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[NEJM临床医学影像]: 犬咬二氧化碳嗜纤维菌感染
2020年10月18日 临床影像, 临床话题 暂无评论

Capnocytophaga canimorsus Infection

Robert D.H. Markewitz and Tobias Graf

N Engl J Med 2020; 383:1167
DOI: 10.1056/NEJMicm1916407

A 62-year-old man presented to the emergency department with a 1-day history of fever and a 3-day history of chest pain. His medical history was notable for coronary heart disease and for a splenectomy that he had undergone after a car accident. Four days before presentation, he had been bitten on the left hand by his dog and had sustained three bite wounds. Laboratory studies showed a white-cell count of 16,700 per cubic millimeter (reference range, 3900 to 10,200), a platelet count of 3100 per cubic millimeter (reference range, 15,000 to 37,000), and a procalcitonin level of more than 100 μg per liter (reference value, 0.05). Blood cultures were obtained, and treatment with broad-spectrum antibiotic agents, intravenous fluids, and norepinephrine was initiated. Review of a peripheral-blood smear showed the presence of both intracellular (arrow) and extracellular (arrowhead) bacilliform bacteria. Capnocytophaga canimorsus was cultured after 17 hours. C. canimorsus is part of the oral flora of healthy cats and dogs and can be transmitted to humans through animal bites. The bacterium can cause particularly severe infection in patients with a history of splenectomy. Despite treatment, the patient died 2 days after admission.

一名62岁男性患者因发热1天,胸痛3天到急诊科就诊。既往史包括冠心病及车祸后脾切除术。就诊前4天,患者左手被狗咬伤,共有3处伤口。实验室检查显示白细胞计数 16,700 /ml (参考范围, 3900 to 10,200),血小板计数 3100 /ml (参考范围, 15,000 to 37,000),降钙素原水平超过 100 μg/L (参考值, 0.05)。留取血培养,采用广谱抗生素、静脉输液及去甲肾上腺素治疗。外周血涂片发现细胞内 (箭号) 和细胞外 (箭头) 存在杆状细菌。17小时后培养分离到犬咬二氧化碳嗜纤维菌。犬咬二氧化碳嗜纤维菌是健康猫和犬类口腔正常菌群,可通过咬伤传染给人类。尤其在脾切除后患者,犬咬二氧化碳嗜纤维菌能够引起严重感染。尽管接受了积极治疗,入院2天后患者去世。

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