Capnocytophaga canimorsus meningitis after routine myelography: a sentinel event identifies multiple opportunities for improvement of standard practices in radiology

Furry, Fomite, and Facultative Anaerobe: A Unique Case of Capnocytophaga canimorsus

Capnocytophaga canimorsus infection is frequently associated with dog and cat bites or scratches in patients who have risk factors such as immunosuppression, asplenia, and alcohol abuse. However, rare instances of C. canimorsus infection in patients without typical risk factors have been reported. Here, we present such a rare and unusual case of C. canimorsus bacteremia in a patient without animal wounds or risk factors. Chronic sinusitis may have contributed to mucosal disruption and served as an entry point for C. canimorsus. Prompt initiation of antibiotics resulted in rapid resolution of symptoms and clearance of bacteremia.

Rare case of Capnocytophaga canimorsus meningitis in a man without risk factors

Capnocytophaga canimorsus meningitis is an uncommon but potentially serious cause of meningitis, which is considered particularly rare in healthy and immunocompetent individuals. We present a case of C. canimorsus meningitis in a young, immunocompetent patient which was acquired following a dog bite. We review the literature and propose that underdiagnosis of this condition is likely. To avoid misdiagnosis, and thus improper management, clinicians should ensure that they identify animal exposure in all meningitic patients, and adopt a higher clinical suspicion in the absence of classical risk factors.

Capnocytophaga canimorsus meningitis diagnosed using next- generation sequencing of microbial cell-free DNA

Capnocytophaga canimorsus meningitis is frequently caused by exposure to dog or cat bites and occurs more commonly in immunocompromised individuals. CSF analysis is the first step in diagnosis; however, in situations where CSF cultures turn negative, molecular techniques such as 16S rRNA gene amplification followed by polymerase chain reaction (PCR) product sequencing have shown promise. Next generation sequencing of cell free DNA (NGS cfDNA) can assist in identifying the causative agent in a quick and accurate manner. We present a rare case of C. canimorsus meningitis in an immunocompetent host that highlights the utility of NGS cfDNA in timely diagnosis after exhausting all other available diagnostic techniques.

Capnocytophaga canimorsus - a potent pathogen in immunocompetent humans - systematic review and retrospective observational study of case reports

Purpose: Severe and fatal Capnocytophaga canimorsus infection has been described in immunocompromised patients. Data of C. canimorsus infection in immunocompetent and risk factors of severe courses are missing. Our aims were to describe the epidemiology of C. canimorsus infection and to identify potential risk factors of sepsis and fatal outcome.Methods: Observational study and systematic review of all cases reported in immunocompetent subjects between 2002 and 2019.Results: A total of 128 cases of C. canimorsus infection in immunocompetent individuals were reported. Male gender comprised 74.2%, the median age was 58 years and 47.7% were admitted with sepsis. Case-fatality rate was 29.7% and especially high in septic patients (55.7%). Transmission by bite (OR = 2.37, 95% CI: 1.05-6.52) and incubation time ≤3 d (OR = 7.98; 95% CI: 2.33-27.34) were identified as risk factors of sepsis on admission, and early wound cleansing as protective (OR = 0.42; 95% CI: 0.14-0.96). Sepsis (OR = 23.67; 95% CI: 2.85-197.89) and septic shock (OR = 45.50; 95% CI: 3.08-676.55) were risk factors of fatal outcome, whereas early wound cleansing (OR = 0.05; 95% CI: 0.01-0.72), initial penicillin therapy with beta-lactamase inhibitors (OR = 0.48; 95% CI: 0.16-0.92) and surgical removal of infectious focus (OR = 0.38; 95% CI: 0.06-0.95) were protective factors.Conclusions: Immunocompetent patients with C. canimorsus infection frequently develop sepsis. A shorter incubation period in cases of sepsis might be related to higher infectious dose. Fatal outcome may be prevented by early wound cleansing, initial use of penicillins in combination with beta-lactamase inhibitors and surgical removal of an infectious focus.

Capnocytophaga canimorsus Meningitis: Three Cases and a Review of the Literature

Bacterial meningitis is a disease with a high morbidity and mortality. It may be caused by the zoonotic pathogen Capnocytophaga canimorsus, which is part of the commensal oral flora in dogs and cats. We report three cases of C. canimorsus meningitis in a nationwide cohort study of bacterial meningitis patients and performed a review of the literature. Three episodes of C. canimorsus meningitis were identified in three patients included in a nationwide cohort study from 2006 through 2014. The calculated annual incidence was 0.03 per million adults. When combined with the literature, 33 patients were identified of which 28 were male (85%). The median age was 63 years, and 13 (42%) were immunocompromised, which consisted of alcoholism in 7 (21%). Animal contact could be established in 29 of 30 patients (93%) and consisted of dog bites in 22 of 29 (76%). One patient died (3%) and 8 had neurological sequelae upon discharge (25%), most often hearing loss (n = 6, 19%). Capnocytophaga canimorsus meningitis is associated with dog bites. Although mortality is relatively low, survivors often have neurological sequelae.

Capnocytophaga canimorsus: an emerging cause of sepsis, meningitis, and post-splenectomy infection after dog bites

Newly named in 1989, Capnocytophaga canimorsus is a bacterial pathogen found in the saliva of healthy dogs and cats, and is transmitted to humans principally by dog bites. This review compiled all laboratory-confirmed cases, animal sources, and virulence attributes to describe its epidemiology, clinical features, and pathogenesis. An estimated 484 patients with a median age of 55 years were reported, two-thirds of which were male. The case-fatality rate was about 26%. Its clinical presentations included severe sepsis and fatal septic shock, gangrene of the digits or extremities, high-grade bacteremia, meningitis, endocarditis, and eye infections. Predispositions were prior splenectomy in 59 patients and alcoholism in 58 patients. Dog bites before illness occurred in 60%; additionally, in 27%, there were scratches, licking, or other contact with dogs or cats. Patients with meningitis showed more advanced ages, higher male preponderance, lower mortality, and longer incubation periods after dog bites than patients with sepsis (p < 0.05). Patients with prior splenectomy presented more frequently with high-grade bacteremia than patients with intact spleens (p < 0.05). The organism possesses virulence attributes of catalase and sialidase production, gliding motility, cytotoxin production, and resistance to killing by serum complement due to its unique lipopolysaccharide. Penicillin is the drug of choice, but some practitioners prefer third-generation cephalosporins or beta-lactamase inhibitor combinations. C. canimorsus has emerged as a leading cause of sepsis, particularly post-splenectomy sepsis, and meningitis after dog bites.

Capnocytophaga canimorsus a novel pathogen for joint arthroplasty

We report the case of a 59-year-old man with Waldenstrom's macroglobulinemia and active alcohol use who presented with bilateral knee pain 5 years after a bilateral staged TKA. Cultures of synovial fluid and periprosthetic tissue specimens from both knees yielded, after prolonged anaerobic incubation, a catalase- and oxidase-positive gram-negative bacillus, which was identified as Capnocytophaga canimorsus by 16S ribosomal RNA PCR analysis. C. canimorsus, an organism that is commonly found in dog and cat saliva, is a rare cause of various infections in immunocompromised and healthy individuals. However, a review of the medical literature indicates C. canimorsus has not been reported previously to cause infection after joint arthroplasty. The patient was immunocompromised by cytotoxic chemotherapy, corticosteroids, and alcohol use. The patient was managed successfully with bilateral two-stage exchange and 6 weeks of intravenous ertapenem therapy. Because of its fastidious and slow-growing characteristics, C. canimorsus may be an unrecognized cause of culture-negative joint arthroplasty infections, especially in cases when dog and cat exposure is evident in the clinical history.

Meningitis caused by Capnocytophaga canimorsus: When to expect the unexpected

In this article we review the available data concerning meningitis caused by Capnocytophaga canimorsus. The clinical presentation of this rare condition is described with the emphasis on associated conditions and management issues. Two additional cases, illustrating the difficulties in recognizing this rare disease, are presented. Reviewing a total of 28 reported cases, a preceding bite-incident by a cat or dog, or close contact with these animals, was described in the majority of cases (89%). Patients had a median age of 58 years; splenectomy and alcohol abuse were noted in, respectively, 18% and 25% of patients. Only in one case immune suppressive drug use was reported. The diagnosis C. canimorsus meningitis should be considered in healthy and immunocompromised adults, especially after splenectomy, who present with symptoms attributable to meningitis and a history of recent exposure to dogs or cats. The possibility of this condition has implications for both the diagnostic work-up and the treatment of the patient.