This case report describes a 29-year-old veterinary assistant who was examined after a cat bite injury (5 days prior to presentation) to the right thenar eminence (a group of muscles on the palm at the thumb base). The cat was an indoor/outdoor cat that was up-to-date on rabies vaccination and presented to the clinic with anemia, jaundice, and fever. The assistant washed the area and took a single dose of amoxicillin per veterinary hospital protocol. The assistant had also handled cats, dogs, guinea pigs, rabbits, horses, and sheep. The cat was subsequently euthanized due to severe illness and the brain submitted for rabies. Over the next few days the patient presented several times to both local and referral hospitals because of progressive swelling, erythema, edema, lymphadenopathy, pain, fever, neck pain, streaking of the thenar eminence, and arthralgia; this progressed to diffuse body aches, abdominal and low pelvic pain, and numbness and tingling in the legs. She was treated with DPT vaccination, ampicillin-sulbactam, amoxicillin-clavulanic acid, morphine, ondansetron, and ketorolac tromethamine; she improved progressively after therapy. The clinicopathology of this case was 2-fold: The first condition was an acute cellulitis secondary to the cat bite, successfully treated with broad-spectrum penicillins, levofloxacin, and doxycycline. Likely organisms may have included Pasteurella multocida, Staphylococcal and Streptococcal species bacteria, Corynebacteria species, diphtheroids, Bartonella henselae, Moraxella species, and anaerobes (from patient skin or feline mouth). In this patient, P multocida was the most likely cause of the cellulitis. The subsequent local and systemic illness was secondary to infection with Francisella tularensis, as determined by acute and convalescent paired antibodies, likely caused by the cat bite. The patient in this report made a full clinical recovery.
Commentary: Most veterinary staff members are aware of the risks for progressive acute cellulitis and potential severe illness from animal bites, particularly cat bites. However, the risks for severe systemic infections such as tularemia are not highlighted. This report emphasizes to all veterinary employees the importance of safe practices.—Indu Mani, DVM, DSc
Case records of the Massachusetts General Hospital: Case 31-2010—A 29-year-old woman with fever after a cat bite. Weinberg AN, Branda JA. NEW ENGL J MED 363:1560-1568, 2010.