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Licking a dog can be fatal
A man came to a hospital in Bremen because he had contracted a severe infection from dog saliva. Despite intensive care, his health deteriorated and he died of multi-organ failure.
Doctors at the Red Cross Hospital in Bremen report in the specialist journal "European Journal of Case Reports in Internal Medicine" about the case of a man who developed flu-like symptoms and, after some delay, severe sepsis (blood poisoning) and purpura fulminans - an acute life-threatening illness that is associated with skin bleeding. He had been infected with a bacterium called Capnocytophaga canimorsus. Despite intensive care, his health deteriorated and he died.
Skin bleeding and shortness of breath
According to the information, the previously healthy man had fever and progressive breathlessness three days before being admitted to the hospital. The day before, red pimples and skin bleeding had formed on the 63-year-old's body. He also showed sensation disorders in the right leg and muscle pain in both legs.
The patient claimed to have been touched and licked by his dog, his only pet, in the past few weeks, but not bitten or injured. In the recent past there has been no hospitalization and no trips abroad.
During the examination, ecchymoses (blotchy skin bleeding) occurred over the lower extremities, but no open wounds. The patient was conscious and had a fever (39 ° C). He did not complain of headaches, neck stiffness, or other symptoms of meningitis.
The patient was found to have acute kidney damage and signs of liver dysfunction.
Patient was resuscitated
After the patient was referred to the intensive care unit, an initial diagnosis of severe sepsis with purpura fulminans was made and he was immediately treated with various antibiotics.
The patient's condition worsened over the next 30 hours. Brain damage and intestinal obstruction resulted in kidney and liver failure and cardiac arrest. However, he was successfully revived and then mechanically ventilated.
On the 4th day of hospitalization, blood cultures revealed the gram-negative Capnocytophaga canimorsus bacillus, which is why another antibiotic was added to the treatment.
The patient's medical history, clinical and laboratory tests showed no immune deficiency, asplenia (splenic dysfunction) or alcohol abuse.
After ten days of antibiotic treatment, signs of systemic infection continued to appear and on the 11th day the patient developed a temperature of 41 ° C.
Since a CT scan of the skull showed signs of severe brain edema at this point, a decision was made to de-escalate the therapy together with the relatives. The patient died after 16 days of treatment.
Bacteria in the mouth of dogs and cats
The Capnocytophaga bacterium occurs mainly in the mouth of dogs and cats. "In its natural environment, the dog's or cat's mouth, the bacterium Capnocytophaga canimorsus does no harm," explains the University of Basel in an older report.
"However, if the pathogen gets into human tissue and blood through a bite or scratch, it can lead to serious illnesses," write the experts.
"In the absence of antibiotic treatment, the bacteria can multiply unhindered and trigger dangerous infections such as gangrene, blood poisoning, meningitis or endocarditis, an inflammation of the inner lining of the heart," it continues.
In extreme cases - as the Bremen case shows - an infection with the bacterium can be fatal.
Patient without immune deficiency fell ill
Our report on a patient with fatal septic shock due to C. canimorsus describes several remarkable features that can be important for clinical practice, according to the Bremen authors.
Infection with C. canimorsus is most commonly transmitted through dog bites. Such infections are generally rare and range from local skin infections to septic shock. Serious and fatal infections have been reported in patients with immunodeficiency, splenectomy (splenectomy), or alcohol abuse.
Our patient showed no immune deficiency, splenectomy, or alcohol abuse. In addition, his dog only touched and licked him in the weeks leading up to the infection. We therefore assume that there was a low bacterial concentration during the transmission and no specific susceptibility to severe C. canimorsus infections. Nevertheless, the patient developed septic shock with fatal multi-organ failure.
Serious C. canimorsus infections without biting or scratching have been reported very rarely. Only one patient had no immune deficiency. C. canimorsus infection is fatal in about 25 percent of patients. However, this high mortality rate is based on collections of case reports and could therefore be distorted.
Infections without animal bites
What are the clinical implications of this case report? Pet owners with flu-like symptoms should urgently seek medical advice if their symptoms exceed those of a simple virus infection.
Doctors faced with such patients should inquire about contact with dogs and cats. You should also consider C. canimorsus infections without animal bites or scratches, and any immune deficiency.
In such cases, treatment with a penicillin in combination with a beta-lactamase inhibitor should be started immediately until a clear diagnosis is available. (ad)
Author and source information
This text corresponds to the specifications of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
- European Journal of Case Reports in Internal Medicine: Being Licked by a Dog Can Be Fatal: Capnocytophaga canimorsus Sepsis with Purpura Fulminans in an Immunocompetent Man, (accessed: November 25, 2019), European Journal of Case Reports in Internal Medicine
- University of Basel: From animals to humans: How dangerous are bacteria ?, (accessed: November 25, 2019), University of Basel