Dysgonic Fermenter Type 2 Septicemia With Purpura Fulminans

Herbst, Jay S.

doi:10.1001/archderm.1989.01670220076012

Cited by 21 publications

(4 citation statements)

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“…Regarding treatment, penicillin has been reported as the drug of choice in the past, although clinical comparative trials are lacking [12]. Since beta-lactamase activity has been reported among some Capnocytophaga species [33], clinical isolates should be tested for β-lactamase production to inform the optimal treatment regimen.…”

Section: Discussionmentioning

confidence: 99%

Capnocytophaga canimorsus Meningitis: Diagnosis Using Polymerase Chain Reaction Testing and Systematic Review of the Literature

Hansen

Crum-Cianflone

2019

Infect Dis Ther

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Introduction Capnocytophaga canimorsus infections are associated with dog bites, especially in asplenic or immunocompromised patients, and typically manifest as sepsis and/or bacteremia. Meningitis has been rarely described, and its diagnosis may be delayed due to poor or slow growth using traditional culture techniques. We provide our experience using polymerase chain reaction (PCR) to establish the diagnosis and perform a comprehensive review of C. canimorsus meningitis cases to provide summary data on the clinical manifestations, diagnosis, and outcomes of this unusual infection. Methods A systematic review of the peer-reviewed English literature (PubMed, Embase, Ovid Medline) from January 1966 to March 2018 was conducted to identify cases of C. canimorsus meningitis. Data collected included demographics, risk factors, cerebrospinal fluid (CSF) findings, PCR results, treatments, and outcomes. Descriptive statistics are presented as numbers (percentages) and medians (ranges). Results A total of 37 patients were reviewed with a median age of 63 years (12 days to 83 years) with a male predominance (76%). A relatively low proportion had an immunocompromised state (16% splenectomy and 5% steroid use); the most common risk factor was alcoholism (19%). Fifty-nine percent reported a dog bite (all within ≤ 14 days prior to presentation), while 22% reported a non-bite dog exposure, 3% reported cat bite, and 3% reported both dog and cat exposures; 11% reported no animal contact. CSF parameters included a median white count of 1024 cells/mm 3 , 81% had neutrophilic predominance, median protein of 190 mg/dl, and median glucose CSF/serum ratio 0.23. In 54% of cases, blood cultures were positive for C. canimorsus (median, 4 days) and 70% had positive CSF cultures (median, 5 days). PCR established the diagnosis in eight (22%) cases. Antibiotic therapy was given for a median of 15 days (range, 7 to 42 days). Prognosis was overall favorable with only one (3%) death reported and adverse neurologic and/or physical sequelae in 19% of the survivors. Conclusion C. canimorsus meningitis is a rare but increasingly important clinical entity occurring in patients of all ages, typically after dog exposure. While classically considered an infection among immunocompromised patients, most cases have occurred in previously healthy, immunocompetent persons. Diagnosis may be rapidly established by PCR, and this test should be considered in culture-negative cases with associated exposures. Outcome was generally favorable after a median antibiotic duration of 15 days.

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Section: Discussionmentioning

confidence: 99%

Capnocytophaga canimorsus Meningitis: Diagnosis Using Polymerase Chain Reaction Testing and Systematic Review of the Literature

Hansen

Crum-Cianflone

2019

Infect Dis Ther

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“…Human infection is characterized by necrotizing eschar at the site of the bite. Alcoholics and patients who have undergone splenectomy are particularly predisposed to severe septicemia following the bite (Herbst et al, 1989).…”

Section: Gram-negative Bacterial Skin Infectionsmentioning

confidence: 99%

Skin Microflora and Bacterial Infections of the Skin

Chiller

Selkin

Murakawa

2001

Journal of Investigative Dermatology Symposium Proceedings

443

292

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The skin is a milieu for controlled bacterial growth. Skin supports the growth of commensal bacteria, which protect the host from pathogenic bacteria. Environmental and local factors, host immunity, and organism adherence and virulence are intricately related to cutaneous infection. Resident gram-positive bacteria include Staphylococcus, Micrococcus, and Corynebacterium sp. Staphylococcus aureus and Streptococcus pyogenes are notoriously pathogenic in the skin. In order for bacteria to be pathogenic, they must be able to adhere to, grow on, and invade the host. Bacteria possess numerous virulence genes that allow for growth in these privileged niches. Epidermal infections caused by S. aureus and S. pyogenes include impetigo and ecthyma. Dermal infections consist of erysipelas, cellulitis, and necrotizing fasciitis. The pilosebaceous unit is involved in folliculitis, furunculosis, and carbunculosis. Moreover, S. aureus and S. pyogenes produce toxins that may elicit a superantigen response, causing massive release of cytokines. Staphylococcal scalded skin syndrome, toxic shock syndrome, and scarlet fever are all superantigen-mediated. Gram-negative organisms such as Pseudomonas aeruginosa, Pasteurella multocida, Capnocytophaga canimorsus, Bartonella sp., Klebsiella rhinoscleromatis, and Vibrio vulnificus are not typical resident skin microflora but may cause cutaneous infection.

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“…Hematologic evidence of DIC is usually observed, and protein C levels have been shown to be reduced in several cases of purpura fulminans secondary to Hemophilus influenza sepsis (10) and meningococcemia (10,11). In particular, gram-negative bacilli like Dysgonic fermenter type 2 are increasingly detected as causative organisms of purpura fulminans (12). Although the reason why only certain patients with DIC associated with septicemia develop purpura fulminans is not known, depression of protein C levels would occur in those with marked liver dysfunction such as an advanced alcoholic cirrhosis (4,13) because of its inability to replace the rapidly used protein C.…”

Section: Discussionmentioning

confidence: 99%

Purpura Fulminans Secondary to Xanthomonas Maltophilia Sepsis in an Adult with Aplastic Anemia

Kato

Morioka

1991

The Journal of Dermatology

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Purpura fulminans is a rare disease characterized by purpura ecchymosis, hypotension, and fever associated with disseminated intravascular coagulation. It often begins as a benign infectious process and subsequently progresses to a severe, catastrophic outcome. It is recognized to originate from congenital or acquired protein C deficiency. We present an unusual case of an adult with Xanthomonas maltophilia sepsis that subsequently developed into purpura fulminans with involvement of the four extremities. We discuss the importance of the protein C system in coagulation homeostasis and its relationship to purpura fulminans.

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Dysgonic Fermenter Type 2 Septicemia With Purpura Fulminans

Cited by 21 publications

References 1 publication

Capnocytophaga canimorsus Meningitis: Diagnosis Using Polymerase Chain Reaction Testing and Systematic Review of the Literature

Capnocytophaga canimorsus Meningitis: Diagnosis Using Polymerase Chain Reaction Testing and Systematic Review of the Literature

Skin Microflora and Bacterial Infections of the Skin

Purpura Fulminans Secondary to Xanthomonas Maltophilia Sepsis in an Adult with Aplastic Anemia

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