Factors affecting the quality and reproducibility of MALDI-TOF MS identification for human Capnocytophaga species

Reproducibility and quality of MALDI-TOF MS spectra are critical in the identification process, however, information on the factors affecting the identification scores are scarce. Here, we studied the influence of various factors during the identification process of human oral Capnocytophaga species. The influence of two incubation times, plate-spotting reproducibility of two examiners, extraction technique, storage period of plates, and different laser repetition rates on the quality of MALDI-TOF MS identification of 34 human Capnocytophaga strains (including C. gingivalis, C. granulosa, C. haemolytica, C. leadbetteri, C. ochracea, C. sputigena, and Capnocytophaga genospecies AHN8471) was examined. The identification rate did not show a significant difference (P = 0.05) between the two incubation times, except that C. haemolytica needed a longer incubation time to be recognized at the genus level. The reproducibility of spotting between two examiners was ensured by following the manufacturer's instructions. At the species level, formic acid extraction improved the identification of species with limited representation in the database, such as C. haemolytica and C. granulosa. The storage of plates for one week decreased the identification scores. No significant difference (P = 0.39) was observed between the 60 Hz and 120 Hz laser repetition rates for identifying Capnocytophaga species to the genus or species level. In conclusion, the MALDI TOF MS offers a reliable Capnocytophaga identification after following the universal protocol, while the formic acid extraction is restricted to species with a limited number of strains in the database.

Bacterial peritonitis secondary to Capnocytophaga canimorsus

We present the case of a patient with liver cirrhosis and several previous episodes of ascitic decompensation, who was admitted for bacterial peritonitis secondary to Capnocytophaga canimorsus infection. The initial clinical presentation, diagnosis, treatment and resolution are described. This is the first case described of peritonitis caused by this agent in a patient with similar characteristics.

Postoperative Capnocytophaga Sputigena Presenting as Diffuse Recalcitrant Intra-abdominal Abscesses

Capnocytophaga sputigena is rarely implicated as the cause of postsurgical intra-abdominal abscess because it is almost exclusively found in oral flora. Despite its rarity in intra-abdominal infection, there are examples of this atypical presentation, and an awareness of this organism as a potential etiology of surgical infection is relevant for both obstetric and general surgeons. We report a case of a young female who presented just over a week after an uncomplicated C-section with complaint of abdominal discomfort and fevers. Imaging revealed multiple intra-abdominal fluid collections and cultures revealed the presence of C. sputigena. Percutaneous drainage and intravenous antibiotics were unable to provide significant source control, so she underwent surgical exploration with a multi-specialty team of obstetric and acute care surgeons. Although postsurgical pelvic abscesses are rarely due to C. sputigena, this organism has been documented to serve as a source of intra-abdominal infection.

Antibiotic Resistance among Fusobacterium, Capnocytophaga, and Leptotrichia Species of the Oral Cavity

PURPOSE

Antibiotics play an important role in treating periodontal diseases. Due to the effectiveness of antibiotic therapies, their usage in dentistry has significantly increased. The aim of this study focused on the in-vitro susceptibility of different gram-negative oral bacteria species - which are associated with periodontal diseases (Fusobacterium spp., Capnocytophaga spp. and Leptotrichia buccalis) and have different geographical origins (Asia and Europe) - against antimicrobials that are clinically relevant in dental therapy.

MATERIALS AND METHODS

A total of 45 strains were tested (29 Fusobacterium spp., 13 Capnocytophaga spp. and 3 L. buccalis) that were either isolated from Chinese patients or were obtained from different strain collections. Their antimicrobial susceptibility to the antimicrobial agents benzylpenicillin, amoxicillin, amoxicillin-clavulanic acid, ciprofloxacin, moxifloxacin, clindamycin, doxycycline, tetracycline and metronidazole was tested using the E-Test. Strains with particular resistance to penicillin, clindamycin and metronidazole were further analysed for resistance genes.

RESULTS

All tested bacterial isolates were sensitive to amoxicillin, amoxicillin-clavulanic acid, doxycycline and tetracycline, but showed variable sensitivity towards other antibiotics such as benzylpenicillin, ciprofloxacin, moxifloxacin, clindamycin and metronidazole.

CONCLUSION

The results of the present study suggest that certain periodontal disease-related bacterial strains can be resistant towards antimicrobial agents commonly used in adjuvant periodontal therapy.

Renal abscess with Capnocytophaga canimorsus infection from a dog bite

We present a case of renal abscess caused by Capnocytophaga canimorsus infection in a previously healthy middle-aged man. He presented with sepsis and an acute kidney injury, and although not identified on his initial assessment, he had sustained a dog bite 5 days prior to hospital admission. The patient developed left loin pain and imaging investigation revealed a renal abscess. Gram stain showed a gram-negative bacillus and C. canimorsus was identified by 16S PCR from these samples along with aspirate from the abscess. The patient responded to treatment with carbapenems but required a prolonged course. His clinical condition was further complicated by a pleural effusion and the development of fatigue symptoms consistent with a post-infection chronic fatigue syndrome. We present this case which we believe to be the first documented case of C. canimorsus causing renal abscess. We discuss the challenges relating to investigation, management and the importance of detailed diagnostic exposure histories in sepsis of unknown origin.

[Rare complication of a dog bite: Capnocytophaga species bacteremia followed by an hemolytic uremic syndrome]

Dog bites are a frequent reason for medical consultation. These can be responsible for severe infectious complications. Bacteria of the genus Capnocytophaga species are Gram-negative bacilli commonly found in the oral cavity of certain animals such as dogs and cats. Following a dog bite or wound contamination with animal spit, these bacteria can cause local (cellulitis), systemic and invasive manifestations (bacteremia, endocarditis, meningitis) or lead to rare and dreadful complications such as thrombotic microangiopathies. The identification of Capnocytophaga is slow due to their specific characteristics and their culture conditions. The treatment of Capnocytophaga species infections is based on antibiotic therapy with amoxicillin - clavulanic acid as the first choice. Although different types of Capnocytophaga have been described, C. Canimorsus appears to be associated with a higher rate of atypical complications. Here is the description of an immunocompetent patient who presented with C. Canimorsus bacteremia complicated by hemolytic uremic syndrome following a dog bite.

Putative Novel Species of Genus Capnocytophaga, Capnocytophaga stomatis Bacteremia in a Patient with Multiple Myeloma after Direct Contact with a Cat

Capnocytophaga species are among the typical zoonotic pathogens causing infections following direct contact with animals. Recently, a putative novel species of zoonotic Capnocytophaga, Capnocytophaga stomatis, was reported. We herein report the first case of bacteremia caused by C. stomatis. A woman in her 80s with multiple myeloma who was receiving bortezomib and dexamethasone therapy was admitted to our hospital with a 2-day history of a fever and right calf redness. She was often licked by her cat. On a blood culture, thin, Gram-negative rods were detected, which were identified as C. stomatis by whole-genome sequencing. The patient was successfully treated with ampicillin-sulbactam treatment. Our case highlights the pathogenic potential of the putative novel Capnocytophaga, C. stomatis, in immunocompromised hosts.

Structure and Composition of Candidate Phyla Radiation in Supragingival Plaque of Caries Patients

OBJECTIVE

To investigate the composition and abundance of candidate phyla radiation (CPR) in the oral cavity in caries patients and a healthy population.

METHODS

The raw macrogenomic sequencing data for a total of 88 subjects were downloaded from the National Centre for Biotechnology Sequence Read Archive (NCBI SRA) public database according to the public data usage specifications. Trimmomatic (Department for Metabolic Networks, Potsdam, Germany) and Bowtie 2 (University of Maryland, College Park, MD, USA) were used to quality control and dehost the host sequences. Species annotation was made using Kraken2 (Johns Hopkins University, Baltimore, MD, USA) and Bracken (Johns Hopkins University) based on the reference database. According to the results of the species annotation, the species-significant differences and species correlation of caries and healthy oral microbiota in species composition and microbiota diversity were analysed to study the distribution and abundance differences of CPR in the oral environment.

RESULTS

Proteobacteria, Firmicutes, Bacteroidetes, Actinobacteria and Fusobacteria were the main components. The relative abundance of TM7 (Candidatus Saccharibacteria) and GN02 (Candidatus Gracilibacteria) of CPR is second only to the aforementioned five bacteria, indicating that CPR is an important part of the oral microbiota. TM7 and GN02 were common to both the caries patients and healthy patients and were detected in all samples, suggesting that CPR is the 'core microbiome'. There was a correlation between CPR and a variety of oral microbiota, among which the positive correlation with Capnocytophaga was the strongest, suggesting that Capnocytophaga might be the potential host bacteria of CPR.

CONCLUSION

CPR is an indispensable part of the oral microbiota. It is the 'core microflora' of the oral cavity and may play an important role in the stability and function of the oral microecological environment. Capnocytophaga may be the potential host bacteria of CPR.

Capnocytophaga canimorsus meningitis in a 38-year-old immunocompetent woman from household pet exposure

A 38-year-old otherwise healthy woman with no history of immunocompromise, recent travel, or concerning exposures presented to the ED with several days of nonspecific cold-like symptoms with associated generalized headache. After the patient was symptomatically treated and discharged, she returned several hours later with worsening of symptoms and new vomiting, confusion, and sensorineural hearing loss. Blood and cerebrospinal fluid cultures eventually returned positive for a Capnocytophaga canimorsus infection, a bacterial pathogen found in the saliva of dogs and cats. Only after that, the patient recalled being scratched and licked by her pets, two dogs and a cat. She was treated with a course of systemic steroids, antibiotics and discharged home.

Treatment of Capnocytophaga sputigena meningitis in a neurosurgical patient

A woman in her 50s developed meningitis following an endoscopic, endonasal resection of a clival meningioma which was complicated by a cerebrospinal fluid (CSF) leak through the nose. CSF analysis showed a raised white cell count, and Capnocytophaga sputigena was isolated. This organism is an oral commensal and is implicated in periodontal disease; the CSF leak explains the portal of entry. C. sputigena is rarely isolated, and this is the first report of a central nervous system (CNS) infection caused by this organism. A worsening of our patient's dermatological condition, urticaria pigmentosa, coincided with empiric treatment with vancomycin and meropenem, which were therefore discontinued. Treatment was continued with chloramphenicol for 3 weeks, and the patient made a full recovery. Systemic chloramphenicol is uncommonly used in contemporary UK practice, but remains an excellent antibiotic for CNS penetration and it has excellent bioavailability. We anticipate increased chloramphenicol use as the number of multiresistant Gram-negative infection increases.

Meningitis caused by Capnocytophaga canimorsus in a COVID-19 patient: a rare complication of dog bites

Capnocytophaga canimorsus is a gram-negative rod that is part of the commensal microbiota of dogs' and cats' mouths. In this case, we report an 85-year-old man with COVID-19 who had his right arm bitten by a dog. His symptoms were impaired consciousness, agitation and aggressive behavior. Physical examination revealed neck stiffness and Brudzinski's sign. The cerebrospinal fluid culture was compatible with Capnocytophaga canimorsus. He required intensive care and received a 14-day prescription of meropenem. After 40 days of hospitalization, the patient was fully recovered and was discharged. This case highlights the importance of physician and microbiologist be awareness of this disease, mainly in patients with neurological symptoms after a dog or cat bite.

Exposure of Thomsen-Friedenreich Antigen on the Renal Tubules of a Patient with Capnocytophaga Infection-induced Acute Kidney Injury

Infections with neuraminidase-producing bacteria can lead to acute kidney injury (AKI). We herein report a 74-year-old woman who developed AKI in the course of Capnocytophaga infection, a neuraminidase-producing bacterium. A renal biopsy showed tubulointerstitial injury accompanied by specific binding of fluorescence-conjugated peanut lectin to the tubular epithelial cells, suggesting exposure of Thomsen-Friedenreich antigen (T-antigen) on the tubules. Although AKI is often observed in patients infected with Capnocytophaga, little is known about its etiology and associated pathology. This case suggests that tubulointerstitial injury caused by neuraminidase production and resultant T-antigen exposure is a mechanism of Capnocytophaga infection-induced AKI.

[Relationship between oral Candida albicans and flora in children with severe early childhood caries]

PURPOSE

To investigate the relationship between oral Candida albicans and flora in children with severe infant caries.

METHODS

Forty-two children with severe infant caries (experimental group) and 40 caries-free children (control group) treated in Peking University Shenzhen Hospital from March 2018 to June 2019 were enrolled. The samples of saliva and plaque were collected and cultured. According to the culture results, the experimental group was further divided into two subgroups: Candida albicans positive group and Candida albicans negative group. The samples were sequenced by high-throughput sequencing technology, then the diversity and abundance of bacteria were analyzed. The data were processed by SPSS 23.0 software package.

RESULTS

The positive rates of Candida albicans in saliva and plaque were significantly higher in the experimental group than in the control group(P<0.05). The abundance of Leptotrichia and Cardiobacterium in the saliva of children with positive Candida albicans in the experimental group was significantly higher than that of children with negative Candida albicans(P<0.05). The abundance of Prevotella in plaque of children with positive Candida albicans in the experimental group was significantly higher than that of children with negative Candida albicans and control group(P<0.05). The abundance of Leptotrichia in saliva of children with positive Candida albicans in the experimental group was significantly higher than that of children with negative Candida albicans (P<0.05), while the abundances of Capnocytophaga, Cardiobacterium hominis, and Capnocytophaga granulose were significantly lower than those of children with negative Candida albicans(P<0.05). The abundance of Streptococcus mutans, Lactobacillus gasseri, and Lactobacillus vaginalis in the plaque of positive Candida albicans in the experimental group were significantly higher than those of children with negative Candida albicans(P<0.05), while the abundance of Lactobacillus plantarum was significantly lower than that of children with negative Candida albicans (P<0.05).

CONCLUSIONS

Candida albicans in children with severe infant caries children is closely correlated with the abundance of Leptotrichia, Capnocytophaga, Cardiobacterium hominis, Capnocytophaga granulosa, Streptococcus mutans and Lactobacillus, which may play a synergistic or antagonistic role.

Subgingival microflora in adolescent females with polycystic ovary syndrome and its association with oral hygiene, gingivitis, and selected metabolic and hormonal parameters

OBJECTIVES

Research studies suggest that polycystic ovary syndrome (PCOS) may influence the composition of the oral microflora in women. This study aimed to investigate factors affecting the number of selected periopathogens in a young cohort of females with PCOS and to assess the association between oral hygiene, subgingival microbiome, gingival health, and metabolic and hormonal parameters.

MATERIALS AND METHODS

Thirty-two subjects with PCOS and twenty-three healthy controls aged 15-19 years were examined periodontally by a calibrated dentist. A real-time PCR method was used for the identification of 9 subgingival microorganisms. Subjects with PCOS underwent blood tests for determination of FSH, LH, total testosterone, DHEA-S, estradiol, SHBG, fasting glucose, fasting insulin, and lipid profile.

RESULTS

Gingival index (GI), the proportion of bleeding sites (BOP%), probing depth (PD), and plaque index (PLI) did not differ significantly between cases and healthy age-mates. The control group had significantly higher levels of Peptostreptococcus micros and substantially greater percentage of subjects infected by Treponema denticola. Capnocytophaga gingivalis count was positively correlated with the level of estradiol, while the concentration of HDL-C was negatively correlated with the number of Aggregatibacter actinomycetemcomitans and orange complex bacteria.

CONCLUSIONS

PCOS in young patients was not associated with higher pathogenicity of subgingival biofilms.

CLINICAL RELEVANCE

Further studies are needed to explain the relationship between hormonal and metabolic abnormalities, subgingival microflora, and periodontal health in patients with PCOS.

Capnocytophaga canimorsus Aortitis in an Immunocompetent Host

Capnocytophaga canimorsus is a commensal organism of canine and feline oral flora known to cause severe infections most frequently reported in immunocompromised hosts. We describe a case of bacterial aortitis secondary to C. canimorsus in an 80-year-old immunocompetent female, who presented with fever, non-specific lower back, and pelvic pain. Infection was confirmed with positive blood cultures and serial imaging.

Antimicrobial effects of a pulsed electromagnetic field: an in vitro polymicrobial periodontal subgingival biofilm model

The objective was to test the influence of a pulsed electromagnetic field (PEMF) on bacterial biofilm colonization around implants incorporated with healing abutments. Healing abutments with (test group) and without (control group) active PEMF devices were placed in a multispecies biofilm consisting of 31 different bacterial species. The biofilm composition and total bacterial counts (x10⁵) were analyzed by checkerboard DNA-DNA hybridization. After 96 h, the mean level of 7 out of the 31 bacterial species differed significantly between groups, namely Eubacterium nodatum, Fusobacterium nucleatum ssp. nucleatum, Streptococcus intermedius, Streptococcus anginosus, Streptococcus mutans, Fusobacterium nucleatum ssp. Vicentii and Capnocytophaga ochracea were elevated in the control group (p < 0.05). The mean total bacterial counts were lower in the Test group vs the control group (p < 0.05). An electromagnetic healing cap had antimicrobial effects on the bacterial species and can be used to control bacterial colonization around dental implants. Further clinical studies should be conducted to confirm these findings.

An Immunocompetent Case of Capnocytophaga canimorsus Infection Complicated by Secondary Thrombotic Microangiopathy and Disseminated Intravascular Coagulation

A 62-year-old woman with no previous history developed a Capnocytophaga canimorsus infection followed by thrombotic microangiopathy (TMA) and disseminated intravascular coagulation (DIC). She was treated with antibiotics and plasma exchange (PE) and recovered. C. canimorsus sepsis sometimes causes not only DIC but also TMA. The mortality of TMA is extremely high, so we should not hesitate to perform PE when a patient shows TMA symptoms.

Canis Caveat (Beware of the Dog) - Septic Shock Due To Capnocytophaga Canimorsus Contracted From A Dog Bite

We describe the case of a 61-year-old immunocompetent male who developed septic shock and multiorgan failure due to Capnocytophaga canimorsus (C. canimorsus) bloodstream infection, sustained from a dog bite. Unusually, this patient developed acute liver failure and splenic infarction in addition to many of the better-known clinical sequelae of C. canimorsus infection.

cynodegmi Causing Zoonotic Infection

Sepsis caused by a Capnocytophaga canis infection has only been rarely reported. A 67-year-old female with a past medical history of splenectomy was admitted to our hospital with fever and general malaise. She had been bitten by a cat. She showed disseminated intravascular coagulation and multi-organ failure because of severe sepsis. On blood culture, characteristic gram-negative fusiform rods were detected; therefore, a Capnocytophaga species infection was suspected. A nucleotide sequence analysis revealed the species to be C. canis, which was newly identified in 2016. C. canis may have low virulence in humans; however, C. canis with oxidase activity may cause severe zoonotic infection.

[Not Available]

Zusammenfassung. Wir präsentieren den Fall einer 83-jährigen Patientin mit einer periprothetischen Knieprotheseninfektion mit Capnocytophaga canimorsus. Er ist die Erstbeschreibung einer erfolgreichen prothesenerhaltenden Behandlung eines periprothetischen Infekts mit C. canimorsus. Dieser Krankheitserreger kommt kommensalisch in Hunde- und Katzenspeichel vor und wird meist bei Tierbissen übertragen. Aufgrund seiner schlechten Kultivierbarkeit könnte C. canimorsus für einen Teil der Kultur-negativen periprothetischen Infekte verantwortlich sein.

Capnocytophaga ochracea-related Bacterium Bacteremia in a Hypertrophic Cardiomyopathy Patient without Neutropenia

Gram-negative fusiform rods were detected in a blood culture obtained from a 63-year-old man who had been hospitalized for a long duration for severe heart failure. Although the organism could not be identified using a conventional method, it was finally identified as a bacterium of the Capnocytophaga ochracea group based on the results of biochemical testing, 16S rRNA sequencing and a matrix-assisted laser desorption ionization time-of-flight mass spectrometry analysis. Although neutropenic patients with poor oral hygiene are exclusively vulnerable to Capnocytophaga bacteremia, this case was unique because such predisposing conditions were not noted. A multi-centered investigation is warranted for a better understanding of this clinically rare, but potentially pathogenic organism.

[Pets are a risk for asplenic patients: Capnocytophaga canimorsus infection in an asplenic patient]

Post-splenectomy sepsis is a serious condition with high mortality rates. We present a case of a 64-year-old patient with a medical history of splenectomy who was referred to the Emergency Department with a fever, shivers, and an altered mental state. The symptoms had started twelve hours before. Upon arrival in the hospital the patient was tachypnoeic, hypotensive and febrile. Blood cultures were taken and broad-spectrum antibiotics were started. He was directly admitted to the Intensive Care Unit with severe sepsis of unknown aetiology. CT imaging did not reveal the source of the infection. A second medical history assessment revealed that the patient had engaged in play fighting with a dog two days previously, which left a superficial lesion on his arm. A Capnocytophaga canimorsus infection was deemed likely and antibiotics were switched to intravenous amoxicillin-clavulanic acid. Despite maximal support the patient's clinical condition deteriorated rapidly. The patient died from multi-organ failure fourteen hours after admission to the hospital.

Alterations of the Subgingival Microbiota in Pediatric Crohn's Disease Studied Longitudinally in Discovery and Validation Cohorts

BACKGROUND

Oral manifestations are common in Crohn's disease (CD). Here we characterized the subgingival microbiota in pediatric patients with CD initiating therapy and after 8 weeks to identify microbial community features associated with CD and therapy.

METHODS

Pediatric patients with CD were recruited from The Children's Hospital of Pennsylvania. Healthy control subjects were recruited from primary care or orthopedics clinic. Subgingival plaque samples were collected at initiation of therapy and after 8 weeks. Treatment exposures included 5-ASAs, immunomodulators, steroids, and infliximab. The microbiota was characterized by 16S rRNA gene sequencing. The study was repeated in separate discovery (35 CD, 43 healthy) and validation cohorts (43 CD, 31 healthy).

RESULTS

Most subjects in both cohorts demonstrated clinical response after 8 weeks of therapy (discovery cohort 88%, validation cohort 79%). At week 0, both antibiotic exposure and disease state were associated with differences in bacterial community composition. Seventeen genera were identified in the discovery cohort as candidate biomarkers, of which 11 were confirmed in the validation cohort. Capnocytophaga, Rothia, and TM7 were more abundant in CD relative to healthy controls. Other bacteria were reduced in abundance with antibiotic exposure among CD subjects. CD-associated genera were not enriched compared with healthy controls after 8 weeks of therapy.

CONCLUSIONS

Subgingival microbial community structure differed with CD and antibiotic use. Results in the discovery cohort were replicated in a separate validation cohort. Several potentially pathogenic bacterial lineages were associated with CD but were not diminished in abundance by antibiotic treatment, suggesting targets for additional surveillance.

A case of Capnocytophaga canimorsus sacral abscess in an immunocompetent patient

We report a unique case of sacral Capnocytophaga canimorsus abscess successfully treated with surgery and antibiotics. Close contact to a dog was assumed to be the most likely source of infection. Established risk factors for invasive C. canimorsus infection such as splenectomy, alcoholism or overt immunosuppression could not be identified. The role of cigarette smoking, portal of entry and the possible relevance of altered skin microbiota as well as the diagnostic value of polymerase chain reaction are discussed in the light of the scarce literature of spinal C. canimorsus infections.

Asplenic fulminant sepsis secondary to a dog bite complicated by toxic epidermal necrolysis/Stevens-Johnson syndrome

We report a case of asplenic fulminant sepsis in Australia following a dog bite which was complicated by toxic epidermal necrolysis/Stevens-Johnson syndrome (TENS/SJS). Capnocytophaga canimorsus, the infective organism, is a rare cause of septicaemia: a high degree of suspicion of this unusual organism and its early aggressive management is paramount. The diagnostic and management difficulties of TENS/SJS in the context of a patient with fulminant sepsis, DIC and on inotropes are also highlighted.

[Frontal mass: diagnostic challenges]

Capnocytophaga spp. are part of the oral flora of humans and animals, being responsible for skin and soft tissues infections and invasive infections. Microbiological identification can be difficult due to its slow growth. We present a case of infection caused by this bacteria in the form of an extracerebral intracranial abscess, presenting as a frontal mass that posed some diagnostic challenges. A surgical drainage was performed together with antibiotic therapy with favourable outcome. This microorganism was identified in the second week of treatment and then a careful history revealed a dog bite days prior to the initial symptoms. This could have been the site of entry to a posterior focalization.

'Biting the hand that feeds': fever and altered sensorium following a dog bite

Capnocytophaga canimorsus infection is the most severe and rapidly progressive bacterial infection transmitted by dog bite and fortunately is very rare. The authors describe a 68-year-old gentleman who presented in an acute confusional state 2 days after having been bitten on the left hand by a dog. Despite immediate broad-spectrum intravenous antibiotics, he developed significant sequelae including disseminated intravascular coagulopathy, microvascular emboli leading to peripheral necrosis, widespread local tissue destruction and septic arthritis. Our case illustrates a life-threatening presentation of infection with C. canimorsus, which is known as 'the dog bite organism'. Early diagnosis and aggressive treatment is key to survival.

[Fatal sepsis due to capnocytophaga canimorsus after dog bite]

A 56-year-old man was bitten by a dog. 8 days later he was admitted to a hospital because of severe deterioration of his clinical situation. He developed the clinical picture of fulminant sepsis. In spite of aggressive intensive care therapy the patient died 24 hours later. Capnocytophaga canimorsus was identified from initial blood cultures. This gram-negative rod is part of the normal oral flora of dogs and cats. It can be spread to humans by bites, licking or scratches and causes severe infections, especially in persons with special risk factors (splenectomy, alcoholism). The mortality rate in the published cases is 25-30%.

Woman's best friend?

Dog bites are commonly thought to be less infectious than similar injuries from other domestic or wild animals. Many people who are bitten by a dog treat themselves at home or go to a medical site to have their wounds simply "cleaned and watched." This report describes a serious delayed consequence of a dog bite that was missed by common bacteriological testing.

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.

[A sepsis caused by Capnocytophaga canimorsus: diagnostic and therapeutic options]

The authors present a case report of a patient with sepsis caused by Gram negative rod Capnocytophaga canimorsus resulting from a dog bite. The infection had a course of septic shock progressing into multiorgan failure and serious ischemic damage to the extremities. The etiologic agent was identified utilizing molecular genetic methods and its detailed microbiologic characteristics are provided below. The report also outlines diagnostic and therapeutic options of this otherwise most likely under-diagnosed infection.

Early cystic lung disease in a premature neonate with perinatally acquired capnocytophaga

We describe a premature infant with early cystic lung lesions and sepsis due to prenatally acquired Capnocytophaga infection. Early cystic lesions have not been described previously as a characteristic of this infection.

[Extensive purpura and septic schock in two patients with Capnocytophaga canimorsus]

INTRODUCTION

Capnocytophaga canimorsus is a Gram negative bacillus present in oral flora and in saliva of dogs and cats. It can be responsible for septicaemia and meningitides in some patients after dog or cat bite two patient with a septic shock due to C. canimorsus, who presented with an extensive pupura are reported.

CASE REPORT

A 50 year-old man with a past history of splenectomy was referred to an emergency department for a shock with vomiting, abdominal pain and generalized ecchymotic purpura culture samples isolated C. canimorsus in peritoneal fluid. Purpura occurred secondary to a disseminated intravascular coagulation. Despite intensive care and major antibiotherapy, the patient rapidly died. Four days previously, the patient administered pills in his dog mouth. The second patient was a 39 year old alcoholic man who was hospitalised for vomiting and septic shock witch occurred 24 hours after a dog bite. He presented with a livido and a diffuse purpura associated with necrotic lesions. Cultures of blood samples isolated C. canimorsus.

CONCLUSION

These severe infections due to C. canimorsus should be avoided by the routine use of early antibiotherapy with amoxicilline and clavulanic acid in patients with dog or cat bite, particularly if patient with associated debilitating disorders.

Epiglottitis and necrotizing fasciitis: a life-threatening complication of infectious mononucleosis

Life-threatening cervical complications associated with infectious mononucleosis are rare. The combination of acute epiglottitis and subsequent necrotizing fasciitis of the head and neck in a patient with infectious mononucleosis has not been reported to date.A 47-year-old female with infectious mononucleosis and epiglottitis was admitted to hospital for i.v. therapy. Owing to her poor clinical condition and the spread of the infection to the throat and superior mediastinum, as evidenced by CT, a cervical debridement was performed. After cervical debridement, histological findings were consistent with necrotizing fasciitis. The bacteria identified were Streptococcus viridans, Veilonella spp. and Capnocytophaga spp. The patient was hospitalized for 33 days.Mononucleosis, usually a benign condition, may be associated with life-threatening septic complications in the neck and chest. Serial CT or MRI scans are necessary to assess the development of the infection in the deep layers of the neck. Rapid medical treatment, extensive surgical debridement and intensive care are vital.

Le chien est-il toujours le meilleur ami de l'homme ?

The mortality of overwhelming postsplenectomy infections (OPSI) is significant (50 to 80 percent). Capnocytophaga canimorsus belongs to the normal oral flora of dogs and cats. It is seldom responsible for human infections, but its prognosis is bad (about 30 percent of overall mortality), especially in asplenic patients. We report a case of a splenectomized patient who suffered from communal septic shock due to C. canimorsus septicaemia. The course of events was rapidly fatal. Diagnosis and mode of contamination were determined only a few weeks after the patient's death. This late microbiological diagnosis is due to a slow growth of C. canimorsus in vitro.

[Bite-associated bacterial wound infections in humans]

Bite wounds are common injuries that are often mistakenly considered innocuous by both patients and physicians. These wounds consist of laserations, evulsions, punctures, and scratches. While many of these wounds require minimal or no therapy, a significant number results in infections, which may even be life-threatening. The bacteria associated with bite-wound infections generally originate from the oropharyngeal flora of the biting animal. The clinical presentation and appropriate treatment of infected bite wounds vary according to the causative microorganisms. This review focuses on dog, cat, small rodents, monkey, and snake bite-wound infections, risk factors, bacteriology, antimicrobial susceptibility patterns of the causative organisms, and recommended treatment strategies.