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犬咬伤后引起的败血病:病例回顾。

Capnocytophaga canimorsis a cause of septicaemia following a dog bite: a case review.

机构信息

Clinical Nurse Level Two Critical Care Services, Calvary Healthcare Tasmania, Australia.

出版信息

Aust Crit Care. 2011 May;24(2):93-9. doi: 10.1016/j.aucc.2010.12.002. Epub 2011 Jan 15.

Abstract

Described in this study is the case of a 53-year-old woman who developed a life-threatening infection caused by the bacterium Capnocytophaga canimorsus (C. canimorsus), subsequent to being bitten by a dog. The patient presented to an Emergency Department with a 24-h history of diarrhoea and vomiting with dehydration but within 36 h of presentation developed an overwhelming severe sepsis with septic shock, disseminated intravascular coagulation, acute renal failure, metabolic acidosis and threatened acute respiratory failure requiring urgent intensive care intervention. At subsequent questioning her husband volunteered that she had been bitten on the wrist by the family dog 24h prior to the onset of symptoms; this bite had been extremely minor, requiring no treatment at the time and leaving only a very superficial wound. The causative organism was finally identified two weeks later as C. canimorsus, a common commensal in the oral flora of dogs. C. canimorsus has been reported as a rare cause of severe infection in susceptible individuals; however this case is of particular interest as there were no apparent predisposing factors conferring risk of severe infection. This case also raised significant practice issues for the treating hospital.

摘要

本研究描述了一位 53 岁女性的病例,她因被狗咬伤而感染了一种名为嗜吞噬细胞菌(Capnocytophaga canimorsus,C. canimorsus)的细菌,导致生命受到威胁。患者因腹泻和呕吐伴脱水症状就诊于急诊科,发病 24 小时,但在就诊后 36 小时内迅速发展为严重的败血症性休克、弥散性血管内凝血、急性肾衰竭、代谢性酸中毒和急性呼吸窘迫综合征,需要紧急重症监护干预。随后在询问病史时,她的丈夫主动报告称,在出现症状前 24 小时,患者被家里的狗咬伤了手腕;这次咬伤非常轻微,当时无需治疗,只留下了非常浅的伤口。两周后,最终确定病原体为嗜吞噬细胞菌,它是狗口腔菌群中的一种常见共生菌。嗜吞噬细胞菌已被报道为易感个体中一种罕见的严重感染原因;然而,这个病例特别有趣,因为没有明显的易感染因素导致严重感染。该病例还为治疗医院带来了重大的实践问题。

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