Capnocytophaga Bacteremia Precipitating Severe Thrombocytopenia and Preterm Labor in an Asplenic Host

Abstract

Capnocytophaga species are gram-negative bacilli that inhabit mammalian oral surfaces and can cause opportunistic infection, especially in asplenic patients. The species Capnocytophaga canimorsus is particularly associated with dog bites and is known to cause endocarditis, meningitis, and sepsis in the general population. In pregnant patients, infections tied to Capnocytophaga species from human flora have been associated with preterm labor, chorioamnionitis, and neonatal septicemia. There is little known about the effects of zoonotically-acquired Capnocytophaga infection in pregnant patients. In this case report, we present a patient with Capnocytophaga bacteremia acquired after a dog bite associated with profound thrombocytopenia and preterm labor. Dog bites are common in the United States, and we present basic recommendations for management of dog bites in pregnant patients in order to avoid morbidity associated with delay in time to antibiotic treatment of infection as described in this case.

A classic case of Capnocytophaga induced septic shock with multi-organ failure after a dog bite in an asplenic patient

“…While profound thrombocytopenia, prolonged PT and PTT, elevated D -dimers and low fibrinogen level supported the existence of DIC, the presence of greater than normal factor VIII activity and the absence of schistocytes or platelet clumps raise concerns for other etiologies. Acute hepatic failure can similarly present with a deranged coagulation profile and elevated factor VIII activity, while the presence of bone marrow suppression in fulminant sepsis can lead to thrombocytopenia as seen in this patient [12] , [23] , [24] . Therefore, we predict that our patient sustained acute liver failure and DIC, in the presence or absence of bone marrow suppression.…”

“…Among a variety of reasons for immunocompromise, the absence of spleen remains the most common associated risk factor for systemic infections with Capnocytophaga spp. after a dog bite [1] , [10] , [11] , [12] , [13] , [14] .…”

Lethal Waterhouse–Friderichsen syndrome caused by Capnocytophaga canimorsus in an asplenic patient

“…2 Department of Cardiology, University Hospital Münster, Münster, Germany. 3 Department of Medicine D, Division of General Internal Medicine, Nephrology, and Rheumatology, University Hospital Münster, Münster, Germany. 4 Gerhard Domagk Institute of Pathology, University Hospital Münster, Münster, Germany.…”

“…The total number of documented cases of C. canimorsus infections from 1990 to 2014 is 292 with a Case-fatality rate about 24% [2]. Splenectomy and alcohol abuse are common predisposing factors, but up to 40% of patients have no obvious risk factor, implying that C. canimorsus cannot solely be considered an opportunistic pathogen Open Access [2][3][4][5]. A history of dog scratching or biting, but also licking of pre-existing wounds is common [2].…”