Pasteurella multocida Bacteremia and Osteomyelitis from a Diabetic Foot Ulcer

Ekamjeet Randhawa¹, John R. Woytanowski¹, Sara Schultz² and Benjamin Bluen²

¹Department of Internal Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia PA

²Department of Infectious Disease and HIV Medicine, Drexel University College of Medicine, Hahnemann University Hospital, Philadelphia PA

Cite this paper:
Ekamjeet Randhawa, John R. Woytanowski, Sara Schultz and Benjamin Bluen. Pasteurella multocida Bacteremia and Osteomyelitis from a Diabetic Foot Ulcer. American Journal of Medical Case Reports. 2017; 5(8):229-231. doi: 10.12691/ajmcr-5-8-7

Abstract

Pasteurella multocida is a gram-negative coccobacillus that causes a spectrum of illnesses. P multocida lives as commensal bacteria in the upper respiratory tracts of fowl and mammals. Infections most commonly result from cat or dog bites; however, direct inoculation via saliva has been reported. Although the majority of P. multocida infections manifest in skin and soft tissue, it may cause bacteremia with disseminated infection in an immunocompromised host. Dissemination is responsive to treatment but carries a significant mortality risk of about 30%. We present a case of a 46 year old male with type 2 diabetes mellitus, coronary artery disease and chronic kidney disease with stage 4 neuropathic heel ulcer who presented with hypothermia and chills. One day into admission, 4/4 blood culture bottles were positive for Pasteurella multocida. MRI of the foot was concerning for osteomyelitis which was confirmed via I&D. The patient did report having a dog and a cat at home, but adamantly denied any bites from either animal. Examination of his boot used for support with his foot containing the ulcer revealed extensive animal hair stuck to the boot. It was deemed likely that the route of inoculation occurred from contamination of his neuropathic ulcer from his dog’s saliva, likely from a lick, for which his diabetic neuropathy may have impaired initial sensation of the contamination. The patient was treated with ampicillin-sulbactam while admitted and discharged with oral levofloxacin 6 week course for residual osteomyelitis.

Keywords:
Pasteurella multocida diabetic ulcer bacteremia osteomyelitis neuropathy

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