Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment
<i>Capnocytophaga canimorsus</i> is zoonotic agent isolated from humans bitten by dogs or cats. Although rare, severe infection usually affects male patients over the age of 50, asplenic or immunocompromised. Diagnosis is often challenging, often missing a history of contact with dogs or...
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MDPI AG
2022-01-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/12/2/260 |
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| author | Fulvio Nisi Andrea Dipasquale Elena Costantini Enrico Giustiniano Umberto Ripani Maurizio Cecconi |
| author_facet | Fulvio Nisi Andrea Dipasquale Elena Costantini Enrico Giustiniano Umberto Ripani Maurizio Cecconi |
| author_sort | Fulvio Nisi |
| collection | DOAJ |
| description | <i>Capnocytophaga canimorsus</i> is zoonotic agent isolated from humans bitten by dogs or cats. Although rare, severe infection usually affects male patients over the age of 50, asplenic or immunocompromised. Diagnosis is often challenging, often missing a history of contact with dogs or pre-existing wounds. Mortality rate is extremely high, since infection can lead to fulminant sepsis. We report a case of a patient admitted to ED for septic shock of unknown origin. Severe sepsis developed since our patient was asplenic and possessed multiple comorbidities. Due to hypoxia and respiratory failure, the patient was promptly intubated and mechanically ventilated. Supportive treatment for hemodynamic shock was administered. Cultures were obtained in the ED and empiric antibiotic therapy with piperacillin/tazobactam was started, aiming at infection control. As for source identification, common infectious etiologies, SARS-CoV-2 swab, bronchoalveolar lavage and urine cultures were negative. Blood cultures proved Gram-negative rods after 12 h incubation and <i>C. canimorsus</i> was identified on day 4. During ICU stay, clinical conditions gradually improved, and source control proved to be effective. Culture samples collection and starting empiric antibiotic treatment are the essential points in ensuring patient survival, especially in sepsis or septic shock of unknown origin or uncommon etiology, as in our case. Why should an emergency physician be aware of this? <i>C. canimorsus</i> bacteremia is rare and difficult to diagnose. Although considering patient history in such cases is crucial, laboratory results are often delayed. Hence, the chance of survival is dependent on prompt culture samples collection and start of empiric antibiotic treatment, along with supportive treatment. |
| first_indexed | 2024-03-09T22:12:24Z |
| format | Article |
| id | doaj.art-7ec03ae9e56e4c1d8a29639cf383aece |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-09T22:12:24Z |
| publishDate | 2022-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-7ec03ae9e56e4c1d8a29639cf383aece2023-11-23T19:29:01ZengMDPI AGDiagnostics2075-44182022-01-0112226010.3390/diagnostics12020260Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt TreatmentFulvio Nisi0Andrea Dipasquale1Elena Costantini2Enrico Giustiniano3Umberto Ripani4Maurizio Cecconi5Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, ItalyDepartment of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, ItalyDepartment of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, ItalyDepartment of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, ItalyDivision of Clinic Anaesthesia, Department of Emergency Hospital Riuniti, Conca Street 71, 60126 Ancona, ItalyDepartment of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy<i>Capnocytophaga canimorsus</i> is zoonotic agent isolated from humans bitten by dogs or cats. Although rare, severe infection usually affects male patients over the age of 50, asplenic or immunocompromised. Diagnosis is often challenging, often missing a history of contact with dogs or pre-existing wounds. Mortality rate is extremely high, since infection can lead to fulminant sepsis. We report a case of a patient admitted to ED for septic shock of unknown origin. Severe sepsis developed since our patient was asplenic and possessed multiple comorbidities. Due to hypoxia and respiratory failure, the patient was promptly intubated and mechanically ventilated. Supportive treatment for hemodynamic shock was administered. Cultures were obtained in the ED and empiric antibiotic therapy with piperacillin/tazobactam was started, aiming at infection control. As for source identification, common infectious etiologies, SARS-CoV-2 swab, bronchoalveolar lavage and urine cultures were negative. Blood cultures proved Gram-negative rods after 12 h incubation and <i>C. canimorsus</i> was identified on day 4. During ICU stay, clinical conditions gradually improved, and source control proved to be effective. Culture samples collection and starting empiric antibiotic treatment are the essential points in ensuring patient survival, especially in sepsis or septic shock of unknown origin or uncommon etiology, as in our case. Why should an emergency physician be aware of this? <i>C. canimorsus</i> bacteremia is rare and difficult to diagnose. Although considering patient history in such cases is crucial, laboratory results are often delayed. Hence, the chance of survival is dependent on prompt culture samples collection and start of empiric antibiotic treatment, along with supportive treatment.https://www.mdpi.com/2075-4418/12/2/260critical care medicinesepsisinteresting cases in emergency medicine |
| spellingShingle | Fulvio Nisi Andrea Dipasquale Elena Costantini Enrico Giustiniano Umberto Ripani Maurizio Cecconi Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment Diagnostics critical care medicine sepsis interesting cases in emergency medicine |
| title | Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment |
| title_full | Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment |
| title_fullStr | Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment |
| title_full_unstemmed | Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment |
| title_short | Surviving Capnocytophaga Canimorsus Septic Shock: Intertwining a Challenging Diagnosis with Prompt Treatment |
| title_sort | surviving capnocytophaga canimorsus septic shock intertwining a challenging diagnosis with prompt treatment |
| topic | critical care medicine sepsis interesting cases in emergency medicine |
| url | https://www.mdpi.com/2075-4418/12/2/260 |
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