Cat fever: Curiosity almost killed the owner

Be wary of animals and dialysis patients

Sillery J, Hargreaves J, Marin P, et al. Pasteurella multocida peritonitis: Another risk of animal-assisted therapy. Letter to the Editor. Infect Control Hosp Epidemiol 2004; 25:5-6.

Here’s one for the strange-but-true case file: A 48-year-old woman under home therapy for continuous ambulatory peritoneal dialysis (CAPD) presented to the emergency department with a one-day history of fever and chills accompanied by general abdominal discomfort without nausea or vomiting. She had end-stage renal failure and had been on maintenance peritoneal dialysis for three years. The patient was admitted to the hospital for management of suspected peritonitis.

Empiric antibiotic therapy, consisting of intra-peritoneal cefazolin and gentamicin, was initiated with no improvement. Pasteurella multocida was isolated from the peritoneal fluid on day 4 and found to be sensitive to gentamicin, ciprofloxacin, and trimethoprim-sulfamethoxazole, and the patient responded to intravenous ampicillin.

The patient reported she had a cat, which was — for her — an important source of psychosocial support. She admitted to frequent breaks in hand-washing technique, with her cat frequently licking her hands before and during fluid cycling.

"The cat also displayed his curious nature by habitually investigating the tubing and fluid bags during the cycling process," the authors noted. The patient’s outcome could have been dire had the novel infecting pathogen gone undetected.

"This case illustrates the potential for zoonotic transmission of diseases to humans undergoing CAPD," the authors concluded. "With the number of patients using at-home [dialysis treatment] increasing and the numbers of dogs or cats in the home burgeoning, the clinician must be suspicious of a pet-acquired illness in a patient with peritonitis. Given the proximity of pets to their owners and the natural attraction of a carnivorous animal to human body fluid, it is clear that the supposedly healing touch of a dog’s or cat’s tongue could be fatal for a patient undergoing CAPD."