View Abstract

A5236 - Deadly Bite: Fulminant Sepsis Due to Capnocytophaga Canimorsus in an Elderly Man
Author Block: P. Echeverria1, L. Osei1, J. Saa2, M. Jacob1, E. Yeager1; 1Belleville Memorial Hospital, Belleville, IL, United States, 2Universidad de las Americas (UDLA), Escuela de Medicina, Quito, Ecuador.
Human infections by Capnocytophaga species have a mortality as high as 30% in patients with or without comorbidities with infection being more frequent in the former, especially those who are asplenic or have history of alcohol abuse. The incidence of this type of infection is estimated to be around 0.6 cases per million per year. Severe cases of fulminant sepsis following exposure to Capnocytophaga species have been described, most commonly after dog bites.
We report a case of a 71-year-old male who presented to the Emergency Department (ED) three days after a dog bite on his left hand (Figure 1). He had a history of bladder cancer and alcohol abuse, and his Pneumococcal vaccine was up-to-date. He complained of nausea, vomiting, malaise, and fever for one day prior to coming the hospital. In the ED he was found to be hypotensive, mottled, and showed purpuric lesions in the trunk and lower extremities (Figure 2). He received a dose of ceftriaxone and later levofloxacin and meropenem, but deteriorated quickly in the Intensive Care Unit despite aggressive intravenous fluid resuscitation, vasopressors, and steroids. A profound lactic acidosis was noted, as well as acute kidney injury, liver failure, thrombocytopenia and disseminated intravascular consumption (Fibrinogen 89 mg/dL, PT 31, INR 2,96, and PTT 86). He was transfused fresh frozen plasma, required mechanical ventilation, and high doses of vasoactive drugs. Within six hours of
presentation to the hospital, he had a cardiac arrest to which he did not survive despite heroic measures. Capnocytophaga species infection was suspected due to the clinical presentation after a dog bite. The microbiology laboratory was informed of the high suspicion, and ten days later, Capnocytophaga carnimorsus was identified in blood.
The presence of purpura fulminans has been reported in other cases of sepsis related to Capnocytophaga infections, and is linked to poor outcome despite aggressive treatment. Our patient delayed seeking medical attention until severe symptoms developed, including a diffuse maculopapular rash that prompted his family to come to the hospital. His fatal outcome was most likely related to delay in therapy, although some individuals, mostly immunocompromised, may die from sepsis despite rapid interventions. Once a high clinical suspicion for Capnocytophaga species infections is raised, the clinician should make the microbiology laboratory aware since these species are often missed due to the slow growth of these microorganisms in vitro.