Postgrad Med J: first published as 10.1136/pgmj.56.654.250 on 1 April 1980. Downloaded from

Postgraduate Medical Journal (April 1980) 56, 250-251

CASE REPORTS Pasteurella multocida meningitis F. R. SMITH M.B., M.R.C.P. Department ofNeurology, Charing Cross Hospital, Fulham Palace Road, London W6 8RF

Summary inary pathogen and commensal, it is the commonest Pasteurella multocida appears to be a very rare cause infection acquired after a dog bite. Systemic of meningitis. The bacterium has morphological involvement occurs most frequently in the respiratory similarities with other causative organisms, particu- tract and is unrelated to animal bite (Hubbert and larly Haemophilus influenzae, and its apparent rarity Rosen, 1970). may be due partly to misidentification. This case, P. multocida meningitis is under-diagnosed. only the fourth reported from the United Kingdom, Only 16 cases had been reported by 1967 could not be distinguished clinically from the menin- (Whitmore and Whelan, 1963; Controni and Jones, gitis, owing to other pyogenic bacteria. 1967) yet a further 6 were found in the United States ofAmerica over a 3-year period (Hubbert and Rosen, Case report 1970). These latter cases represented 5 % of systemic A 35-year-old male publisher presented in August P. multocida infections. All age groups are affected 1978 with a 36-hr history of earache followed by with a male predominance, and the infection maycopyright. drowsiness. There was a past history of chronic follow a skull fracture or previous neurosurgical otitis media, with a persistent painless aural dis- procedure. A long incubation period has been charge following an atticotomy in 1972. On examina- reported by Controni and Jones (1967) but based tion he was pyrexial (37.5°C) and only responded purely on the interval between previous skull to simple questions. He had marked neck stiffness trauma and subsequently clinically manifest infec- but neurological examination was otherwise normal. tion. A history of close animal contact is obtained The right external auditory meatus contained a in about 75% of cases, and was present in this

purulent discharge. patient who kept 4 cats. Spread of the infection http://pmj.bmj.com/ The CSF was cloudy with a protein of 0.3 g/l from the middle ear has been described and was a and glucose 3-3 mmol/l. There were 870 polymorpho- possible mechanism in this case. The usual CSF nuclear leucocytes/mm3 but no organism was seen findings are a polymorphonuclear leucocytosis on Gram-staining. There was a peripheral poly- with a depressed glucose concentration. The recorded morphonuclear leucocytosis of 29 x 109/l and the mortality is around 50% despite the fact that the ESR was 69 mm/hr (Westergren). Pasteurella organism is very sensitive to the penicillins. Fatalities multocida was cultured from the CSF and a mixed continue to occur despite appropriate antibiotic growth of Escherichia coli and diphtheroids from therapy. Reports of erythromycin resistance suggest on October 1, 2021 by guest. Protected an ear swab. that chloramphenicol or tetracycline are indicated He was treated with ampicillin (50 mg/kg body in a penicillin-sensitive patient (Francis, Holmes weight as a bolus intravenous injection every 4 hr) and Brandon, 1975). and within 24 hr was mentally alert. He complained P. multocida may be dismissed as a contamin- of a severe headache and had developed early ant or misidentified as H. influenzae. It may papilloedema. Forty-eight hours later he was asymp- therefore account for some of the variability tomatic and the fundal appearances had returned to in the incidence and antibiotic sensitivity of menin- normal by the fifth day. gitis due to that organism. Similarly, some cases of meningitis where no organisms are identified (20% Discussion in one survey by Goldacre and Miller, 1976) may P. multocida is a non-motile, Gram-negative, represent infections by this agent. pleomorphic coccobacillus having morphological similarities to H. influenzae, but possessing distinc- Acknowledgment tive fermentation characteristics. A frequent veter- I thank Dr G. D. Perkin for his helpful advice and criticism. 0032-5473/80/0400-0250 $02.00 © 1980 The Fellowship of Postgraduate Medicine Postgrad Med J: first published as 10.1136/pgmj.56.654.250 on 1 April 1980. Downloaded from Case reports 251

References GOLDACRE, M.J. & MILLER, D.L. (1976) Completeness of statutory notification for acute bacterial meningitis. CONTRONI, G. & JONES, R.J. (1967) Pasteurella meningitis. British Medical Journal, 2, 501. A review of the literature. American Journal of Medical HUBBERT, W.T. & ROSEN, M.N. (1970) Pasteurella multocida Technology, 33, 379. infection in man unrelated to animal bite. American FRANCIS, D.P., HOLMES, M.A. & BRANDON, G. (1975) Journal of Public Health, 60, 1109. Pasteurella multocida. Infections after domestic animal WHITMORE, D.N. & WHELAN, M.J. (1963) Pasteurella bites and scratches. Journal of the American Medical septica meningitis with survival. Postgraduate Medical Association, 233, 42. Journal, 39, 98. copyright. http://pmj.bmj.com/ on October 1, 2021 by guest. Protected