg. 2013 Jul;15(7):570-2. doi: 10.1177/1098612X13489215.[CROSSREF]

14. Harper M, Boyce JD, Adler B. Pasteurella multocida pathogenesis: 125 years after Pasteur. FEMS Microbiol Lett. 2006 Dec;265(1):1-10. doi: 10.1111/j.1574- 6968.2006.00442.x.[CROSSREF]

15. Zhu W, Fan Z, Qiu R, Chen L, Wei H, Hu B, et al. Characterization of Pasteurella multocida isolates from rabbits in China. Vet Microbiol. 2020 May;244:108649. doi: 10.1016/j.vetmic.2020.108649.[CROSSREF]

16. Cid D, Fernández-Garayzábal JF, Pinto C, Domínguez L, Vela AI. Antimicrobial susceptibility of Pasteurella multocida isolated from sheep and pigs in Spain - Short communication. Acta Vet Hung. 2019 Dec;67(4):489-498. doi: 10.1556/004.2019.048.[CROSSREF]

17. Savić B, Ivetić V, Milošević B, Valter D i sar. Reproduktivni i respiratorni sindrom svinja (PRRS): sa posebnim osvrtom na respiratornu formu kod zalučene prasadi. Zbornik referata i kratkih sadržaja simpozijuma “V epizootiološki dani” sa međunarodnim učešćem. 2003 april 2-5; Subotica. p. 316-321.

18. Žutić M, Ivetić V, Drezga J, Markić Z, Mrenoški S. Pleuropneumonia in pigs in farm conditions. Mac Vet Rev 1999;28(1):51-56. doi: 619.636.4].616.24-002- 02.579.943.96.

19. Banu A, Lax AJ, Grigoriadis AE. In Vivo Targets of Pasteurella Multocida Toxin. Int J Mol Sci. 2020 Apr 15;21(8):2739. doi: 10.3390/ijms21082739.[CROSSREF]

20. Giordano A, Dincman T, Clyburn BE, Steed LL, Rockey DC. Clinical Features and Outcomes of Pasteurella multocida Infection. Medicine (Baltimore). 2015 Sep;94(36):e1285. doi: 10.1097/MD.0000000000001285.[CROSSREF]

21. Wade T, Booy R, Teare EL, Kroll S. Pasteurella multocida meningitis in infancy - (a lick may be as bad as a bite). Eur J Pediatr. 1999 Nov;158(11):875-8. doi: 10.1007/s004310051232.[CROSSREF]

22. Ujvári B, Weiczner R, Deim Z, Terhes G, Urbán E, Tóth AR, et al. Characterization of Pasteurella multocida strains isolated from human infections. Comp Immunol Microbiol Infect Dis. 2019 Apr;63:37-43. doi: 10.1016/j.cimid.2018.12.008.[CROSSREF]

23. Cuevas I, Carbonero A, Cano D, García-Bocanegra I, Amaro MÁ, Borge C. Antimicrobial resistance of Pasteurella multocida type B isolates associated with acute septicemia in pigs and cattle in Spain. BMC Vet Res. 2020 Jun 30;16(1):222. doi: 10.1186/s12917-020-02442-z.[CROSSREF]

24. Fukumoto Y, Moriyama Y, Iguro Y, Toda R, Taira A. Pasteurella multocida endocarditis: report of a case. Surg Today. 2002;32(6):513-5. doi: 10.1007/ s005950200087.[CROSSREF]

25. Rukma P, Sunil M. Antimicrobial Therapy for Pasteurella multocida Empyema in Immunocompetent Adults. Am J Ther. 2018 Mar/Apr;25(2):e278-e279. doi: 10.1097/MJT.0000000000000577.[CROSSREF]

26. Arons MS, Fernando L, Polayes IM. Pasteurella multocida--the major cause of hand infections following domestic animal bites. J Hand Surg Am. 1982 Jan;7(1):47-52. doi: 10.1016/s0363-5023(82)80013-0.[CROSSREF]

27. Jankovic J, Vesovic R, Djurdjevic N, Mitic J. Hemoptysis. Is it caused by Pasteurella multocida infection or congenital pulmonary artery anomalies? Germs. 2019 Dec 2;9(4):193-197. doi: 10.18683/germs.2019.1177.[CROSSREF]

28. Weber DJ, Wolfson JS, Swartz MN, Hooper DC. Pasteurella multocida infections. Report of 34 cases and review of the literature. Medicine (Baltimore). 1984 May;63(3):133-54.

29. Pak S, Valencia D, Decker J, Valencia V, Askaroglu Y. Pasteurella multocida pneumonia in an immunocompetent patient: Case report and systematic review of literature. Lung India. 2018 May-Jun;35(3):237-240. doi: 10.4103/ lungindia.lungindia_482_17.[CROSSREF]

30. Bilić V, Žutić M. Osetljivost prema antibioticima i kemofarmaceutskim preparatima bakterija izdvojenih iz organa svinja. Praxis Vet. 1982;30:61-65.

31. Singer RS, Case JT, Carpenter TE, Walker RL, Hirsh DC. Assessment of spatial and temporal clustering of ampicillin- and tetracycline-resistant strains of Pasteurella multocida and P haemolytica isolated from cattle in California. J Am Vet Med Assoc. 1998 Apr 1;212(7):1001-5. PMID: 9540872.[HTTP]

32. Van Driessche L, Bokma J, Gille L, Ceyssens PJ, Sparbier K, Haesebrouck F, et al. Rapid detection of tetracycline resistance in bovine Pasteurella multocida isolates by MALDI Biotyper antibiotic susceptibility test rapid assay (MBT-ASTRA). Sci Rep. 2018 Sep 11;8(1):13599. doi: 10.1038/s41598-018-31562-8.[CROSSREF]

1. Connor DH, Chandler FW, Schwartz DA, Manz HJ, Lack EE. Pathology of Infectious Diseases. Stamford: Appleton & Lange; 1997. p. 819-820.

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