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Pasteurella multocida meningitis: case report and review of the last 11 y
Bryan T Green1, Keith M Ramsey, Patrick E Nolan
1Department of Internal Medicine, University of South Alabama, College of Medicine, Mobile, USA.
Abstract:
Pasteurella multocida meningitis is a rare clinical occurrence. We report a new case and review the 28 other cases described in the English literature. A history of recent animal contact remains strongly associated with P. multocida meningitis (noted in 89% of all cases), with licking of mucus surfaces or injured skin being most common. Bacteremia was present in 63% of all patients. Spread from an adjacent site of infection continues to be an important factor, with otitis media being documented or strongly suspected in 24% of all cases. The presenting signs and symptoms were characteristic of bacterial meningitis, with fever, headache, nucal rigidity and an altered level of consciousness being present in most patients. Cerebrospinal fluid analysis was typical for bacterial meningitis. Penicillin G or ampicillin was the most common definitive treatment; however, third-generation cephalosporins have been successful. The mean duration of treatment was 14 d. Neurologic complications were present in 17% of patients overall and mortality remains substantial at 25%. Although not statistically significant, there is a trend toward decreased neurologic complications and mortality during the last 11 y.
Insights
Pasteurella multocida meningitis, though rare, is strongly linked to animal contact and often presents with typical bacterial meningitis symptoms. Early treatment with antibiotics is crucial, as complications and mortality remain significant.
Area of Science:
- Infectious Diseases
- Neurology
- Microbiology
Background:
- Pasteurella multocida meningitis is an uncommon but serious infection.
- Understanding its transmission, clinical presentation, and outcomes is vital for effective management.
Observation:
- A review of 29 cases highlights a strong association with animal contact (89%), particularly through licking.
- Bacteremia occurred in 63% of cases, and otitis media was a common source (24%).
- Clinical signs included fever, headache, nuchal rigidity, and altered consciousness, consistent with bacterial meningitis.
Findings:
- Cerebrospinal fluid analysis showed typical signs of bacterial meningitis.
- Penicillin G or ampicillin were common treatments, with third-generation cephalosporins also proving effective.
- Neurologic complications affected 17% of patients, and the overall mortality rate was 25%.
Implications:
- Despite a trend towards improved outcomes in recent years, Pasteurella multocida meningitis requires prompt diagnosis and treatment.
- Awareness of the zoonotic link is critical for prevention and early intervention in at-risk individuals.
- Continued research into optimal treatment strategies may further reduce morbidity and mortality.