Capnocytophaga canimorsus
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| Capnocytophaga canimorsus |
Capnocytophaga canimorsus is a Gram-negative bacillus (rod-shaped) bacterium that causes a zoonotic disease in mostly asplenic patients. It is a member of the normal gingival flora of dogs and cats. It causes fulminant sepsis with disseminated intravascular coagulation (DIC), in typically asplenic patients.
Treatment
Treatment is via antibiotics with the possible aid of activated protein C or plasmapheresis in severe cases.
Following animal bites, co-amoxiclav is often given to asplenic individuals to prevent disseminated infection; but in patients who are allergic to penicillins, the combination of doxycycline and metronidazole (to cover anaerobic organisms) may be used instead.
In patients with sepsis, treatment with imipenem, clindamycin, or a penicillin-β-lactamase inhibitor combination (e.g., co-amoxiclav or piperacillin-tazobactam) should be used.[1] Doxycycline is active in vitro[2][3] but there is little experience in using it in treating sepsis, and in many countries there is no intravenous form available, which suggests that it should be reserved for when no other options are available.
Capnocytophaga canimorsus was AKA Dysgonic fermenter type 2 (DF2).
Antimicrobial Regimen
- Capnocytophaga canimorsus[4]
- 1. Severe cellulitis/sepsis or endocarditis
- Preferred regimen (1) (Beta-lactam/beta-lactamase inhibitor): Ampicillin/sulbactam 3 g IV q6h
- Preferred regimen (2) (Non-beta-lactamase producing): Penicillin G 2-4 MU IV q24h
- Alternative regimen (1): Ceftriaxone 1-2 g IV q24h
- Alternative regimen (2): Meropenem 1 g IV q8h
- Alternative regimen (3) (complicated infections or immunocompromise): Clindamycin 600 mg IV q8h may be combined with above agents
- Note (1): Resistance to aztreonam described, and variable susceptibility reported to TMP-SMX and aminoglycosides
- Note (2): For endocarditis, alternatives to penicillins not well established, treated for duration of 6 weeks
- Note (3): For non-endocarditis infections, duration not well established, but most authorities recommend at least 14-21 days of therapy
- 2. Mild cellulitis/dog or cat bites
- Preferred regimen (1): Amoxicillin/clavulanate 500 mg PO q8h or 875 mg PO bid
- Preferred regimen (2): Amoxicillin 500 mg PO q8h
- Alternative regimen (1): Clindamycin 300 mg PO q6h
- Alternative regimen (2): Doxycycline 100 mg PO bid
- Alternative regimen (3): Clarithromycin 500 mg PO bid
- Alternative regimen (4): Moxifloxacin 400 mg PO qd
- 3. Meningitis or brain abscess
- Preferred regimen (1): Ceftriaxone 2 g IV q12h AND Ampicillin 2 g IV q4h
- Preferred regimen (2) (if beta-lactamase producing or polymicrobial brain abscess): Imipenem/Cilastin 1000 mg q6-8h AND Clindamycin 600 mg IV q8h
- 4. Prevention
- Although no firm data supports this recommendation, many clinicians do give prophylaxis for dog and cat bites in asplenic patients with Amoxicillin/clavulanate for 7-10 days
References
- ↑ Jolivet-Gougeon A, Sixou J, Tamanai-Shacoori Z, Bonnaure-Mallet M (2007). "Antimicrobial treatment of Capnocytophaga infections". Int J Antimicrob Agents. 29 (4): 367–373. doi:10.1016/j.ijantimicag.2006.10.005.
- ↑ Chraibi DI, Girond S, Michel G (1990). "Evaluation of the activity of four antimicrobial agents using an in vitro rapid micromethod against oral streptococci and various bacterial strains implicated in periodontitis". J Periodontal Res. 25 (4): 201&ndash, 6. PMID 2142728.
- ↑ Heimdahl A, Nord CE (1988). "Antimicrobial agents in the treatment of periodontal diseases: special aspects on tetracycline and doxycycline". Scand J Infect Dis Suppl. 53: 35&ndash, 45. PMID 3047856.
- ↑ Bartlett, John (2012). Johns Hopkins ABX guide : diagnosis and treatment of infectious diseases. Burlington, MA: Jones and Bartlett Learning. ISBN 978-1449625580.
External links