Volume 3, Number 3—September 1997
Acute Epiglottitis due to Pasteurella multocida in an Adult without Animal Exposure
To the Editor: Pasteurella multocida infection in humans usually involves animal contact, most commonly with a domestic dog or cat (1). Epiglottitis due to human P. multocida infection associated with animal contact is very rare (2-4). We report a case of epiglottitis due to P. multocida not associated with animal contact.
A 44-year-old patient was admitted to the hospital with fever, throat fullness, and drooling. He had been healthy until 12 hours before admission when he noticed difficulty in swallowing liquids; anterior neck discomfort and fever followed, and soon he could not swallow his saliva.
When he arrived at the Emergency Department of Montefiore Medical Center on September 23, 1996, the patient was mildly toxic and had an oral temperature of 103.2°F. Pulse was 110 and blood pressure 110/70. He was drooling. He had mild anterior neck tenderness, no cervical adenopathy, no pharyngitis on inspection of the oropharynx, and no palate deviation. The heart, lungs, abdomen, and skin showed no abnormalities. A lateral neck radiograph showed an enlarged epiglottis ("thumb sign"). Indirect laryngoscopy confirmed inflamed and edematous epiglottis and supraglottic structures. A culture of the epiglottis was not performed.
On admission, the patient had a hemoglobin of 1.9 g/dL; hematocrit was 48%; white blood cell count was 14,100/mm3; and platelet count was 170,000/mm3. A machine differential count showed 86% granulocytes, 9% lymphocytes, and 5% monocytes.
The patient was treated with dexamethasone and ceftriaxone. The fever abated rapidly, and all symptoms resolved. Repeat laryngoscopy on day 3 confirmed resolving epiglottitis. Blood cultures taken on admission grew gram-negative, oxidase-positive bacilli that did not grow on MacConkey agar (BBL, Cockeysville, MD) in two sets, both aerobically and anaerobically. The isolate was identified as P. multocida by the Vitek GNI card (BioMérieux-Vitek, Inc., Hazelwood, MO). Kirby-Bauer susceptibility testing demonstrated susceptibility to penicillin. Because of the patient's marked improvement after treatment with ceftriaxone and convenience of outpatient parenteral therapy, this antibiotic was continued to complete a 10-day course. On extensive questioning, the patient denied contact with any cat, dog, or other animal. He had recently traveled to Nigeria but denied even transient animal contact.
Since 1966, three cases of P. multocida epiglottitis have been reported (2-4). Although no direct culture of the epiglottis was performed in the present case, the clinical syndrome and the absence of any other focus accounting for P. multocida bacteremia strongly suggest that this organism caused the epiglottitis. Including the present case, three of the four reported cases have occurred since 1993, which suggests that either earlier cases were not recognized or the incidence of this condition may be increasing. In all three previous cases of P. multocida epiglottitis, the patients had cats as pets. As in the current case, the clinical features of P. multocida epiglottitis were indistinguishable from epiglottitis secondary to more common bacterial pathogens. However, the cases were all associated with positive blood cultures. In contrast, a 23% rate of bacteremia was reported in a series of epiglottitis cases in adults (including patients with blood cultures positive for Haemophilus influenzae type b or Group A streptococci) (5).
The vehicle of infection for this patient remains unknown, as human-to-human transmission has not been documented. This case demonstrates that epiglottitis due to P. multocida, a rare condition that may be increasing in frequency, need not be accompanied by recognized exposure to animals.
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