e Pasteurella multocida is a rare cause of neonatal bacterial meningitis. We describe such a case and verify two household cats as the source of infection using repetitive-element PCR (rep-PCR) molecular fingering.
CASE REPORTA 17-day-old boy was seen in the emergency department after a 2-day history of worsening fussiness, irritability, fever, and bilateral eye crusting of 7 days' duration. Upon presentation, his rectal temperature was 39.7°C, and his heart and respiratory rates were 149 beats/min and 44 breaths/min, respectively. Laboratory studies showed the following: hemoglobin, 15.7 g/dl; hematocrit, 44.6%; white blood cell (WBC) count, 18.2 bilateral/liter (neutrophils, 63%; lymphocytes, 23%; monocytes, 14%); platelet count, 379 ϫ 10 9 /liter; Na, 129 mmol/liter; K, 5.4 mmol/liter; chloride, 95 mmol/liter; CO 2 , 22 mmol/liter; blood urea nitrogen (BUN), 12 mg/dl; creatinine, Ͻ0.1 mg/dl; albumin, 4.0 g/dl; alkaline phosphatase, 648 U/liter; total bilirubin, 3.1 mg/dl; aspartate transaminase (AST), 61 U/liter; and alanine aminotransferase (ALT), 50 U/liter. Cerebrospinal fluid (CSF) studies showed 1,500 red blood cells/l, 20,822 WBCs/l (neutrophils, 73%; mononuclear cells, 27%), 7 mg/dl glucose, and 148 mg/dl protein. Gram stain showed many polymorphonuclear leukocytes, moderate mononuclear cells, and rare Gram-negative bacilli. Bacterial antigen was negative for Haemophilus influenzae type b, Streptococcus agalactiae, Streptococcus pneumoniae, Neisseria meningitidis (A, B/E, C, Y, and W135), and Escherichia coli K1. Cefotaxime, ampicillin, and acyclovir (one dose) were empirically started. He was transferred to the pediatric intensive care unit (PICU).On examination, the infant had a patent, slightly full anterior fontanelle and a right-sided middle ear effusion with mild tympanic membrane injection. He was tachycardic with a grade I-II/VI systolic murmur. There was full passive range of motion of all joints; none were red, warm, or swollen. Kernig and Brudzinski signs were negative. Moro and stepping reflexes were present. There was no neck stiffness, and he had good motor tone. Ampicillin was discontinued, and he was treated with cefotaxime (200 mg/kg body weight/day every 8 h) and gentamicin (2.5 mg/kg/ dose every 8 h). An echocardiogram revealed physiologic peripheral pulmonic stenosis and a patent foramen ovale. The xTAG respiratory viral panel (Luminex, Austin, TX) was negative. By history, the neonate was born at term to a 35-year-old GI (primigravida) mother who had no illnesses during her pregnancy and received no antibiotics; she developed hypertension late in pregnancy and was induced at 39 weeks' gestation. She delivered by cesarean section 10.5 h after rupture of membranes. She was screened during pregnancy for HIV-1 antibodies, hepatitis B surface antigen, VDRL test, Chlamydia trachomatis, Neisseria gonorrhoeae, and group B Streptococcus anogenital carriage; all tests were negative. The neonate lived with his mother, father, and maternal grandmother; a 10-year-old paternal half-brother staye...
