□ CASE REPORT □

Pasteurella multocida Infective : A Possible Link with Primary Upper Respiratory Tract Infection

Joel Branch, Takuya Kakutani, Shun Kuroda, Yasuhiro Shiba and Izumi Kitagawa

Abstract

A 50-year-old Japanese man presented with fever and upper respiratory tract symptoms that required ur- gent inpatient admission. A physical examination revealed conjunctival hemorrhages and peripheral embolic phenomena. Blood cultures grew Pasteurella multocida, and an echocardiography revealed a mitral valve vegetation suggestive of (IE), which was confirmed using the Modified Duke Criteria. After several antibiotic regimens proved ineffective, valve replacement was performed, with a good eventual outcome. P. multocida IE is rare and may sometimes have no preceding risk factors. P. multocida infections of the upper respiratory tract are unusual but may be an inciting event for IE. It is essential to check blood cultures and to repeat the performance of physical examinations to appreciate the developing features of IE.

Key words: upper respiratory tract infection, infective endocarditis, Pasteurella multocida, Janeway lesion, Osler nodes, septic emboli

(Intern Med 54: 3225-3231, 2015) (DOI: 10.2169/internalmedicine.54.4973)

inexperienced physicians, which may therefore delay the di- Introduction agnosis of this potentially lethal infection. The usual causes of IE encompass Gram-positive organ- Infective endocarditis (IE) is an uncommon infection, isms such as the viridans streptococci and staphylococcal which can occur in individuals with underlying cardiac dis- species. P. multocida is a very rare cause of IE with very ease, including congenital bicuspid aortic valves (1), valvu- few cases having ever been described in the literature (13). lar regurgitation (2), valvular stenosis (3), prior valve dam- P. multocida infection is usually associated with animal bites age from IE or (2) and the presence of a from cats and dogs, with these animals carrying this organ- prosthetic valve (4). The known predisposing factors include ism in their mouths, whereas it is rare for it to be carried by invasive dental treatment (5), fiberscopic upper and lower humans (14). P. multocida infection can cause several severe gastrointestinal investigations (6, 7), the presence of pol- illnesses including meningitis (15), pneumonia (16), bactere- yps (8), the presence of malignancy of the colon (9), liver mia (17), and septic arthritis (17). cirrhosis (10) and the presence of extensive dermatitis (11). We herein report the case of a 50-year-old Japanese man The diagnosis is confirmed by the use of the Modified Duke who developed P. multocida IE following an upper respira- Criteria (12), which requires the fulfillment of one of the tory tract syndrome, without predisposing factors or contact following conditions: both of the two major criteria, one with animals. To the best of the authors’ knowledge, this is major and three minor criteria, or five minor criteria. The the first case of P. multocida IE that has been documented diagnosis is often established by identifying a valvular vege- with a preceding upper respiratory tract syndrome, suggest- tation by echocardiography, and through the growth of bac- ing a possible link for the spread of this organism through teria by blood cultures. However, the minor criteria require the upper airways or associated pharyngeal structures to some knowledge of physical examination to identify cause bacteremia and subsequent seeding on the mitral endocarditis-specific lesions such as Janeway lesions, Osler valve. nodes and Roth spots. These can sometimes be missed by

Department of General Internal Medicine, Shonan Kamakura General Hospital, Japan Received for publication January 17, 2015; Accepted for publication April 12, 2015 Correspondence to Dr. Joel Branch, [email protected]

3225 Intern Med 54: 3225-3231, 2015 DOI: 10.2169/internalmedicine.54.4973

normal, but his throat demonstrated an erythematous soft Case Report palate with a single clear vesicle. There was no evidence of pus, tonsillar swelling or . Two premolar teeth A 50-year-old Japanese male department store employee showed evidence of extensive dental caries. There was no experienced a fever of five days in duration, after which he cervical, axillary or inguinal lymphadenopathy. presented to his primary care physician. He was diagnosed A cardiovascular examination revealed a normal jugular with bacterial pharyngitis, and treated with azithromycin venous pressure, apex position and ; no mur- (500 mg for three-days). After this, he developed watery di- murs were detectable. Examinations of the respiratory, gas- arrhea, which occurred between 2-3 times in 24 hours, and trointestinal, genitourinary, neurological, dermatological and which resolved spontaneously after two days. One day prior musculoskeletal systems was all entirely normal. to the hospital admission, the patient developed a non- The laboratory data at admission are shown in Table. productive cough. He denied the expectoration of sputum, Tests for Legionella pneumophila, Mycoplasma pneumoniae hemoptysis or . The fever was persistent, which and human immunodeficiency virus were negative. The ad- prompted him to seek a second opinion at this hospital. mission chest radiograph revealed no acute infectious proc- On further questioning, he also complained of twice- ess. The electrocardiogram revealed an irregular heart rate of nightly drenching sweats, which necessitated the changing 105 beats per minute, with frequent atrial ectopic beats and of his bed clothes and which were associated with occa- compensatory pauses. sional chills, headache, bilateral knee arthralgia, anorexia, In view of the clinical presentation and serum trans- fatigue, thirst, polydipsia and polyuria. He had previously aminase elevation, the patient was initially admitted to the had a dental implant, which had spontaneously loosened and hospital with a suspected diagnosis of an acute viral upper fallen out one year previously. He did not complain of any respiratory tract infection, and he was observed while under- current dental problems and he had not undertaken recent going diagnostic tests. On the 3rd hospital day of admission dental treatment. He admitted to contact with a female com- the blood cultures grew Gram-negative bacilli in two out of mercial sex worker but without penetrative intercourse, one- four bottles (aerobic only). The initial microscopic analysis month prior to the onset of his symptoms. He denied high- revealed a possible Pasteurella infection. However, the result risk sexual behavior including unprotected oral, vaginal or was not immediately available as the specific bacterial typ- anal intercourse. He also denied intravenous drug use, blood ing was referred to an outside reference laboratory. On the transfusions and tattoos. On admission, there were no symp- same day, a repeat physical examination revealed two new toms of photophobia, nuchal pain or rigidity, pharyngalgia, right-sided small palpebral conjunctival hemorrhages. Blood penile pain or discharge. He had no prior underlying heart cultures were repeated because of the suspicion of IE. How- conditions. He denied any contact with animals including ever, antibiotic treatment was not immediately initiated be- scratches, bites or licking. cause it was also considered that the initial growth might His previous medical history included multiple spontane- have occurred due to contamination especially as his history ous pneumothoracies of the right lung in his late teens and was not consistent with such an infection, and that the pa- idiopathic sudden deafness had been diagnosed one year tient otherwise appeared to be well. Repeat blood cultures previously. He took no regular medications, over the counter became positive on the 6th day of hospitalization in all six drugs or herbal supplements. There was no history of any bottles (aerobic and anaerobic), again with the same organ- drug or food allergy. ism. As a result, empiric treatment with piperacillin- His family history was non-contributory. He was married tazobactam (4.5 grams four-times daily) was commenced for and he had no unusual hobbies or recent travel outside of suspected IE. Japan. He was a non-smoker and he consumed one small Despite the antibiotic treatment, the patient had persistent can of regular beer per day. He enjoyed water sports but he spiking fevers, night sweats and he developed new physical had not engaged in these in the recent months prior to ad- signs on a daily basis, which included hemorrhages of the mission. Apart from the above information, the review of conjunctivae, uvula, and skin. Osler nodes and Janeway le- systems did not elucidate any other symptoms or risk factors sions were variably noted in the digits of the upper and for disease. lower extremities, with the latter manifestation also affecting On physical examination, the patient appeared mildly un- the palmar and plantar surfaces (Fig. 1, 2). well. His body temperature was 38.6℃ (axilla), his heart A transthoracic echocardiogram revealed a thickening of rate was 116 beats per minute and irregular, his blood pres- the anterior leaflet of the mitral valve, consistent with IE sure was 98/72 mmHg (his usual systolic blood pressure (Fig. 3). A formal fundoscopic slit lamp examination of the was 130 mmHg), his respiratory rate was 16 breaths per eyes was normal. An urgent head magnetic resonance imag- minute, and his oximetry oxygen saturation (SpO2) ing (MRI) scan, revealed multiple septic emboli affecting level was 98% when breathing ambient room air. the right cerebral hemisphere (Fig. 4) and a lesion in the The patient was normocephalic and atraumatic. There was right lobe of the cerebellum (Fig. 5). A three-dimensional no conjunctival or icterus, but bilateral palpebral con- cerebrovascular MRI reconstruction revealed no evidence of junctival hemorrhages were evident. His ears and nose were mycotic aneurysms. A computed tomography scan of the

3226 Intern Med 54: 3225-3231, 2015 DOI: 10.2169/internalmedicine.54.4973

Table. The Initial Laboratory Data on Admission to the Hospital.

Complete blood count Serology WBC 81×102 ȝL (30-97 ×102 /ȝL ) HA IgM <0.4 Neut 83.90 % (36.6-79.9 %) HBs antigen (-) Hb 15.2 g/dL (13.1-17.6 g/dL) HBs antibody (-) Ht 44.40 % (38.1-50.8 %) HCV antibody (-) MCV 91.7 fL (84.6-100.6 fL) EBV-IgM <10 Plt 7.7×104 ȝL (12.4-30.5 ×104 ȝ/ EBV-IgG 40 EBNA antibody <10 PT % 89.00 % (88.3-132.7 %) CMV-IgM (-) APTT 28.5 secs (23.6-31.3 secs) CMV-IgG (-) HIV antibody 0.195 COI Biochemistry Urinalysis CK 32 IU/L (52-192 IU/L) Protein (-) T.bil 1.6 mg/dL (0.1-1.2 mg/dL) Occult blood (-) AST 281 IU/L (12-35 IU/L) Bacteria (-) ALT 223 IU/L (6-40 IU/L) WBC (-) LDH 461 IU/L (119-229 IU/L) RBC (-) Ȗ*73 170 IU/L (0-48 IU/L) ALP 442 IU/L (115-359 IU/L) TP 7.7 g/dL (6.4-8.3 g/dL) Alb 3.5 g/dL (3.8-5.2 g/dL) WBC: white blood cells, Neut: neutrophils, Hb: hemoglobin, Ht: hematocrit, MCV: mean cell volume, Plt: platelets, PT%: prothrombin time percentage, APTT: activated partial thromboplastin time, HA: hepatitis A, HBs: hepatitis B surface, HCV: hepatitis C virus, EBNA: Epstein-Barr Nuclear Antigen, CMV: cytomegalovirus, HIV: human immunodefi- ciency virus, CK: creatinine kinase, T.bil: total bilirubin, AST: aspartate transaminase, $/7DODQLQHWUDQVDPLQDVH/'+ODFWDWHGHK\GURJHQDVHȖ*73JDPPDJOXWDP\OWUDQV- peptidase, ALP: alkaline phosphatase, Alb: albumin, RBC: red blood cells

Figure 2. Two Janeway lesions on the medial plantar aspect of the patient’s left great toe (black arrows). Figure 1. Four Janeway lesions on the hypothenar eminence of the patient’s right hand (black arrows). was changed to ceftriaxone. However, the patient had persis- chest and abdomen revealed mild hepatosplenomegaly. tent daily fevers and his general condition did not improve. As a result of the above tests, the patient met one major Eventually, he underwent mitral valve replacement with a 27 (valvular vegetation), and four minor criteria (septic emboli, mm mechanical valve (St. Jude’s MedicalⓇ,St.Paul,USA) Janeway lesions, Osler nodes, fever >38℃) of the Modified on the 23rd hospital day of admission. In the immediate Duke Criteria, thereby confirming the diagnosis of definite postoperative period, the patient became afebrile and there IE. were no new embolic phenomena noted. Ampicillin- On the 15th day of hospital admission, microbiological sulbactam was added to the antimicrobial regimen. His con- studies confirmed a definite P. multocida infection. The in- valescent period was complicated by paroxysmal atrial flut- itial antimicrobial sensitivities showed that the organism was ter, which subsided spontaneously. He went on to make a susceptible to cephalosporins, but resistant to piperacillin- full recovery and he was discharged from the hospital on the tazobactam. The sensitivities were determined using the disc 32nd day of hospitalization for follow-up as an outpatient. diffusion method rather than by formal minimum inhibitory concentrations (MIC), because of the difficulty in perform- ing the latter test on this organism. As a result, the antibiotic

3227 Intern Med 54: 3225-3231, 2015 DOI: 10.2169/internalmedicine.54.4973

Figure 3. A vegetation on the anterior mitral valve leaflet (white striped arrow). Figure 4. The right posterior parieto-occipital area with sep- tic embolic impaction (white striped arrow).

tients (40%) and immunosuppressed patients (up to 57%) (13). Immunosuppression is considered to be a risk factor for the infection. The causes of immunosuppression include alcoholic cirrhosis (19), diabetes mellitus (16) and kidney disease (20). Other identified risk factors include chronic obstructive pulmonary disease (16) and the licking of leg ulcers by pets (20). However, native bicuspid aortic valve disease (20), mitral stenosis (3) and mechanical valve replacement (20, 21) are also risk factors for infection. Like other forms of endocarditis, P. multocida IE is also associ- ated with clinical manifestations including arterial em- boli (18, 22) and mycotic aneurysms (22). The infection ap- Figure 5. A septic embolus of the right cerebellar hemi- pears to show no preference for the valves involved on the sphere (white striped arrow). left side of the heart, with the aortic and mitral valves being affected nearly equally (13), and with the tricuspid and pul- monic valves having been affected in a patient after a cat bite (23) and in an intravenous drug user (24), respectively. Discussion In our patient, the onset of symptoms was initially sub- acute and simulated what was considered to be a viral upper P. multocida is a Gram-negative coccobacillus microor- respiratory tract syndrome. However, the twice nightly ganism that is the main cause of animal bite-associated in- drenching sweats also suggested the possible presence of a fection (14). Cats and dogs are the main carriers of this or- biquotidian fever, the differential diagnosis of which in- ganism in their mouths, whereas it is rare for it to be found cludes IE. The presence of chills, although not specific, also naturally in humans (14). IE caused by P. multocida is a suggested the presence of bacteremia (25). A physical ex- very rare manifestation (13, 18). In the forty years since the amination revealed the presence of a systemic inflammatory first reports of this type of IE, there have been very few response syndrome, (26, 27) hypotension and mucous mem- cases reported in the literature. brane hemorrhages. These symptoms and signs taken to- Soft tissue infections by Pasteurella are frequently associ- gether should have alerted the admitting physician to the ated with animal bites. However, in an analysis of previous possible presence of IE. In such circumstances, antimicro- cases of P. multocida IE, although animal ownership was bial therapy should have been commenced after the acquisi- found in almost 75% of patients, only about 10% had a tion of blood cultures. Notwithstanding this, the presence of definite history of an animal bite (16). Khan et al., experi- Pasteurella-like organisms grown on the initial blood cul- enced a patient with an initial presentation of pneumonia but tures should have been an additional stimulus to commence who was later diagnosed with P. multocida IE. They sug- antimicrobial therapy. Therefore, there was a delay before a gested that in cases without an animal bite history, the definitive diagnosis could be made and appropriate treatment spread may occur via the respiratory route (16). was commenced. Pasteurella infection usually begins with a rapid onset of Treatment of P. multocida IE has previously included illness, and in an analysis of patients by Camou et al., high penicillin G (18), or ampicillin with gentamicin (21, 22). rates of mortality were reported in immunocompetent pa- Recent recommendations from the Infectious Disease Soci-

3228 Intern Med 54: 3225-3231, 2015 DOI: 10.2169/internalmedicine.54.4973 ety of America for skin and soft tissue infections caused by symptoms including pharyngitis, and later, a non-productive Pasteurella advocate the use of amoxicillin-clavulanate, cough, and the findings on the physical examination of an piperacillin-tazobactam or second or third generation cepha- erythematous soft palate with a vesicle, we consider that an losporins (among other agents) (28). Because of the rarity of upper respiratory mode of entry was possible, perhaps via this form of endocarditis, the Infectious Disease Society the pharynx and/or the laryngotracheobronchial route. Entry guidelines do not currently provide any specific advice. via the upper respiratory tract has been previously found to Thus treatment must be extrapolated from the general dis- cause epiglottitis and laryngopharyngitis (35) but not endo- ease guidelines and from previous experience in case re- carditis. Although the upper respiratory manifestations may ports (29, 30). However, guidance for the empiric treatment be unrelated to the IE in this case, the history of symptoms of endocarditis by the European Society of beginning from the upper respiratory tract and then proceed- (2009) advocates the use of amoxicillin-clavulanate or ing to the development of signs of IE, would suggest other- ampilicin-sulbactam with gentamicin or vancomycin with wise. In this case, an upper respiratory tract primary infec- gentamicin and ciprofloxacin; the former regimen can ade- tion leading to bacteremia and the subsequent seeding on quately treat Pasteurella infections (30). the mitral valve of this patient could not be excluded. Although piperacillin-tazobactam was the antimicrobial It should be borne in mind that there are several other im- agent that was initially chosen, the final sensitivities re- portant pathogens that may cause infections of the upper vealed that the organism was resistant to this regimen, but respiratory tract, which can lead to disseminated infection sensitive to cephalosporins. The absence of the specific MIC and which may mimic some of the features seen in this pa- for each antibiotic made the choice of definitive treatment tient early in their natural history, and/or result in the devel- more challenging. However, ceftriaxone was chosen because opment of IE. Such pathogens include Group A streptococci of its better penetration through the blood brain barrier with (GAS), Streptococcus pneumoniae,andNeisseria meningiti- the patient having known cerebral septic emboli (Fig. 4, 5). dis. Unfortunately, this antimicrobial agent also proved ineffec- GAS infection is a common cause of pharyngitis in chil- tive because of the continued occurrence of embolic phe- dren (36), but it can also be a rare cause of IE (5% of all nomena, and the persistence of the daily spikes of fever. cases) (37). Moreover, pharyngeal infection can sometimes In addition to antimicrobial therapy, early surgical valve be asymptomatic (38). Both S. pneumoniae and N. meningi- replacement has been shown to play an important role in the tidis are carried in the human nasopharynx to relatively high treatment of this form of endocarditis. Such treatment has degrees in Western individuals (39, 40). However, the car- been successful, and in several cases it has been an impera- riage of N. meningitidis is not endemic in Japanese individu- tive intervention for the cure of affected patients (3, 19, 21, als (41). Although it is rare, these encapsulated organisms 24, 31). can become invasive, particularly in asplenic individuals, Surgical intervention was considered to be emergent in and produce the catastrophic syndrome of purpura fulminans this case, but again, there was a delay before the patient’s as characterized by disseminated intravascular coagula- mitral valve was replaced. The concern of the surgical spe- tion (41, 42). Such patients typically demonstrate a rapid cialists was of recurrent infection if the valve was replaced and fulminant course, and if they survive, they may suffer too early before the resolution of inflammation and infec- limb amputations amongst other severe complications; early tion. However, this case demonstrated that antibiotics alone disease may produce seemingly innocuous minor hemor- were unable to control the infection or its sequelae. The cur- rhage (43), similar to this case. Moreover, both organisms rent evidence favors very early valve replacement when in- may also rarely produce IE (44, 45). dicated (as early as 48 hours after the diagnosis of IE), In summary, we experienced a patient who presented with whichinturnhasbeenshowntoreducethemorbidityre- a suspected upper respiratory tract illness, but through close lated to the embolic phenomena and the recurrence of the observation and inspection, the signs of IE were eventually disease (32). In addition, the various case reports of this rare ascertained in the absence of a cardiac murmur. The entry of form of endocarditis also support earlier (rather than de- P. multocida via the upper respiratory tract was considered layed) surgical intervention. It is important to note that post- most likely in this case. This case teaches the reader that the operatively, our patient’s symptoms and signs abated prior empiric antibiotic treatment for IE should include a penicil- to the administration of amoxicillin-clavulanate. lin derivative with an anti-penicillinase agent along with an In trying to elucidate the mode of entry of P. multocida, aminoglycoside. Moreover, the knowledge of the minimum although human-to-human spread was initially considered inhibitory concentrations of available antimicrobial agents via the patient’s sexual encounter, such horizontal transmis- can better guide the treatment of this catastrophic infection. sion is rare and although it has been found to occur both Nevertheless, in certain circumstances, basic tests including horizontally (33) and vertically (34), such cases have oc- the disc diffusion method to determine sensitivities may be curred in neonates, but not in adults. Moreover, the sexual the only immediately available means of guiding antimicro- encounter occurred approximately one month prior to the bial choices. In addition, early surgical valve replacement is onset of symptoms, making it a somewhat unlikely cause. essential in selected patients, especially in those with P. m u l - Considering that the patient presented with upper respiratory tocida IE who may otherwise suffer a fulminant course. The

3229 Intern Med 54: 3225-3231, 2015 DOI: 10.2169/internalmedicine.54.4973 presence of persistent fever and ongoing embolic phenom- 16. Khan MF, Movahed MR, Jung J. Pasteurella multocida endocardi- ena in IE should alert the physician that antimicrobial treat- tis. J Dis 21: 260-262, 2012. 17. Samarkos M, Fanourgiakis P, Nemtzas I, Platsouka E, Paniara O, ment alone is insufficient, when sensitivities are known and Skoutelis A. Pasteurella multocida bacteremia, spontaneous bacte- drug dosing is adequate. Emergent surgical intervention rial peritonitis and septic arthritis in a cirrhotic patient. Hippokra- should be undertaken to improve the chances of a cure. tia 14: 303, 2010. Lastly, this case also highlights other diseases that may 18. Lehmann V, Knutsen SB, Ragnhildstveit E, Skagseth E, Solberg potentially mimic the symptoms and signs as experienced by CO. Endocarditis caused by Pasteurella multocida. Scand J Infect our patient, which may include early purpura fulminans or Dis 9: 247-248, 1977. 19. Fayad G, Modine T, Mokhtari S, et al. Pasteurella multocida aor- disseminated GAS infection. Hence, urgent antibiotic ad- tic valve endocarditis: case report and literature review. J Heart ministration is imperative in such circumstances, after the Valve Dis 12: 261-263, 2003. acquisition of relevant microbiological cultures. 20. Hombal SM, Dincsoy HP. Pasteurella multocida endocarditis. Am J Clin Pathol 98: 565-568, 1992. 21. Reinsch N, Plicht B, Lind A, et al. Recurrent infective endocardi- The authors state that they have no Conflict of Interest (COI). tis with uncommon Gram-negative Pasteurella multocida and Pseudomonas aeruginosa: a case report. J Heart Valve Dis 17: References 710-713, 2008. 22. Thamlikitkul V, Sangruchi T. Pasteurella multocida infective endo- 1. Tribouilloy C, Rusinaru D, Sorel C, et al. Clinical characteristics carditis: a case report. J Med Assoc Thai 73: 704-706, 1990. and outcome of infective endocarditis in adults with bicuspid aor- 23. Naba MR, Araj GF, Kanafani ZA, Kanj SS. First case of Pas- tic valves: a multicentre observational study. Heart 96: 1723-1729, teurella multocida endocarditis of the tricuspid valve: a favorable 2010. outcome following medical treatment. Int J Infect Dis 13: e267- 2. Lacassin F, Leport C. [Infectious endocarditis, risk factors, preven- e269, 2009. tion. Research group for infectious endocarditis and jury of the 24. Graf S, Binder T, Heger M, Apfalter P, Simon N, Winkler S. Iso- consensus conference]. Rev Med Interne 14: 871-876, 1993 (in lated endocarditis of the pulmonary valve caused by Pasteurella French). multocida. Infection 35: 43-45, 2007. 3. Fukumoto Y, Moriyama Y, Iguro Y, Toda R, Taira A. Pasteurella 25. Tokuda Y, Miyasato H, Stein GH, Kishaba T. The degree of chills multocida endocarditis: report of a case. Surg Today 32: 513-515, for risk of bacteremia in acute febrile illness. Am J Med 118: 2002. 1417, 2005. 4. Hill EE, Vanderschueren S, Verhaegen J, et al. Risk factors for in- 26. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ fective endocarditis and outcome of patients with Staphylococcus ACCP/ATS/SIS International Sepsis Definitions Conference. Crit aureus bacteremia. Mayo Clin Proc 82: 1165-1169, 2007. Care Med 31: 1250-1256, 2003. 5. Marchetti M, De Bonis T, Chiarioni W. [Risk of bacterial endo- 27. Dellinger RP, Levy MM, Rhodes A, et al. Surviving Sepsis Cam- carditis after dental treatment. Recent findings]. G Anest Stomatol paign: international guidelines for management of severe sepsis 18: 19-21, 1989 (in Italian). and septic , 2012. Intensive Care Med 39: 165-228, 2013. 6. Logan RF, Hastings JG. Bacterial endocarditis: a complication of 28. Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines gastroscopy. Br Med J (Clin Res Ed) 296: 1107, 1988. for the diagnosis and management of skin and soft tissue infec- 7. Kwang Tay Y, Yin Tay J, Naqash N, Cashin P. Infective endo- tions: 2014 update by the Infectious Diseases Society of America. carditis and infected aneurysm of splenic post colonoscopy. Clin Infect Dis 59: e10-e52, 2014. Ann Gastroenterol 26: 170-172, 2013. 29. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis: 8. Ben-Haim SA, Nechmad M, Edoute Y, Reisner S, Barzilai D. diagnosis, antimicrobial therapy, and management of complica- Colonic villous adenoma, polyp, and leiomyoma presenting with tions: a statement for healthcare professionals from the Committee Streptococcus bovis endocarditis. Am Heart J 115: 192-195, 1988. on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council 9. Vaska VL, Faoagali JL. Streptococcus bovis bacteraemia: identifi- on in the Young, and the Councils on cation within organism complex and association with endocarditis Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anes- and colonic malignancy. Pathology 41: 183-186, 2009. thesia, American Heart Association: endorsed by the Infectious 10. Otones J, Fernandez Clua MA, Castrillo JM, Fernandez Guerrero Diseases Society of America. Circulation 111: e394-e434, 2005. ML. [Infectious endocarditis in patients with liver cirrhosis]. Med 30. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, Clin (Barc) 93: 561-564, 1989 (in Spanish). diagnosis, and treatment of infective endocarditis (new version 11. Mohiyiddeen G, Brett I, Jude E. Infective endocarditis caused by 2009): the Task Force on the Prevention, Diagnosis, and Treat- Staphylococcus aureus in a patient with atopic dermatitis: a case ment of Infective Endocarditis of the European Society of Cardiol- report. J Med Case Rep 2: 143, 2008. ogy (ESC). Endorsed by the European Society of Clinical Micro- 12. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of biology and Infectious Diseases (ESCMID) and the International infective endocarditis: utilization of specific echocardiographic Society of Chemotherapy (ISC) for Infection and Cancer. Eur findings. Duke Endocarditis Service. Am J Med 96: 200-209, Heart J 30: 2369-2413, 2009. 1994. 31. Mikaberidz N, Li EY, Taub CC. Pasteurella multocida infective 13. Camou F, Guisset O, Pereyre S, et al. [Endocarditis due to Pas- endocarditis in an immunocompetent patient complicated by rhab- teurella sp. Two cases]. Med Mal Infect 35: 556-559, 2005 (in domyolysis and permanent hearing loss. J Cardiovasc Dis Res 4: French). 55-57, 2013. 14. Nettles RE, Sexton DJ. Pasteurella multocida prosthetic valve en- 32. Kang DH, Kim YJ, Kim SH, et al. Early surgery versus conven- docarditis: case report and review. Clin Infect Dis 25: 920-921, tional treatment for infective endocarditis. N Engl J Med 366: 1997. 2466-2473, 2012. 15. Yamaguchi H, Tamura T, Abe M, et al. Prolonged incubation pe- 33. Siahanidou T, Gika G, Skiathitou AV, et al. Pasteurella multocida riod in neonatal Pasteurella multocida meningitis and bacteremia. Infection in a neonate: evidence for a human-to-human horizontal Pediatr Int 56: e79-e81, 2014. transmission. Pediatr Infect Dis J 31: 536-537, 2012.

3230 Intern Med 54: 3225-3231, 2015 DOI: 10.2169/internalmedicine.54.4973

34. Nakwan N, Nakwan N, Atta T, Chokephaibulkit K. Neonatal pas- strains: a longitudinal study within three cohorts of military re- teurellosis: a review of reported cases. Arch Dis Child Fetal Neo- cruits. Epidemiol Infect 121: 85-94, 1998. natal Ed 94: F373-F376, 2009. 41. Kubo K, Chishiro T, Okamoto H, Matsushima S. Purpura fulmi- 35. O’Connell K, Fennell J, Callaghan J, Rowaiye B, Cormican M. A nans (symmetric peripheral gangrene): 7-year consecutive case re- fatal case of Pasteurella multocida epiglottitis. Ir J Med Sci 178: view in Japan. Kansenshogaku Zasshi (The Journal of the Japa- 541-542, 2009. nese Association for Infectious Diseases) 83: 639-646, 2009 (in 36. Pichichero ME. Group A streptococcal tonsillopharyngitis: cost- Japanese, Abstract in English). effective diagnosis and treatment. Ann Emerg Med 25: 390-403, 42. Marnejon T, Watanakunakorn C. Purpura fulminans and adrenal 1995. hemorrhage due to group Y meningococcemia in an elderly 37. Burkert T, Watanakunakorn C. Group A streptococcus endocardi- woman. South Med J 84: 527-529, 1991. tis: report of five cases and review of literature. J Infect 23: 307- 43. Rapid Review of Clinical Medicine for MRCP Part 2. 2nd ed. 316, 1991. Sharma S, Kaushal R, Eds. Manson Publishing, London, 2006: 38. Branch J, Suganami Y, Kitagawa I, Stein GH, Tanaka E. A rare 29-30. case of group A streptococcal endocarditis with absence of valvu- 44. Wilbring M, Tugtekin SM, Matschke K, Kappert U. Austrian syn- lar vegetation. Intern Med 49: 1657-1661, 2010. drome in the context of a fulminant pneumococcal native valve 39. Gray BM, Dillon HC Jr. Clinical and epidemiologic studies of endocarditis. Braz J Infect Dis 16: 486-488, 2012. pneumococcal infection in children. Pediatr Infect Dis 5: 201-207, 45. Benes J, Dzupova O, Kabelkova M, Krizova P, Gabrielova A. In- 1986. fective endocarditis due to Neisseria meningitidis: two case re- 40. Andersen J, Berthelsen L, Bech Jensen B, Lind I. Dynamics of ports. Clin Microbiol Infect 9: 1062-1064, 2003. the meningococcal carrier state and characteristics of the carrier

Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html

3231