CAT BITE AND SCRATCH WOUNDS WITH CONSEQUENT PASTEURELLA
INFECTION OF MAN*
G. H. HANSMANN, M.D.,
AND MARION TULLY,
M.T.
Departments of Laboratory Medicine, Columbia and Milwaukee Children's Hospitals, Milwaukee,
T h i s report is concerned primarily with an infection of t h e hand which followed a cat-bite. T h e
cellulitis which developed was a t first interpreted
as being of streptococcic origin, b u t unlike streptococcic cellulitis there was excruciating pain requiring morphine for relief and absence of any
i m p o r t a n t rise in temperature. Thirty-three
m o n t h s later the same individual was bitten on the
opposite hand b y the same cat. A similar train of
events followed except t h a t the clinical course of
t h e disease was not quite so severe. On each occasion a n organism belonging to t h e genus
" P a s t e u r e l l a " was isolated from the wound. T h e
two organisms isolated appeared identical.
Incidentally, during the cdurse of this study a
nine year old girl was scratched on her face and left
a r m b y a p e t cat. This resulted in a reddening and
a p u r u l e n t discharge from the wounds without
further incident. A similar organism was isolated
from t h e wounds.
T h e purpose of this paper is to report the results
of o u r studies of this disease which appears to be
a n e n t i t y in the endeavor of extending the knowledge a n d appreciation of the infection. A fewreports of pasteurella infection of m a n following
cat-bite have appeared in foreign and Canadian
medical literature during the p a s t fifteen years.
CLINICAL REPORTS
Case 1. The patient was a forty-seven year old white
male who was bitten while stroking a pet cat on March
12, 1939. The cat, as far as the owner knew, had been
closely confined to quarters since she was a kitten. The
bite was inflicted at the right wrist on the thumb side.
The injury, even though represented by only two small
puncture holes, soon became extremely painful and
required sedatives. He remained in bed the following
two days with his right arm elevated. He took codeine
and aspirin for the relief of pain. During the night of
March 14, 1 grain of morphine was also required. On
the third day, the pain became even more severe and
swelling of the arm and hand continued to increase for
which reason he was admitted to the hospital with a
tentative diagnosis of streptococcus cellulitis of the
* The record of the cases reported were made available by Drs. R. E. Morter and VV. J. Carson.
312
Wisconsin
arm. Examination revealed two [juncture marks with
a surrounding swelling and a complaint of excruciating
pain of the hand and arm. The swelling involved the
back of the hand and the forearm with a slight amount
of edema of the lower half of the arm. There was a 3
cm. area of extreme erythema about the wound. Temperature, pulse, and respirations were normal and remained so throughout the hospital period of seven days.
LABORATORY STUDY
The blood count on admission was 5,870,000 red
blood cells'and 12,850 white blood cells. The white
blood cells rose to 14,200 while in the hospital. The
blood count on discharge was 5,730,000 red blood
cells and 8,150 white blood cells. Granulocytes accounted for 7.8 per cent of the white blood cells on the
initial count of which 97 per cent were segmented.
Lymphocytes, monocytes, and basophiles accounted
for 18, 3, and 1 per cent respectively. At the time of
discharge the blood contained 5 per cent monocytes, 3
per cent eosinophiles, and 1 per cent Turk irritation
lymphocytes. The urine was of good gravity and of
normal color. No abnormal constituents were found
in it.
The patient was placed in bed with the arm elevated
and wet dressings were applied. Neoprontosil was
given. Twenty-three grains of codeine, one-half grain
of morphine, and seventy-five grains of aspirin were
required for the control of pain between March 15, and
March 19.
The patient received three diathermy treatments
daily during the next seven days. He insisted that
pain was relieved by this method of treatment. He
was discharged from the hospital on March 22, with
only residual redness about the wound. On March 24,
a small abscess had formed from which a pure culture of
a small, gram negative, bipolar staining, nonmotile
bacillus was isolated. An indolent ulcer resulted which
finally healed on May 4. The hand returned to full
function about July 1. The same patient reported
above entered the hospital on December 12,1941. This
time he had been bitten on the left hand by the same
cat. The train of events on this admission was similar
to that of the admission in 1939 except that all symptoms and signs were not as severe. A similar organism
was isolated from the wound.
Case 2. The patient entered the hospital on July
25, 1941, and was discharged on August 1, 1941. Two
days before admission she was scratched on the face and
left arm by her pet cat which she was carrying as a dog
came up barking. The wounds were superficial and not
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313
CAT BITE WITH PASTEURELLA
painful. They became swollen, reddened and discharged a small amount of pus. A gram negative bacillus similar to those described above was isolated from
the wounds.
LABORATORY INVESTIGATION
Bacteriologic study
The three organisms isolated during the course
of this study appeared identical from results obtained on food requirements, staining reactions,
and biological characteristics. The colonies were
small, whitish, elevated, smooth, glistening aggre-
above, and with morphological characteristics, and
staining reaction of Pasteurella is found to be nonmotile and ferments dextrose, saccharose, and
galactose, and fails to ferment lactose, produces
indol, and does not elaborate an hemolysin should
call for a consideration of the Pasteurella strain
associated with cat-bite wound infection.
Immunologic study
The organism isolated from the initial infection
failed to be agglutinated by serum of the host which
was drawn about one month after the onset of the
CHART 1
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SACCHAROSE
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BIBL'Y NO.
BIOCHEMICAL CHARACTERISTICS OF PASTEURELLA AVICTDA AND OF PASTEURELLA FROM AIRWAYS OF CATS AND
FROM WOUNDS OF THE HUMAN INFLICTED BY CATS
—
—
—
— '
—
Xi X2 Xa = Pasteurella organisms isolated by authors, + = action, — = no action.
Blank = no record. Action = acid only on carbohydrate mediums.
gations one to two millimeters in diameter with
entire margins. Growth was enhanced about 50
per cent by the addition of blood to the medium.
The organisms were very small coccoid bacillary
forms which were gram negative with distinct bipolar staining appearance. The organisms were
non-motile. Biochemical characteristics are tabulated in the following chart under designation Xi,
X 2 , and X3.
It will be noted in chart 1 that the organisms
isolated in this study compare quite favorably with
those isolated from the airways of cats and other
organisms isolated from cat-bite wounds of man as
well as Pasteurella avicida as described by Bergey2.
They were otherwise biologically similar except
that some of the strains described in the literature
were absolute in their hemoglobin requirement.
An organism which has food requirements as stated
FIG. 1. APPROX.
X 2000
Xote very small coccoid, rod-shaped organism
infection. It was, however, agglutinated by serum
produced by Dr. James Foerester of the University
of Pennsylvaniawitha strain of Pasteurella avicida.
314
G. H. HANSMANN AND MARION TTLLY
An immune serum produced with this organism
agglutinated it in a dilution of 1:620. Serum produced with this organism did agglutinate the other
two strains here isolated. It did not agglutinate
Salmonella and Salmonella thyphimurium (5 and
5A) described by Bergey. The cross immunity
between genus Pasteurella and genus Salmonella
has been pointed out by Pirosky11. We failed
to establish any such immunological relationship.
The serum failed to agglutinate strains of Brucella
suis, Pasteurella tularense, Eberthella typhosis,
amount of slightly turbid fluid. The liver and
spleen were severely damaged. The histologic
FIG. 3. APPROX. X 90. LUNG OF GUINEA PIG
FIVE DAYS AFTER INOCULATION
Note proliferation of bronchiole epithelium, fibrinous plugs in bronchioles and interstitial pneumonitis.
FIG. 2. APPROX. X 90. LUNG OF GUINEA PIG
FIVE DAYS AFTER INOCULATION
Note proliferation of bronchiole epithelium and
pleural endothelium with interstitial pneumonitis.
Salmonella paratyphosis A and B, and several
strains of Pasteurella obtained from Roscnbusch
and Merchant13. The serum also did not agglutinate a strain of influenza identified with specific " B "
serum or the Pasteurella pseudotuberculosis
isolated by Moss and Battles 1 .
Animal pathogenicity studies
Guinea pigs: Guinea pigs inoculated intraperitoneally with a suspension of a twenty-four
hour culture of the organism in doses ranging from
1.0 to 0.25 cc. regularly died of a diffuse peritonitis
and in one case an extensive pneumonitis had developed. The exudate in the peritoneal cavity was
attended with abdundant fibrin and a copious
FIG. 4. APPROX. X 90. SPLEEN OF GUINEA PIG
THIRTY-SIX HOURS AFTER INOCULATION.
Note thick fibrinous exudate on surface and disappearance of lymphoid cells.
features of the lesions, in addition to the extensive
fibrinous exudate which extended into the liver and
CAT BITE WITH PASTEURELLA
lung, were a pronounced endothelial cell response in
the spleen (late), thrombophlebitis (early), proliferation of the epithelium of the bronchioles
(late), toxic necrosis of lymphocytes in the splenic
pulp (early), and focal necrosis in the liver and
adrenal.
The survival period after inoculation varied with
the dosage. One cubic centimeter of the suspension caused death in 16 hours, while the animals
lived one to five days after an inoculation of 0.25
cc.
315
toneally, while 0.S cc. caused death in forty-eight
hours. There was a diffuse peritonitis in each
instance. Two cubic centimeters administered
intravenously caused death in twelve hours. One
cubic centimeter inoculated into the trachea caused
death in seventeen hours. There was an extensive
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Fic. 5. APPROX. X 90. SPLEEN OF RABBIT TWENTY FOUR HOURS AFTER INOCULATION
Note marked destruction of cells
Subcutaneous inoculation resulted in a local abscess which healed. The guinea pig was examined
six weeks after inoculation and no residual
pathology was noted except for the healed local
lesions.
Mouse: A mouse was inoculated intraperitoneally with 0.5 cc of a twenty-four culture of the
organism. The mouse died forty-eight hours later.
A diffuse peritonitis as noted in the guinea pigs was
found.
Rabbits: Rabbits were inoculated intraperitoneally, intravenously, and intratracheal!}-. The
organism caused death by all routes. Death was
caused in twelve hours from 1.5 cc. intraperi-
Fic. 6. APPROX. X 1900.
ADRENAL OF GUINEA
PIG FIVE DAYS AFTER INOCULATION
Note phagocytosis of adrenal cells
hemorrhagic tracheitis and confluent hemorrhagic
bron chopn eu monia.
Histologic features of the lesions were similar to
those in the guinea pig. The spleen was almost
devoid of lymphocytes except for a small collar
about the splenic corpuscles.
COMMENT
Rivers and Bayne-Jones12, while searching the
ainvavs of cats for hemolytic streptococci, came
316
G. H. HANSMANN AND MARION TULLY
upon seven strains of influenze-like bacilli, six of
which required the "A" factor for growth. The
seventh strain was hemolytic and required whole
blood for growth. The food requirements of these
organisms were not significantly unlike certain
strains of Pasteurella isolated from man following
cat-bites. The organisms had colony characteristics which were quite similar to Pasteurella and
they did not produce an hemolysin and did produce
indol. The saccharolytic variations from typical
Pasteurella strains may be considered minor. The
hemolytic organism may have been an atypical
Whether or not the organism is a harmless parasite
in the throat of cats or whether it is the proposition
of a cat that has recovered from an infection carrying the organism is yet not clear.
Most strains of organisms isolated from cat-bite
wound infection grow much better on mediums
containing blood or upon chocolate agar. Some
strains are strict in this requirement. Others require hemoglobin upon isolation, but after a number of transplants will adapt themselves to more
simple mediums containing no hemoglobin. Our
strains grew on ordinary mediums from the begin-
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FIG. 7. APPROX.
X 450.
SPLEEN OF GUINEA PIG FIVE DAYS AFTER INOCULATION
Note marked endothelial proliferation
strain of Pasteurella now known as Pasteurella
hemolytica. The authors classified their organisms as parainfluenza bacilli. Animal pathogenicity tests and immunologic reactions may have
more nearly allied them with the Pasteurella genus.
Kremsreiter5, Rimpau 9 , Foerster3, Schenk14, and
Leuze 8 isolated Pasteurella strains from throats of
healthy cats. In Schenk's investigation the percentage of recovery of this organism was six from
six sick cats and from nine out of fourteen healthy
cats. I t appears that the organism is a harmless
parasite apparently becoming more numerous
during illness of the animal. The history of our
case would indicate that a healthy cat had harbored
the organism for at least thirty-three months.
ning, but growth was always more abundant on the
mediums containing blood. When these features
are coupled with the facts that the organism does
not produce an hemolysin, has colony characteristics as well as staining reactions quite similar to
influenza strains, and is non-motile, it appears to
the authors that this organism should be given
careful consideration when an indol producing organism thought to be a member of the influenza
group is up for consideration. Animal pathogenicity tests and serological investigations should be
helpful. After a careful consideration of this subject the authors reflect upon how frequently strains
of Pasteurella may have passed for influenza bacilli
in the routine bacteriological studies.
CAT BITE WITH PASTEURELLA
Even though the Pasteurella micro-organism
associated with cat-bite wound infection is a harmless parasite in the throat of cats, it is distinctly
pathogenic when inoculated into guinea pigs, mice,
rabbits, and man. Kapel and Holm4 first called
attention to the relationship of cat-bite and Pasteurella infection of man. Their observation has
since been confirmed by Foerster3, Leuze7, Kremsreiter5, Rimpau9, Kristensen6, Schenk14, Allin1, and
the authors. The clinical syndrome is quite
similar in all cases; namely excruciating pain, little
or no rise in temperature, swelling of the arm,
317
A brief statement of the work of Rosenbusch and
Merchant1* may help us in the visualization of the
proper position of the species of Pasteurella associated with cat-bite and scratch wound.
Revoltee, in 1877, isolated the first member of the
genus Pasteurella following, his study of foul
cholera. Soon thereafter, similar or closely allied
organisms were isolated from hemorrhagic septicemias of foul cholera, cattle, rabbit, swine, deer,
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FIG. 8. APPROX. X 185. ADRENAL or GUINEA PIG
FIVE DAYS AFTER INOCULATION
Note focal necrosis and fatty change in adrenal cells
localization of a small abscess from which the organism is isolated, the formation of.a slowly healing
ulcer at the point of the abscess and absence of
important lymph node involvement. In our case
the pain began soon after the man was bitten.
Rarely, several days elapse between the bite and
the onset of severe pain. There is usually no further consequence of the infection. However, in
one of the cases reported by Allin1, a subperiosteal
abscess due to the same organism developed at the
site of a cat-bite eleven months after the wound
had been inflicted. Future observations may associate the occasional cryptogenic systemic
pasteurella infections which occur in man to animal
bites or injuries obtained in the handling of
animals.
FIG. 9 APPROX. X 185. LIVER OF RABBIT SEVENTEEN HOURS AFTER INOCULATION
Note focal necrosis, fibrinous deposit in sinuses, and
thrombophlebitis.
horses, sheep, and goats. Kitt, in 1885, designated
the organisms as "Bacterium bipolar-multicidum," inferring that it was a bipolar staining organism which cut across many host species lines.
Hueppe (1886), named the organism "Bacterium
septicemia hemorrhagica." These two authors
were the first exponents of the unicist school. In
light of our present knowledge, the work of Lignieres (1900), set back our thinking through the
introduction of a zoologic species classification;
that is, he named the organism according to the
318
G. H. HANSMANN AND MARION Tt'UA"
species of animal from which it was isolated. A
member of the ubiquitous Pasteurella genus has
now been isolated from the horse, bird, cat, dog,
rat, guinea pig, and man, in addition to the animals
enumerated above. Baumgarten (1911), was one
of the first to object to the validity of the zoological
classification because there was no species
specificity in cross pathogenicity or cross immunity. Cultural, biochemical, and serologic
characterization of the genus has supported his
stand. These studies led to a division of the genus
into two groups, namely typical and atypical or
Pasteurella hemolytica. The work of Rosenbusch
and Merchant13 removes the atypical forms
through their ability to hemolyze blood and inability to form indol. The atypical strains also
ferment inositol, lactose, maltose, trehalose. The
authors further subdivided the typical strains
roughly into three groups through the use of xylose,
arabinose, and dulcitol. Group I ferments
arabinose and dulcitol, but not xylose. Group I I
ferments xylose, but not arabinose or dulcitol.
Group I I I ferments xylose, arabinose, and dulcitol.
There were a number of variants which did not fall
into the above groups. Agglutination tests with
serum produced from organisms derived from
various hosts failed to reveal any host specificity.
The conclusion arrived at was that a single name
would include all typical strains. They suggested
the name "Pasteurella multocida." According to
their discussion our organism falls in the group of
typical Pasteurella organisms. I t has also been
agglutinated by a serum produced with the species
Pasteurella avicida. Accepting transfer of the
Pasteurella tularense to the Brucella genus or to a
separate genus and the designation of Pasteurella
pestis and Pasteurella pseudotuberculosis as distinct species, the authors would be content to
classify this organism as Pasteurella avicida or
better still, in our opinion, as Pasteurella multocida.
However, it now seems likely that the organisms
isolated from cat-bite wounds of men will be sufficiently homologous to warrant a definitive species
name.
CONCLUSIONS
Two Pasteurella infections and one reinfection
in man are reported through cat-bite and scratch
wounds.
The Pasteurella organisms isolated here and the
Pasteurella organisms isolated elsewhere from catbite and scratch wounds are quite homologous.
The reinfection of man caused by a wound in- ^M
flicted by the cat which caused the initial infected
wound indicates that the organism remains as a
harmless parasite in the airways of healthy cats for
a long time.
The condition appears to be a clinical and microbiologic entity.
The literature has it that the organism lies dormant in tissue, particularly bone, for months.
All of the consequences of the infection may not
yet be recognized.
REFERENCES
1. ALLIN, A. E.: Cat-bite wound infection. Canad.
M. A. J., 46: 48, 1942.
2. Bergey's Manual of Determinative Bacteriology,
5th edition, Williams & Wilkins, Baltimore, 1939.
3. FOERSTER, W.: Pasteurella-Bakterien als Krankheitserreger beim Menschen. Klin. Wchnschr.,
17:599,1938.
4. KAPEL, O., AND HOLM, J.: Pasteurella infection in
man after cat-bite. Hospitalstid., 73: 1044,
1930.
5. KREMSREITER, J.: Menschenpathogene Haemoglobinophile Baketeien in den Luftwegen einer
gesunden Katze. Arch. Arch. f. Hyg., 188: 87,
1937.
.
6. KRISTENSEN, M.: Pasteurella-Bakterien als Kran- "
kheitserreger beim Menschen. Bemerkungen zu
der Arbeit von Wolfgang Foerster. Klin. Wchnschr., 17:939,1938.
7. LEUZE, ERICH: New points in the pathology of
cat-bites. Rev. mecl. veterinaire, 91: 221, 1939.
8. LEUZE, ERICH: Neue Gesichtspunkte in der Pathologie des Katzenbisses. Zentralbl. f. Chir., 64:
2741,1937.
9. RIMPAU, W.: Ueber infektionen des Menschen
durch Haus und Stalltiere. Miinchen. med.
Wchnschr., 84:413, 1937.
10. Moss, E. S., AND BATTLE, J. D., JR.: Human infection with Pasteurella pseudotuberculosis rodentium of Pfeiffer. Report of case, Am. J. Clin.
Path., 11:677,1941.
11. PIROSKY, I.: Sur la spScificite et sur leurs affinites
serologiques avec les antigenes glucido-lipidiques
des Salmonella. Compt. rend. Soc. de biol., 128:
347, 1938.
12. RIVERS, T. M.,
AND BAYNE-JONES, STANHOPE:
Influenze-like bacilli isolated from cats., J. Exper.
med., 37: 131, 1923.
13. ROSENBUSCH, C. T., AND MERCHANT, I. A.: Study
of hemorrhagic septicemia Pasteurellae, J. Bact.,
37: 69, 1939.
14. SCHENK, H.: Pasteurellen in den Luftwegen von
Katzen als Ursache von Wundinfektionen beim
Menschen nach Katzenbiss. Staatliche bacteriologischer. Untersuchunganstalt, Miinchen,
1938.
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