Pasteurella multocida Infections with Unusual Modes of Transmission from Animals to Humans: A Study of 79 Cases with 34 Nonbite Transmissions.

Pasteur discovered the causative agent of fowl cholera (Pasteurella multocida) in 1880. Since then, multiple zoonotic infections affecting humans have been reported. P. multocida infections usually result from bites of cats or dogs. The earliest reports of nonbite transmissions (NBTs) were attributed to cat scratches and lung colonization. More recently, multiple modes of unusual NBTs have been reported, including animal exposures with no direct contact. Here, we report 79 cases of pet-associated infections, with 34 NBTs. Previously unreported and unsuspected, novel modes of NBTs presented include stepping on dog drool infecting a submetatarsal ulcer, contamination of a wound by socks covered with cat hair and dander resulting in P. multocida bacteremia, stumbling over a dog and falling while drunk and abrasions contaminated with dog saliva resulting in wound infection, and severe epiglottitis and supraglottitis after eating peanut butter and crackers half eaten by a dog. Cat bites were more common than dog bites. Both bite and nonbite infections were more common in the elderly, with more older patients in the nonbite group. Upper extremity bites were more than lower extremity bites for both cats and dogs. NBTs were associated with more co-morbidities and resulted in more life-threatening infections than bites, confirming the findings of a prior smaller series. Open wounds were the most common point of entry for nonbite infections, with majority in the lower extremity. Based on this study and prior reports, pet owners must protect open wounds and individuals with certain underlying conditions and infants should avoid pet exposure completely. Our findings and animal transmission of bite and nonbite P. multocida infections reported in literature are summarized.

Report of Non-Lyme, Erythema Migrans Rashes from New Jersey with a Review of Possible Role of Tick Salivary Toxins.

Erythema migrans (EM) rashes once considered pathognomonic of Lyme disease (LD) have been reported following bites of arthropods that do not transmit LD and in areas with no LD. Also, EM rashes have been reported in association with organisms other than members of Borrelia burgdorferi sensu lato complex. Arthropod saliva has chemicals that have effects on the host and pathogen transmission. Tick saliva has protein families similar to spiders and scorpions and even substances homologous to those found in snakes and other venomous animals. Ticks "invertebrate pharmacologists" have a sophisticated arsenal of chemicals that assist in blood feeding, pathogen transmission, and suppressing host defenses. No organisms have been isolated from many EM rashes. We propose that tick salivary toxins may play a role in the causation of rashes and laboratory abnormalities in tick-borne diseases. The role of tick salivary toxins needs further exploration. Cases of Lyme-like EM rashes referred to as STARI (Southern Tick-Associated Rash Illness) following bites of the lone star tick, Amblyomma americanum, in the United States have been reported predominantly in Southeastern Missouri and a few in South Carolina, North Carolina, Georgia, and one case each in Mississippi and Long Island, New York. Although there is one report of Borrelia lonestari in a patient with a rash, biopsies of 31 cases of STARI, with cultures and PCR, failed to show a relationship. Distribution of A. americanum, whose bites are associated with STARI, now extends along the East Coast of the United States, including New Jersey, up to the Canadian border. As far as we are aware, there have been no prior reports of Lyme-like rashes in New Jersey. In this study, we present case examples of 2 Lyme-like rashes, variations of EM rashes, and a brief review of studies that suggest a role of tick salivary toxins in tick-borne diseases.