Capnocytophaga meningitis, bacteremia and septic shock following a dog bite in an asplenic patient
Author(s):
Sara E Parli, UK HealthCare/University of Kentucky College of Pharmacy; Rebecca Krall; Derek Forster, UK HealthCare; Phillip Chang, University of Kentucky
Background: Overwhelming post-splenectomy infection (OPSI) is an uncommon occurrence but carries a high risk of mortality following splenectomy, especially with delayed recognition and/or treatment. The majority of cases of OPSI are due to Streptococcus pneumoniae for which a vaccine has been recommended for use following splenectomy by the CDC since the early 1980s. Other common causative encapsulated organisms for which vaccine administration is recommended following splenectomy include Meningococcal and Haemophilus influenzae type b. Although no preventative therapies available, there are several reported cases of Capnocytophaga causing bacteremia in asplenic patients who have suffered a dog bite or had recent contact.
Hypothesis: .
Methods: 50-year-old male with significant surgical history of splenectomy (at the age of 14 following trauma in late 1970’s) presents to clinic the morning after sustaining dog bite and is offered antibiotics and receives tetanus shot. The following evening the patient, not feeling well, goes to an urgent treatment center, found to have temperature of 102.9oF, otherwise normal vitals, is sent to the emergency department for further work-up and treatment. He was found to have altered mental status, fever, shock, worsening respiratory status, acute kidney injury, anion gap metabolic acidosis, diffuse petechial rash of bilateral lower extremities and disseminated intravascular coagulopathy, which precluded him from having a lumbar puncture. Imaging revealed effacement of sulci concerning for meningitis. Patient was intubated, received appropriate blood products, and started on empiric antibiotics, pressors, and CRRT. Blood cultures obtained ultimately reveal Capnocytophaga canimorsus and received 3 weeks of deescalating beta lactam therapy (ultimately ceftriaxone). His course was complicated by bilateral profound sensorineural hearing, but otherwise made a full recovery. He was discharged to long term care facility after 22 day course.
Results: .
Conclusions: Following splenectomy or intervention resulting in functional asplenia, preventative vaccines should be administered as appropriate per CDC guidelines along with targeted education regarding infection risk. Patients who became asplenic prior to the widespread use of vaccines should be screened to ensure compliance with vaccine schedule including boosters. Following exposure to dogs or dog bites in this patient population and presentation with infectious symptoms should warrant high suspicion of Capnocytophaga involvement.