Renal abscess with Capnocytophaga canimorsus infection from a dog bite 2022 Trainor-Moss et al

Abstract

We present a case of renal abscess caused by Capnocytophaga canimorsus infection in a previously healthy middle-aged man. He presented with sepsis and an acute kidney injury, and although not identified on his initial assessment, he had sustained a dog bite 5 days prior to hospital admission. The patient developed left loin pain and imaging investigation revealed a renal abscess. Gram stain showed a gram-negative bacillus and C. canimorsus was identified by 16S PCR from these samples along with aspirate from the abscess. The patient responded to treatment with carbapenems but required a prolonged course. His clinical condition was further complicated by a pleural effusion and the development of fatigue symptoms consistent with a post-infection chronic fatigue syndrome. We present this case which we believe to be the first documented case of C. canimorsus causing renal abscess. We discuss the challenges relating to investigation, management and the importance of detailed diagnostic exposure histories in sepsis of unknown origin.

Paywall, https://casereports.bmj.com/content/15/12/e250447

 

Unfortunately the article is behind a pay wall so it is not possible to tell from the abstract what criteria they used to diagnose ‘fatigue symptoms consistent with a post-infection chronic fatigue syndrome’, though the focus on fatigue and the failure to use the term ME/CFS is of concern. I am not sure what the official position on naming now is in Scotland though obviously the current NICE guidelines do not automatically apply there. Also it would be interesting to know what time scale is involved though it sounds fairly early to be diagnosing ME/CFS when the hospital admission leading to identifying the abscess was only five days after the initial dog bite.

It is not unknown for bacterial infection to be associated with the onset of ME/CFS, but a viral infection is more common, so it would also be of interest to know if they had tested for previous viral exposure, particularly EBV or Covid-19. However, it does seems strange that they are considering an ME/CFS diagnosis so apparently soon, particularly whilst the patient has an active bacterial infection. How easy would it be to unambiguously identify PEM whilst an active bacterial infection and fluid on the lungs are ongoing?

 

Looks like the immunosuppressed (those lacking a spleen and alcoholics among the conditions listed) are at risk.
Otherwise healthy people, not:

https://en.wikipedia.org/wiki/Capnocytophaga_canimorsus

My takeway message is: to be careful around dogs and cats, first aid to bites and scratches and if you're immunocompromised, alcoholic, a smoker, or asplenic, or an older individual, perhaps pet ownership could be a potential health risk of contracting this sometimes harmful bacterium which lives in the mouth of many cats and dogs.

Also, remember to report bites and proximity to cats and dogs to MDs should any symptoms arise.