P2.M247: Pasteurella Multocida empyema from canine kisses: A rare case of Pasteurella meningitis in a 9-month-old infant complicated by empyema.

Introduction: Pasteurella Multocida are small, gram negative, nonmotile, coccobacilli. It is a known cause of intraabdominal infection, bone infection, and endocarditis. Rare cases of meningitis and empyema have been reported through direct and indirect inoculation with a cat or dog's saliva via lick, scratch, or bite. Fifty per cent of P. Multocida meningitis cases have involved infants younger than one year of age, and 30 percent have involved adults older than 60 years.

Case Description: A 9-month-old term infant presented to our ER with an episode of jerky movements lasting about 2 minutes. The patient was noted to have a weak cry and bulging anterior fontanelle. Due to clinical concern for meningitis, a complete workup was done and empiric antibiotics were started. CSF showed neutrophilic leucocytosis, decreased glucose, and elevated protein. Blood and CSF cultures came positive for P. Multocida. He was treated with ceftriaxone at meningitis dose and keppra. The family has a pet dog who was known to lick the baby, but there were no known bites or scratches. Past medical history was significant for IUGR and HIE. EEG was reassuring. MRI brain showed leptomeningeal enhancement in bilateral frontal lobes with no infarct, collection or bleed. The patient continued to spike fevers during the hospital course and had breakthrough seizures needing multiple rescue medications. MRI brain on day 7 showed progression of leptomeningeal enhancement, and edematous changes in frontal lobes, and left occipital region concerning empyema. Neurosurgery took patient for craniotomy with washout. Patient showed a dramatic improvement after the surgery and continues on a three-week course of IV antibiotics.

Discussion: Pasteurella multocida can rarely cause meningitis and CSF findings include polymorphonuclear leukocytes with a low glucose and elevated protein, similar to other forms of bacterial meningitis. CSF gram stain is positive in 80 percent patients, but organisms are frequently misidentified as Haemophilus influenzae or Neisseria meningitidis. Ceftriaxone is the drug of choice for severe Pasteurella infection (i.e. meningitis, endocarditis, etc). Clinical management of P. Multocida meningitis warrants 21 days of therapy. A prolonged course of intravenous antibiotics (4-6 weeks) is to be considered for complications such as meningitis, empyema. Mortality in Pasteurella meningitis is approximately 25 per cent

Conclusion: Healthcare providers need to gather infant pet exposure histories and recognize P. Multocida as a potential infectious source from pet dogs and cats. It's also recommended that we encourage handwashing after handling pets, children should be supervised around animals.

1.Slehria, Trisha BS*; Hendricks, Sydney MD*; Honeycutt, Travis MD*,†. Pasteurella multocida Bacterial Meningitis in a 33-Day-Old Infant. The Pediatric Infectious Disease Journal 41(6):p e267-e268, June 2022. | DOI: 10.1097/INF.0000000000003523
2.Jones T. Nauseef, Nathan B. Price, Kelly E. Wood, Infantile Pasteurella multocida meningitis, IDCases, Volume 6, 2016, Pages 31-33, https://doi.org/10.1016/j.idcr.2016.09.00