Pyogenic cervical spondylitis caused by Pasteurella haemolytica attributed to excessive contact with dogs.

Abstract

The bacterium Pasteurella haemolytica is resident in the oral cavities of dogs and cats and is often a cause of zoonotic infection. However, it is rare for it to be the pathogenic bacteria behind pyogenic spondylitis, and few studies have been conducted on it. This article reports a case of pyogenic cervical spondylitis thought to be caused by excessive contact with pet dogs.A 52-year-old man reported neck pain and pain in the right upper limb. He was admitted after plain radiographs and magnetic resonance imaging suggested pyogenic spondylitis. Pasteurella haemolytica was detected by needle aspiration biopsy of the intervertebral disk. Because the patient owned 2 dogs and frequently kissed them on the mouth, the cause of infection was thought to be excessive contact with pet dogs. Symptoms were alleviated with bed rest and administration of antibiotics with a higher sensitivity to this bacterium.

Full text

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NOVEMBER 2011 | Volume 34 • Number 11
■ Case Report
abstract
Full article available online at ORTHOSuperSite.com. Search: 20110922-32
The bacterium Pasteurella haemolytica is resident in the oral cavities of dogs and cats
and is often a cause of zoonotic infection. However, it is rare for it to be the pathogenic
bacteria behind pyogenic spondylitis, and few studies have been conducted on it. This
article reports a case of pyogenic cervical spondylitis thought to be caused by exces-
sive contact with pet dogs.
A 52-year-old man reported neck pain and pain in the right upper limb. He was ad-
mitted after plain radiographs and magnetic resonance imaging suggested pyogenic
spondylitis. Pasteurella haemolytica was detected by needle aspiration biopsy of the
intervertebral disk. Because the patient owned 2 dogs and frequently kissed them on
the mouth, the cause of infection was thought to be excessive contact with pet dogs.
Symptoms were alleviated with bed rest and administration of antibiotics with a higher
sensitivity to this bacterium.
Drs Machino, Yukawa, Ito, Nakashima, Kanbara, Morita, and Kato are from the Department of
Orthopedic Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, Nagoya, Japan.
Drs Machino, Yukawa, Ito, Nakashima, Kanbara, Morita, and Kato have no relevant fi nancial rela-
tionships to disclose.
Correspondence should be addressed to: Masaaki Machino, MD, Department of Orthopedic
Surgery, Chubu Rosai Hospital, Japan Labor Health and Welfare Organization, 1-10-6 Komei, Minato-
ku, Nagoya, Aichi, 455-8530, Japan (masaaki_machino_5445_2@yahoo.co.jp).
doi: 10.3928/01477447-20110922-32
Pyogenic Cervical Spondylitis Caused
by Pasteurella haemolytica Attributed to
Excessive Contact With Dogs
MASAAKI MACHINO, MD; YASUTSUGU YUKAWA, MD, PHD; KEIGO ITO, MD, PHD; HIROAKI NAKASHIMA, MD;
SHUNSUKE KANBARA, MD; DAIGO MORITA, MD; FUMIHIKO KATO, MD, PHD
Figure: Lateral plain radiograph at admission con-
fi rmed narrowing of the intervertebral disk space
between the fi fth and sixth cervical vertebrae.
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ORTHOPEDICS | ORTHOSuperSite.com
■ Case Report
T
a cause of zoonotic infection. However, it
is rare for it to be the pathogenic bacte-
ria behind pyogenic spondylitis, and few
studies have been conducted on it. This
article reports a case of pyogenic cervical
spondylitis thought to be caused by exces-
sive contact with pet dogs.
he bacterium Pasteurella haemo-
lytica is resident in the oral cavi-
ties of dogs and cats and is often
CASE REPORT
A 52-year-old man with no notewor-
thy history presented to his local clinic
with neck pain and pain in the upper
right limb. He was referred to our insti-
tution when plain radiographs and mag-
netic resonance imaging (MRI) suggested
spondylitis. On admission, he had normal
deep tendon refl exes, and no muscle
weakness or sensory impairment was
confi rmed. White blood cell count was
11800 ?L, C-reactive protein level was
3.1 mg/dL, and erythrocyte sedimenta-
tion rate was 74 mm/hour, indicating an
infl ammatory reaction.
Plain radiographs confi rmed narrow-
ing of the intervertebral disk space be-
tween the fi fth and sixth cervical vertebrae
(Figure 1). Magnetic resonance imaging
confi rmed uneven compression of the fi fth
and sixth cervical intervertebral disks and
a low T1, high T2 signal variation in the
vertebral bodies (Figure 2).
Needle aspiration biopsy was per-
formed under diskographic guidance on
the day of admission. Bed rest was ad-
vised and an antibiotic (cefazolin) was
administered. Pasteurella haemolytica
was detected on bacterial culture. On fur-
ther history taking, the patient was found
to have 2 Corgi dogs that he frequently
kissed on the mouth. He was switched to
another antibiotic (cefmetazole), which
has a higher sensitivity to this bacterium,
and was given this drug for 1 month.
His neck pain gradually subsided, and
improvement of infl ammation was con-
fi rmed.
Two months later, radiographs showed
progression of the narrowing of the inter-
vertebral disk space, and MRI confi rmed
alleviation of the infl ammation (Figure
3), after which ambulation was initiated.
Having experienced no relapse after being
fully ambulatory, he was discharged. No
relapse of the spondylitis or accompany-
ing neck pain was observed 1 year after
discharge.
DISCUSSION
Pyogenic spondylitis is an infectious
disease that mainly occurs through he-
matogenous dissemination and is more
likely to affl ict compromised hosts, such
as diabetics, cirrhosis patients, or patients
who are on hemodialysis.1 The pathogenic
bacterium is often Gram-positive bacteria,
and Pasteurella species are only rarely ob-
served. In the present case, P haemolytica
was identifi ed from the results of a culture
from the biopsy. We searched the litera-
ture for reports on spondylitis caused by
P haemolytica to the greatest extent pos-
sible, but it seems that the present case is
the fi rst.
The P haemolytica bacterium is an
anaerobic Gram-negative short bacillus
bacterium resident in the oral cavities of
animals other than humans (71%-90%
of cats and 21%-60% of dogs), causing
zoonosis (zoonotic infection). An animal
bite or scratch sometimes leads to cellu-
litis or osteomyelitis.2-4 When compared
to the causative bacteria in other zoonotic
infections, the prevalence of this pathogen
is high, but little is known about this bac-
terium.
Generally, in pyogenic spondylitis, the
fi rst line of treatment is administration of
fi rst-generation cephalosporin antibiotics,
to which Gram-positive bacteria are sensi-
tive. However, in certain cases, as in the
present case, the pathogenic bacterium is
an anaerobic Gram-negative bacillus bac-
terium, rendering this treatment ineffec-
tive, indicating that it is extremely impor-
tant to identify the causative bacterium.
The identifi cation rate tends to be refrac-
tory and decreases according to the delay
in beginning treatment. Accordingly, in
pyogenic spondylitis, it is important to di-
Figure 1: Lateral plain radiograph at admission confi rmed narrowing of the intervertebral disk space between the fi fth and sixth cervical vertebrae. Figure 2:
Sagittal T1-weighted (A) and T2-weighted (B) MRIs at admission confi rmed uneven compression of the fi fth and sixth cervical intervertebral disks and also con-
fi rmed a low T1, high T2 signal variation in the vertebral bodies. Figure 3: Sagittal T1-weighted (A) and T2-weighted (B) MRIs 2 months after treatment showed
progression of the narrowing of the intervertebral disk space and confi rmed alleviation of the infl ammation.
1
2A
2B3A 3B
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NOVEMBER 2011 | Volume 34 • Number 11
PYOGENIC CERVICAL SPONDYLITIS | MACHINO ET AL
agnose early, proceed to proper treatment
that includes rest, and conduct tests.
In the present case, because the patient
owned 2 dogs and frequently kissed them
on the mouth, this excessive contact was
thought to be the cause of infection. The
recent pet boom has caused an increase in
the infections caused by P haemolytica
bacteria from bite wounds. Osteomyelitis
has also been reported in the fi eld of or-
thopedics,3,4 and keeping in mind the fact
that pyogenic spondylitis is also caused
by this bacterium, it is important to en-
gage in routine treatment regimens.
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