Abstract Introduction Pasteurella multocida, gram-negative anaerobic coccobacillus bacterium, is commonly found in the oral microbiota of dogs and cats (1). While it is primarily associated with skin and soft tissue infections caused by cat or dog bites, licks and scratches, Pasteurella can also lead to respiratory tract infections including pneumonia, lung abscess, and empyema with underlying lung disease or immunosuppression, however, the incidence of P. remains underreported (1). We present a case of Pasteurella empyema in an immunocompetent patient. Case A 70-year-old male who presented with acute dyspnea and fatigue with a past medical history notable for Heart Failure with reduced ejection fraction and Chronic Obstructive Pulmonary Disease (COPD). Due to these concomitant medical conditions, he had chronic hypoxic respiratory failure the year prior to admission and required three liters of supplemental oxygen. During admission, he describes progressively worsening shortness of breath and fatigue a few days prior, especially with exertion. At the time of presentation, he was markedly hypoxic, with a significant right-sided pleural effusion on chest x-ray. A chest tube was placed with serosanguinous drainage. Pleural fluid analysis demonstrated an exudative effusion with 10,000 WBC/uL with a 95% neutrophilic predominance, protein of 4.0g/dl of protein, and LDH of 284 IU/L. Cytology was negative for malignant cells. However, the fluid culture grew Pasteurella multocida. At this juncture, the patient revealed that he had two dogs at home. Additional work-up during admission included negative blood cultures. A second chest tube was placed due to slowed output from intrapleural loculations, and the patient ultimately required 4 doses of intrapleural lytics for adequate drainage. He was empirically treated with intravenous ceftriaxone along with oral doxycycline. At the time of discharge, both chest tubes were removed, and the patient no longer had an oxygen requirement. He was discharged with amoxicillin-clavulanate to complete an additional two weeks of antibiotic treatment. Discussion The true incidence of Pasteurella infection is unknown, as most available evidence is derived from case reports and small case series. It has been recognized as a potential cause of empyema, with one case series identifying Pasteurella respiratory infections, an empyema was the final diagnosis in nearly 25% of cases (1). Mortality associated with these advanced infections is considerable, with one study reporting rates approaching 30% (1). Therefore, prompt recognition and appropriate management, including adequate pleural fluid drainage and antibiotic treatment, are essential for successful treatment. This abstract is funded by: none
Azore et al. (Fri,) studied this question.