A Perilous Puppy Love: Pasteurella Multocida Meningitis in a Newborn

Introduction: Pasteurella multocida is a gram-negative coccobacillus that is part of the nasopharyngeal flora of cats and dogs. Here we present a rare case of P. multocida infant meningitis and discuss pet exposure in infancy.

Case Description: A 2-week-old previously healthy male presented with 3 days of lethargy, fever, poor feeding, and decreased urinary output. He was febrile to 100.9℉ with otherwise normal vitals for his age. He appeared irritable yet non-toxic. Initial workup identified a leukocytosis (13.4 x 103/uL) and hyponatremia (133 mmol/L). Lumbar puncture revealed turbid cerebrospinal fluid (CSF) with 28,925 total white blood cells with a neutrophilic predominance and 2,800 red blood cells. Protein and glucose levels were normal, and gram-stain was negative. Empiric antibiotic therapy with intravenous ampicillin and gentamicin was started. He was then transferred. Blood cultures from the outside hospital returned positive for gram-negative rods, presumed as Escherichia coli. The antibiotic regimen was adjusted to ceftazidime and ampicillin with continued clinical improvement. Blood and CSF cultures ultimately speciated to P. multocida. The patient was transitioned to ceftriaxone and completed a 14-day course to treat P. multocida bacteremia and meningitis. He quickly returned to baseline and was discharged home.

Discussion: In our case, the patient had no evidence of any dog or cat-inflicted wounds. However, the family dog did gently lick the patient. Pasteurella spp. are the most frequent pathogens isolated in dog and cat bites. The most recently reported cases of P. multocida meningitis in infants totaled less than forty. The majority (87%) of cases had a non-traumatic exposure to dog and/or cat oropharyngeal secretions. Transmission has also been reported to occur vertically through vaginal childbirth, typically presenting within the first few days of life.

According to the American Veterinary Medical Association, dog ownership has been rising over the last thirty years, and at least 38% of American households owned a dog in 2016. The American Academy of Pediatrics advises against pets licking young infants on its parenting website, www.HealthyChildren.org. In addition, the Centers for Disease Control and Prevention reinforces sanitation efforts like handwashing after handling pets, recommends that children be supervised around animals, and dissuades from animals licking children.

Conclusion: Conclusion
If the number of household dogs in the United States continues on a rising trajectory, it may become essential for healthcare providers to consistently gather infant pet exposure histories and recognize P. multocida as a potential infectious source. Furthermore, anticipatory guidance would need to reflect the prevalence and risk of P. multocida induced illness to allow caregivers to make informed decisions regarding safe pet exposures for their infants, as a seemingly loving lick from a dog may be more perilous than intended.