Human Pasteurelloses, Activation of Interest in Some Latent Problems

Abstract

(Editor's Note: The following communication is to appear in several medical publications. Attention of readers of Pediatrics is solicited.)

Classic consideration of human infections due to members of the genus Pasteurella is concerned with plague (P. pestis) and tularemia (P. tularensis). There have been extensive investigations on plague and tularemia in the U.S. and elsewhere in the world which now provide excellent clinical and epidemiological pictures of these two diseases.

However, there are at least four other species of Pasteurella (hemolytica multocida, pneumotropica, and pseudotuberculosis), known human pathogens, for which we have little or no understanding of their clinical importance or epidemiological patterns. Each species has been recovered from a variety of domestic and sylvatic animal reservoirs and each is, to some degree, a veterinary medical problem. Although a measure of the importance of these diseases in domestic animals in the United States is available from U.S. Department of Agriculture statistics, no comparable morbidity figures are reported for man. The occasional case reports that are published indicate, nevertheless, that a problem exists. The question remains, "how extensive is the problem?"

The first human infection due to P. multocida to be reported (1913) was a case of puerperal fever. Numerous cases have been reported since, involving respiratory tract infections, appendicitis, bitewound infections, as well as other forms.

Until the 1950's cases of P. pseudotuberculosis infection were considered rare, with less than 20 reports of fatal septicemia appearing in the literature. Recently, however, several hundred cases of mesenteric adenitis, often confused with acute appendicitis, have been observed primarily in Europe. In addition, recent cases of erythema nodosum as well as other forms have been described. Furthermore, P. pseudotuberculosis is of considerable importance as a source of diagnostic confusion due to many cultural and biochemical characteristics that this organism shares in common with P. pestis.

One case of P. hemolytica infection simulating ulceroglandular tularemia has been reported. Atypical strains of P. hemolytica have been isolated from the respiratory tract and from a case of endocarditis. A number of isolations of P. pneumotropica have been obtained from the respiratory tract.

No assessment of the importance of these agents as causes of disease in man in the United States can be made unless clinical and laboratory data can be accumulated. As a step in the right direction, it is suggested that clinical résumés, cultures, and paired sera from any patients, whether typical or atypical cases, be submitted to the U. S. Public Health Service, Communicable Disease Center, San Francisco Field Station, for further study and/or tabulation.