Naslov
MULTIPLE ORGAN FAILURE AFTER AN INNOCENT GAME WITH THE DOG: A DIAGNOSTIC CHALLENGE

Autori
Miletic, Bojan ; Sossai, Gioanna ; Krasniqi, Dukagjin ; Courteney, Udo ; Sokolova Ajtarski, Monika: Cylka, Ana

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, prošireni sažetak, stručni

Izvornik
X / - , 2022, 1-1

Skup
4th European Congress on Infectious Diseases

Mjesto i datum
Pariz, Francuska, 10.11.2022. - 11.11.2022

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
C. canimorsus, Sepsis, Dog

Sažetak
Background: C. canimorsus is a gram-negative rod that occurs in the oral flora of dogs and cats and was first described in 1976. The transmission occurs through contact with the mucous membrane through bites and scratches. Case report: A 35-year-old woman with fever, retrosternal pain and palpitations was admitted to the hospital. Clinically, she was in a slightly reduced general condition, with a fever of 39° C. The laboratory analysis showed leukocytosis, an increased CRP and increased D-dimer. The abdominal ultrasound, chest X-ray, CT of the chest, blood gas analysis and urine status were normal. The anamnesis initially showed no particular abnormalities. Within a few hours, the patient's clinical condition deteriorated rapidly, with hypotension, tachycardia and diffuse skin bleeding. Antibiotic therapy with cefepime was initiated. In the follow-up laboratory analysis, the patient developed pancytopenia, a further increase of the CRP and procalcitonin, a prolonged aPTT time and a further increase of D-dimer. The antibiotic therapy was supplemented with metronidazole. The intubation and circulatory stabilization with vasopressors were necessary. The patient developed kidney and liver failure and required hemodialysis. In the meantime, information was received from the family of a minor injury to the patient’s lower lip whilst playing with the neighbour's dog three days before the hospitalisation. Gram-negative rods were observed in the blood cultures and on suspicion of a Capnocytophaga canimorsus infection, the antibiotic therapy was switched to piperacillin and tazobactam. The diagnosis was confirmed two days later. The patient’s clinical condition slowly improved. The liver function has been recovered. Due to the necrosis, the forefoot on one side and individual toes on the other side had to be amputated. The patient continued to require dialysis but could be transferred to rehabilitation 4 weeks later. Discussion: C. canimorsus is a gram-negative rod that occurs in the oral flora of dogs and cats and was first described in 1976. The transmission occurs through contact with the mucous membrane through bites and scratches. In the best of cases, the germ causes a local reaction, but, in particular in the case of immunocompromised, weakened patients, C. canimorsus shows a wide range of clinical presentations such as soft tissue infections, meningitis, endocarditis, septic arthritis, cholecystitis or pneumonia, up to an extremely severe fulminant septic clinical picture with multiple organ failure and mortality of over 25%. The most common severe clinical picture is registered in patients after splenectomy and in patients with diabetes, alcocholism or liver cirrhosis. Patients under immunosuppressive therapy or hematological malignancies also fall into a particularly at-risk group. Given the fulminant course of the disease, in the acute phase, diagnosis and treatment are focused on the acute care of a life-threatening patient. Since the symptoms develop very quickly, usually 1-8 days after the injury, but are very unspecific, C. canimorsus infection is still an extreme diagnostic challenge today, especially in the case of immunocompetent patients as in our case. Initially, the clinical picture is very often mistaken for a simple viral infection, which means that valuable time is lost before starting the therapy. A precise epidemiological history is extremely important in the timely diagnosis and treatment of C. canimorsus infection and crucial for the patient's chances of survival.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti, Javno zdravstvo i zdravstvena zaštita, Veterinarska medicina

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