Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 29-1986. An asplenic woman with evidence of sepsis and diffuse intravascular coagulation after a dog bite

Evaluation of the patient with recurrent bacterial infections

Recurrent bacterial infection is a complaint encountered regularly in the course of both adult and pediatric care. Defects of neutrophils and monocytes are most commonly associated with recurrent infection, but abnormalities of immunoglobulins and complement must be considered. Defensins, small antibacterial peptides, have been implicated recently in some of the infectious diathesis of cystic fibrosis. A thorough history and physical examination focused on severity, sequelae, and microbiology of infections can usually determine whether a patient needs further evaluation. The diseases and syndromes most frequently associated with recurrent infection are presented, along with discriminating clinical, pathologic, and microbiologic features.

Capnocytophaga canimorsus infections in human: review of the literature and cases report

Capnocytophaga canimorsus, formerly designated Dysgonic fermenter 2 (DF-2) was first described in 1976; it is a commensal bacterium of dogs and cats saliva, which can be transmitted to man by bite (54% of cases), scratch (8.5%), or mere exposure to animals (27%). We present a review of the clinical and microbiological characteristics of the Capnocytophaga canimorsus infections and 12 cases of infection in France. Over 100 cases of human infections have been reported, mainly septicemia in patients with diminished defences, due to splenectomy (33%), alcohol abuse (24%), immunosuppression (5%). However 40% of septicemia occur in patients with no predisposing conditions. Other infections are less frequent: meningitis, endocarditis, arthritis, pleural and localized eye infections. These infections range from mild to fulminating disease, with shock, respiratory distress, disseminated intravascular coagulation. Dermatological lesions (macular or maculopapular rash, purpura) or gangrene are common. This fastidious Gram-negative bacterium grows slowly on chocolate agar or on heart infusion agar with 5% rabbit blood incubated in 5% CO2. In spite of a great susceptibility of bacteria to antibiotics, the mortality is of 30%. Because of the severity of these infections, taking into account this organism in the management of bites is necessary, especially in patients with predisposing factors.

Secretory diarrhea following a dog bite

Overwhelming sepsis is rarely complicated by secretory diarrhea. We present a case of fulminant sepsis associated with dermatologic manifestations, disseminated intravascular coagulation (DIC), and a severe secretory diarrhea that has not previously been described. This followed a dog bite, and the patient was otherwise healthy. The combination of septic shock, skin lesions, and DIC occurring after a dog bite has been attributed to dysgonic fermentor 2 organisms, now called Capnocytophaga canimorsus, but none were cultured in this case (7). Dysgonic fermentor-2 may be a new cause of secretory diarrhea and should be considered in the differential diagnosis of overwhelming sepsis associated with diarrhea.

Dysgonic fermenter 3-associated gastrointestinal disease in a patient with common variable hypogammaglobulinemia

A gram-negative bacteria designated DF-3 was cultured on multiple occasions from stool samples of a patient with common variable hypogammaglobulinemia and chronic diarrhea. Antibiotic therapy resulted in elimination of the organism and resolution of the patient's symptoms. DF-3 has not been linked previously to human disease; because of its fastidious growth characteristics and unique isolation requirements, it may be a rarely identified cause of diarrhea and other gastrointestinal symptoms in immunocompromised patients.

Acinetobacter calcoaceticus infection following a dog bite

A frequent complication of dog bite wounds is bacterial infection. The choice of antibiotics is based upon the most likely organisms. Failure to achieve wound healing suggests that an uncommon organism(s) is present and should lead the clinician to culture the wound. A case of Acinetobacter calcoaceticus infection following a dog bite is described.