Tags: Meningitis

Pasteurella

Pasteurella multocida has been recovered from cultures of specimens from the nasopharynx and the gastrointestinal tract of a large number of asymptomatic wild and domestic animals. The highest carriage rates occur in cats (50%-90%), dogs or swine (50%), and rats (15%). Infections are usually preceded by a cat or dog bite or scratch on an extremity.

Plague

The genus Yersinia, named after Alexander Yersin (1863-1943), includes Y pestis, Y enterocolitica, and Y pseudotuberculosis. Y pestis is the cause of plague, a disease that has left its mark on human history since the medieval time. Y enterocolitica and Y pseudotuberculosis also cause mesenteric lymphadenitis. Plague occurs worldwide.

Tularemia

Francisella tularensis is the causative agent of tularemia (also called rabbit fever or deerfly fever), an infectious disease that occurs primarily in animals. It may occasionally cause human disease, which most often manifests itself by one or more skin lesions, regional lymphadenopathy, fever, and constitutional symptoms.

Important Anaerobes: Clinical Syndromes

Box 1 summarizes different clinical syndromes associated with anaerobic bacteria. The sections that follow describe the various syndromes, including clinical findings. For some syndromes, specific diagnosis and treatment information is included as well.

Haemophilus, Bordetella, & Branhamella Species

Before 1990, strains of Haemophilus influenzae type b were found in the upper respiratory tract of 3-5% of children and a small percentage of adults. Colonization rates with type-b strains are even lower now, reflecting routine immunization of infants against H influenzae type b. Non-type-b encapsulated H influenzae are present in the nasopharynx of < 2% of individuals, whereas nonencapsulated (nontypable [see below]) strains colonize the respiratory tract of 40-80% of children and adults.

Branhamella Catarrhalis: Clinical Syndromes

B catarrhalis causes bronchitis and pneumonia in patients with underlying lung disease, especially chronic obstructive pulmonary disease. It is also a rare cause of invasive disease, including meningitis, endocarditis, bacteremia without a focus, septic arthritis, and cellulitis.

Haemophilus Influenzae: Clinical Syndromes

H influenzae was first isolated during the 1892 influenza pandemic and was originally believed to be the causative agent of influenza. Although subsequent studies revealed the fallacy of this idea, H influenzae has proved to be a common cause of localized respiratory tract and systemic disease, including meningitis, epiglottitis, pneumonia, pyogenic arthritis, cellulitis, otitis media, and sinusitis, among others (Box 1). Meningitis is the most common and serious form of invasive H influenzae type-b disease. In the mid-1980s, before the introduction of effective vaccines, ~ 10,000-12,000 cases of H influenzae type-b meningitis occurred in the United States each year, and 95% of cases involved children < 5 years old.

Pseudomonas Aeruginosa

The genus Pseudomonas consists of a number of human pathogens, the most important of which is Pseudomonas aeruginosa. P aeruginosa is an opportunistic pathogen found widely in soil, water, and organic material, reflecting its limited nutritional requirements. A moist environment is favored. Human colonization in the community is rare, and, when it occurs, the skin, gut, and upper or lower airway are colonized.

Infection in Patients With Aids

Paeruginosa infections may occur in patients with AIDS. Risk factors for infection include a CD4 count of < 100 cells/mL3, neutropenia or functional neutrophil defects, intravascular catheterization, hospitalization, and prior use of antibiotics including ciprofloxacin or trimethoprim-sulfamethoxazole. Many cases are community acquired. Bacteremia is common, and the lung or an intravenous catheter is the most frequent portal of entry.

Ear, Nose & Throat Infections

P aeruginosa infection of the external auditory canal may be acute or may be a chronic serious infection called malignant otitis externa. Acute diffuse otitis externa is often referred to as swimmer’s ear. P aeruginosa may be part of the normal flora of the external auditory canal or may colonize the canal as a result of exposure to water.