I seem to write about this bug a lot - disproportionately for a rare cause of infection - but it just keeps getting attention. Reading the title of a recent article "Woman loses legs, fingers to rare infection from dog bite," it was an easy guess that the infection was caused by Capnocytophaga canimorsus. That's the type of dramatic disease this bug can cause, and as hard as it is to say "lucky" about someone that loses digits or limbs, they are lucky since death rates are very high with this infection.
Capnocytophaga canimorsus is a strange little bacterium. It's found in the mouth of pretty much every dog, so people get exposed to it quite commonly, yet it rarely causes disease. However, when it does cause disease (often after an otherwise inconsequential bite), it's bad.
In the most recent report, a 48 year old woman received some minor bites breaking up a fight between two family dogs. The next night, she had a fever and was vomiting, and things went downhill from there (click here to read the full story). An unusual aspect of this case was that the woman didn't have any of the risk factors that are typically present in a person who gets a Capno infection, such as not having a spleen, being an alcoholic or having an immunosuppressive disease. It is unclear why this bug, which is normally quite innocuous to an otherwise healthy person, almost killed her.
An infectious disease physician at the hospital made a few recommendations:
"If a person experiences a dog or cat bite it’s reasonable to have it examined, especially if it’s swollen, painful or red."
- Pretty good advice. It's never a bad idea to get a bite examined, and in some situations, it should be mandatory (e.g. bites over the hands or face, bites to immunocompromised individuals).
"It’s important for the public to not only closely watch animal bites but also to make sure pets are current on their shots and that the owners are up-to-date on tetanus shots."
- Good general advice, but not really related to Capno.
"Dog owners should use caution when trying to break up a fight between animals, she said. Instead of reaching near a dog’s mouth, pull the tail, she advised."
- I'm not so sure about this one. Grabbing a tail of a fighting dog sounds like a good way to get bitten, although reaching near the mouth of a fighting dog would be just as bad or worse.
"Animals that are the source of such infections don’t need to be euthanized, Mondy said, but the dog that bit Sullins was put down for various reasons, including increasing aggressiveness and concerns about exposing babies in the family to the animal."
- Capnocytophaga should never be a reason to euthanize a dog since basically every dog is a carrier. It doesn't matter if there's a baby in the house or not. If the dog's dangerous because of its biting, that's a different story.
This article, along with various other recent reports, makes me ask a couple of questions:
Are Capnocytophaga canimorsus infections getting more common?
- I don't know. It's possible, as disease trends can change. It could also be that reporters are picking up these cases more often since they tend to be dramatic.
Are more low-risk people becoming infected?
- This one concerns me a bit. Traditionally, when I saw a report of Capnocytophaga in the literature or lay press, I could guarantee I'd eventually come across a statement about the person not having a spleen, or less commonly being an alcoholic or having some other immunocompromising problem. Again, it may just be my impression but I'm seeing more reports where a risk factor isn't apparent. It could be that an immunocompromising problem is there but is not known, but this report, along with some other recent news articles and a published case report, raise concern about the potential for this bug to cause disease in the absence of traditional risk factors.
This doesn't mean owners should fear their dogs, since it's still a very rare problem. However, it re-inforces the need to:
- Reduce the risk of bites through proper training (of both the dog and people who interact with it).
- Use prompt and proper first aid measures after any bite.
- Ensure that people who are at high risk for infection, particularly people without a spleen and those with compromised immune systems, always seek medical attention promptly after a bite.