Butler T
Department of Microbiology and Immunology, Ross University School of Medicine, Portsmouth, Dominica, West Indies,
Eur J Clin Microbiol Infect Dis. 2015 Jul;34(7):1271-80. doi: 10.1007/s10096-015-2360-7. Epub 2015 Apr 1.
Newly named in 1989, Capnocytophaga canimorsus is a bacterial pathogen found in the saliva of healthy dogs and cats, and is transmitted to humans principally by dog bites. This review compiled all laboratory-confirmed cases, animal sources, and virulence attributes to describe its epidemiology, clinical features, and pathogenesis. An estimated 484 patients with a median age of 55 years were reported, two-thirds of which were male. The case-fatality rate was about 26%. Its clinical presentations included severe sepsis and fatal septic shock, gangrene of the digits or extremities, high-grade bacteremia, meningitis, endocarditis, and eye infections. Predispositions were prior splenectomy in 59 patients and alcoholism in 58 patients. Dog bites before illness occurred in 60%; additionally, in 27%, there were scratches, licking, or other contact with dogs or cats. Patients with meningitis showed more advanced ages, higher male preponderance, lower mortality, and longer incubation periods after dog bites than patients with sepsis (p < 0.05). Patients with prior splenectomy presented more frequently with high-grade bacteremia than patients with intact spleens (p < 0.05). The organism possesses virulence attributes of catalase and sialidase production, gliding motility, cytotoxin production, and resistance to killing by serum complement due to its unique lipopolysaccharide. Penicillin is the drug of choice, but some practitioners prefer third-generation cephalosporins or beta-lactamase inhibitor combinations. C. canimorsus has emerged as a leading cause of sepsis, particularly post-splenectomy sepsis, and meningitis after dog bites.
犬咬二氧化碳嗜纤维菌于1989年被重新命名，是一种存在于健康犬猫唾液中的细菌病原体，主要通过犬类咬伤传播给人类。本综述汇总了所有实验室确诊病例、动物来源和毒力特征，以描述其流行病学、临床特征和发病机制。据报道，估计有484例患者，中位年龄为55岁，其中三分之二为男性。病死率约为26%。其临床表现包括严重脓毒症和致命性感染性休克、手指或肢体坏疽、高度菌血症、脑膜炎、心内膜炎和眼部感染。易感因素包括59例患者曾行脾切除术，58例患者酗酒。60%的患者在发病前有犬类咬伤史；此外，27%的患者有抓伤、舔舐或与犬猫的其他接触史。与脓毒症患者相比，脑膜炎患者年龄更大、男性占比更高、死亡率更低且犬类咬伤后的潜伏期更长（p < 0.05）。与脾脏完整的患者相比，曾行脾切除术的患者更常出现高度菌血症（p < 0.05）。该菌具有产生过氧化氢酶和唾液酸酶、滑行运动、产生细胞毒素以及因其独特的脂多糖而对血清补体杀伤具有抗性等毒力特征。青霉素是首选药物，但一些从业者更喜欢使用第三代头孢菌素或β-内酰胺酶抑制剂组合。犬咬二氧化碳嗜纤维菌已成为脓毒症的主要病因，尤其是脾切除术后脓毒症以及犬类咬伤后脑膜炎的主要病因。
