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A5309 - A Rare Cause of Sepsis in an Asplenic Female
Author Block: M. Forte1, D. Lee2, J. Gordon1, K. Cade2; 1Division of Pulmonary and Critical Care Medicine, Parkview Medical Center, Pueblo, CO, United States, 2Division of Internal Medicine, Parkview Medical Center, Pueblo, CO, United States.
A 67 year-old asplenic female patient presented to the ER after being found down in a tent. Initial evaluation uncovered high fever, profound leukocytosis, and hypotension. A diagnosis of severe sepsis was made, and the patient was placed on Vancomycin, Metronidazole and Aztreonam for possible GI or GU source. These antibiotics were chosen due to the patient’s penicillin and floroquinolone allergies. The patient was admitted to the ICU, and steadily improved. Within 24 hours, a fusiform gram-negative bacillus was identified in both blood cultures. Further physical exam demonstrated multiple dog scratches on the lower extremities. Capnocytophagia is a fusiform gram-negative bacillus, commonly found in oral cavities of animals. Penicillin is the treatment of choice, however the patient reported anaphylaxis to both this and Levofloxacin. Coverage was therefore begun with Clindamycin and Azithromycin. The patient continued to improve, and a second set of blood cultures was negative for growth. Further speciation revealed C. Canimorsus, the most common species of infectious Capnocytophagia. Transesophageal Echocardiogram was negative for vegetations, and the patient was discharged home with PO Clindamycin and Azithromycin. Capnocytophagia is a commensal organism in the mouth flora of dogs and cats. In immunocompentent patients, it rarely leads to serious infection, but mortality can exceed 30% of severe cases, and 60% when septic shock is present. The majority of infections come from a dog bite, but up to 8.5% have been reported from dog scratches alone. Though universally sensitive to penicillin, C. Canimorsus is also considered resistant to Aztreonam. Our case is unique for several reasons. First, Capnocytophagia infection is quite rare, with fewer than 500 confirmed cases reported in the United States. The fact that the nidus of infection was likely a scratch, not a bite, makes this rarer still. In addition, though the patient was on the high end of the observed age range for this infection, and only one-third of cases are in females. Lastly, the patient’s penicillin allergy required second- and third-line antibiotic choices, which still showed excellent activity considering the patient’s recovery.