Capnocytophaga Canimorsus Skin Rash 40 M presents w/ N, V, severe epigastric pain. SHx: smoker, drinks 18 beers/day, monogamous with wife, bit by his dog 3d ago, dental cleaning 7d ago, recently installed air conditioning system. Bandemia, AKI. Diffuse blanching rash & mottling. Dx? When considering infections related to dog bites: consider organisms that colonize human skin & inoculate into soft tissue (Staph/Strep). Pasteurella multocida & Capnocytophaga canimorsus normal oral flora in dogs & latter can cause overwhelming sepsis. C. canimorsus fastidious gram-negative bacillus cause selsis after a dog or cat bite. symptoms from cellulitis to meningitis, endocarditis, sepsis, shock. Many w/ underlying r.f as asplenia, alcoholism, cirrhosis, or immunosuppression, although no r.f in approximately 40% Typical abrupt onset of symptoms.+purpuric rash → purpura fulminans & frank gangrene. sepsis due to profound inflammatory response → microvascular injury &endothelial damage; if hypoperfusion & inflammation persist → DIC, MODS, death. Myocarditis & culture-negative IE possible Patient's clinical history is the key to the diagnosis of C. canimorsus infection, because the organism is difficult to culture and may take up to 14 days to identify severe Capnocytophaga infection should be treated initially with a beta-lactam-beta-lactamase combination (pip-tazo) or extended spectrum cephalosporin or a carbapenem pending susceptibility & then adjust accordingly. Nonsevere: amoxicillin-clavulanate or clindamycin Antibiotic prophylaxis with amoxicillin-clavulanate for five days following a dog bite is appropriate for patients at highest risk (including patients who are asplenic, alcoholic, receiving corticosteroids, or otherwise immunocompromised). Indiana University Infectious Diseases Fellowship @IUIDfellowship #Capnocytophaga #Canimorsus #Skin #Rash #dermatology #clinical #photo
