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Pasteurella multocida meningitis in an adult: case report and review
A Kumar1, H R Devlin, H Vellend
1Department of Critical Care Medicine, Health Sciences Centre, Winnipeg, Canada.
Abstract:
Pasteurella multocida is a rare cause of adult meningitis. Close animal contact prior to onset of illness is frequent and represents the usual mode of introduction of the organism. In reports of a total of 21 cases of P. multocida meningitis in adults (this case report and 20 described previously in the English-language literature), 18 researchers commented on the occurrence of animal contact: two cases (11%) involved cat bite, 13 (72%) involved animal contact without bite, and three (17%) occurred in the absence of recognized animal contact. Clinical presentation was typical of bacterial meningitides. Overall mortality rate was 30%. The best predictors of poor outcome were initial hemodynamic instability and age greater than 60 years. Documented bacteremia (40% of cases) was not predictive of higher mortality. Effective therapy is based on early recognition of the possibility of P. multocida meningitis and prompt initiation of treatment with penicillin, ampicillin, or a third-generation cephalosporin.
Insights
Pasteurella multocida meningitis is rare in adults, often linked to animal contact. Early recognition and treatment with specific antibiotics are crucial for improving outcomes in this serious infection.
Area of Science:
- Infectious Diseases
- Bacteriology
- Neurology
Background:
- Pasteurella multocida is an uncommon cause of meningitis in adults.
- Animal contact, particularly with cats, is the primary transmission route.
Observation:
- A review of 21 adult cases revealed animal contact in 86% of instances.
- Clinical symptoms align with typical bacterial meningitis presentations.
- Mortality rate was 30%, with older age and hemodynamic instability predicting worse outcomes.
Findings:
- Hemodynamic instability and age over 60 were significant predictors of mortality.
- Bacteremia occurred in 40% of cases but did not correlate with increased mortality.
- Penicillin, ampicillin, or cephalosporins are effective treatments.
Implications:
- Highlights the importance of considering Pasteurella multocida in meningitis, especially with animal exposure history.
- Emphasizes prompt antibiotic therapy for better patient prognosis.
- Informs clinical practice regarding risk factors and effective management strategies.