Gálvez-Valdovinos Ramiro1*, Arellano Aguilar Gregorio2, Gutiérrez-Velazco José Luis3, Domínguez-Gasca Luis Gerardo4 and Domínguez-Carrillo Luis Gerardo5
1Surgeon. Surgery Division from Hospital Angeles León. León, Guanajuato México
2Internal Medicine Specialist. Medicine Division, México
3Internal undergraduate. Surgery Division from Hospital Angeles León. León, Guanajuato México
4Traumatology and Orthopedic Resident. Surgery Division. General Hospital from León, Guanajuato México
5Rehabilitation Medicine Specialist. Professor of School Medicine from León. Guanajuato University. México
Received: 14 May, 2016; Accepted: 11 June, 2016; Published: 13 June, 2016
Dr. Gálvez-Valdovinos Ramiro, Hospital Ángeles León. Av. Cerro Gordo No. 311, Col. Lomas del Campestre, León, Gto. México, CP, 37150, Tel: 477-7-88-56-83; 044-47-77-87-86-23; E-Mail:
Ramiro GV, Gregorio AA, Luis GVJ, Gerardo DGL, Gerardo DCL (2016) Pasteurella Canis as a Cause of Septic Arthritis and Soft Tissue Infection after Sheep Bite: A Case Report. Global J Med Clin Case Reports 3(1): 012-014. DOI: 10.17352/2455-5282.000025
© 2016 Ramiro GV, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Sheep bite; Pasteurella canis; Septic arthritis
Pasteurella spp is the first organisms to consider in any patient who presents with a soft tissue infection following cat or dog bites. Pasteurella canis is most common isolate of dog bites, but there are no reports of pastereulla canis infection caused by sheep bite. A case of a 66 years old farmer woman with symptoms of infected left hand with wrist septic arthritis, after a lamb bite is described (the sheep was sick after a dog bite). Microbiological examination of the wrist articular liquid was performed. The specimen was both aerobic and anaerobic cultures were performed. After 24 hours, growth of smooth, greyish-white colonies was observed only on Columbia agar. Another Gram stained slide was performed from those colonies and Gram negative cocobacilli to short rod shaped morphology with bipolar staining was observed. They demonstrate positive catalase and oxidase positive reaction. The bacterium was susceptible to all tested antimicrobial agents. Although systemic forms of Pasteurella are possible, cutaneous infections from animal bites are the most common presentation. Most animal-bite injuries can be treated with oral antimicrobials on an outpatient basis, but in this case the patient needed intravenous antimicrobial aggressive therapy.
Animal bites account for about 1 percent of emergency department visits and 10,000 inpatient admissions annually; approximately 1 in every 775 persons seeks emergency care for dog bites each year. Wound infections were diagnosed in 2.1 percent of cases . In relation to microbiology, the predominant pathogens in animal bite wounds are the oral flora of the biting animal and human skin flora . About 85 percent of bites harbor potential pathogens, and the average wound yields five types of bacterial isolates; 60 percent have mixed aerobic and anaerobic bacteria. Skin flora such as staphylococci and streptococci are isolated in about 40 percent of bites . Pasteurella species are isolated from 50 percent of dog bite wounds and 75 percent of cat bite wounds . Capnocytophaga canimorsus, can cause bacteremia and fatal sepsis after animal bites, especially in asplenic patients or those with underlying hepatic disease. Anaerobes isolated from dog and cat bite wounds include Bacteroides, fusobacteria, Porphyromonas, Prevotella, propionibacteria, and peptostreptococci. This is a report of the case of a patient with a sheep bite, (the sheep had sickened by dog bite). In this case Pasteurella canis was the culprit bacteria of the zoonoses transmission of an animal to another and from the latter to the human. Reports of sheep bite are rare, and Actinobacillus spp is the most frequent bacteria in sheep and horses bites [5,6].
A 66- year- old farmer woman presented with symptoms of infected left hand, cellulitis of forearm and wrist septic arthritis after a sheep bite on her thumb. The sheep was sick because a dog bite, the dog has been properly vaccinated. Patient stated that the first symptoms, with redness of thumb fingerprint, swelling and pain appeared 12 hours after the bite, over time (24 hour) they became worse. Clinical examination revealed a little lacerations on the anterior surface of the fingerprint thumb (Figure 1), the wound was regular in shape without secretions. The thumb, volar forearm and wrist were painful, erythematous, and edematous. (Figure 2) There was no evidence of conditions and past procedures that may put the patient at greater risk, such as diabetes, liver disease, immunosupression or splenectomy. The patient was no febrile and she was feeling well except for important pain (in 8 in 0-10 VAS). There were no clinical signs of systemic infection. Laboratory results showed: PCR 201 mg/L, Procalcitonin 0.4 ng/mL, erythrocyte sedimentation rate 43mm/h %r, neutrophils 55%, monocitosis of 14%. Blood cultures were not considered because the patient was not febrile. Magnetic resonance (Figure 3) showed wrist articular liquid increased and cellulitis at volar forearm. Articular liquid of wrist was aspired with puncture guided by ultrasound for microbiological examination and cultures (Figure 4). Patient was hospitalized and provided with analgesics and broad spectrum intravenous antibiotics (Ceftriaxona 1 gr I.V qd, Doxiciclina 100mg V.O bid until the results of microbiological examination were done. She was asked for examinations on daily basis. Two days later, during the control examination, there were signs of local condition improvement, laboratory showed: PCR 64 mg/L. By that time the microbiological examination (Results: Pasteurella canis) was ready and since the administrated antibiotic therapy was satisfying we suggested the patient to proceed with it. The next control (after 4 days) showed even greater progress. Patient left hospital with Ceftriaxona 1 gr I.M qd and Doxiciclina 100mg V.O bid, bouth by 6 weeks. In following twenty days after, she was asymptomatic.