BACKGROUND: Invasive infections caused by Capnocytophaga canimorsus are rare. Immunocompromised patients, who report being bitten by or having a close contact with an animal, represent a high-risk group for this infection. There are only few dozens of infections by this bacteria manifesting as purulent meningitis reported worldwide. The reported case is a first reported case of purulent meningitis caused by by Capnocytophaga canimorsus in Czech Republic with only a limited risk factor history. CASE PRESENTATION: The patient, a 74 years old man, was referred to the infectious diseases department of a teaching hospital with clear signs of developing purulent meningitis. His anamnestic data did not show any unusual findings. He was treated for compensated diabetes mellitus type II. The blood cultures were negative and the etiological agent did not grow from the cerebrospinal fluid (CSF) on common media. Eventually, it was identified by detecting pan-bacterial DNA and DNA sequencing. Subsequently, the pathogen was confirmed by anaerobic cultivation from CSF. Only after then the patient recalled being bitten by his German shepherd puppy during play. The patient was successfully treated intravenously by ceftriaxone. CONCLUSIONS: Purulent meningitis caused by Capnocytophaga spp. is a rare disease, but it needs to be considered in patients at risk with pre-existing conditions, who report close contact with or being bitten by an animal. It is important to test for this microbe in cases with negative microbiological results for the more common agents.

Department of Clinical Microbiology Charles University School of Medicine and Faculty Hospital Hradec Kralove Czech Republic

Department of Infectious Diseases Charles University School of Medicine and Faculty Hospital Hradec Kralove Czech Republic

Faculty of Military Health Sciences University of Defense Trebesska 1575 50001 Hradec Kralove Czech Republic

See more in PubMed

Brenner DJ, Hollis DG, Fanning GR, Weaver RE. Capnocytophaga canimorsus sp. nov. (formerly CDC group DF-2), a cause of septicemia following dog bite, and C. cynodegmi sp. nov., a cause of localized wound infection following dog bite. J Clin Microbiol. 1989;27(2):231–235. doi: 10.1128/JCM.27.2.231-235.1989. PubMed DOI PMC

Dobosz P, Martyna D, Stefaniuk E, Szczypa K, Hryniewicz W. Severe sepsis after dog bite caused by Capnocytophaga canimorsus. Polski Merkuriusz Lekarski. 2015;39(232):219–222. PubMed

Janda JM. 235 - Capnocytophaga. In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8. Philadelphia: Content Repository Only!; 2015. pp. 2645–2648.e2641.

Lion C, Escande F, Burdin JC. Capnocytophaga canimorsus infections in human: review of the literature and cases report. Eur J Epidemiol. 1996;12(5):521–533. doi: 10.1007/BF00144007. PubMed DOI

Pers C, Gahrn-Hansen B, Frederiksen W. Capnocytophaga canimorsus septicemia in Denmark, 1982-1995: review of 39 cases. Clin Infect Dis. 1996;23(1):71–75. doi: 10.1093/clinids/23.1.71. PubMed DOI

Bobo RA, Newton EJ. A previously undescribed gram-negative bacillus causing septicemia and meningitis. Am J Clin Pathol. 1976;65(4):564–569. doi: 10.1093/ajcp/65.4.564. PubMed DOI

Westwell AJ, Kerr K, Spencer MB, Hutchinson DN. DF-2 infection. Bmj. 1989;298(6666):116–117. doi: 10.1136/bmj.298.6666.116-c. PubMed DOI PMC

Umeda K, Hatakeyama R, Abe T, Takakura K, Wada T, Ogasawara J, Sanada S, Hase A. Distribution of Capnocytophaga canimorsus in dogs and cats with genetic characterization of isolates. Vet Microbiol. 2014;171(1–2):153–159. doi: 10.1016/j.vetmic.2014.03.023. PubMed DOI

Shin H, Mally M, Kuhn M, Paroz C, Cornelis GR. Escape from immune surveillance by Capnocytophaga canimorsus. J Infect Dis. 2007;195(3):375–386. doi: 10.1086/510243. PubMed DOI

Meyer S, Shin H, Cornelis GR. Capnocytophaga canimorsus resists phagocytosis by macrophages and blocks the ability of macrophages to kill other bacteria. Immunobiology. 2008;213(9–10):805–814. doi: 10.1016/j.imbio.2008.07.019. PubMed DOI

Gaastra W, Lipman LJ. Capnocytophaga canimorsus. Vet Microbiol. 2010;140(3–4):339–346. doi: 10.1016/j.vetmic.2009.01.040. PubMed DOI

Shin H, Mally M, Meyer S, Fiechter C, Paroz C, Zaehringer U, Cornelis GR. Resistance of Capnocytophaga canimorsus to killing by human complement and polymorphonuclear leukocytes. Infect Immun. 2009;77(6):2262–2271. doi: 10.1128/IAI.01324-08. PubMed DOI PMC

Ittig S, Lindner B, Stenta M, Manfredi P, Zdorovenko E, Knirel YA, dal Peraro M, Cornelis GR, Zahringer U. The lipopolysaccharide from Capnocytophaga canimorsus reveals an unexpected role of the core-oligosaccharide in MD-2 binding. PLoS Pathog. 2012;8(5):e1002667. doi: 10.1371/journal.ppat.1002667. PubMed DOI PMC

Mally M, Paroz C, Shin H, Meyer S, Soussoula LV, Schmiediger U, Saillen-Paroz C, Cornelis GR. Prevalence of Capnocytophaga canimorsus in dogs and occurrence of potential virulence factors. Microbes Infect. 2009;11(4):509–514. doi: 10.1016/j.micinf.2009.02.005. PubMed DOI

Hloch O, Mokra D, Masopust J, Hasa J, Charvat J. Antibiotic treatment following a dog bite in an immunocompromized patient in order to prevent Capnocytophaga canimorsus infection: a case report. BMC Res Notes. 2014;7:432. doi: 10.1186/1756-0500-7-432. PubMed DOI PMC

Butler T. Capnocytophaga canimorsus: an emerging cause of sepsis, meningitis, and post-splenectomy infection after dog bites. Eur J Clin Microbiol Infect Dis. 2015;34(7):1271–1280. doi: 10.1007/s10096-015-2360-7. PubMed DOI

Le Moal G, Landron C, Grollier G, Robert R, Burucoa C. Meningitis due to Capnocytophaga canimorsus after receipt of a dog bite: case report and review of the literature. Clin Infect Dis. 2003;36(3):e42–e46. doi: 10.1086/345477. PubMed DOI

van Samkar A, Brouwer MC, Schultsz C, van der Ende A, van de Beek D. Capnocytophaga canimorsus meningitis: three cases and a review of the literature. Zoonoses Public Health. 2016;63(6):442–448. doi: 10.1111/zph.12248. PubMed DOI

Arias-Constanti V, de la Maza Trenchs-Sainz V, Sanz-Marcos NE, Guitart-Pardellans C, Gene-Giralt A, Luaces-Cubells C. Invasive disease by streptococcus pyogenes: patients hospitalized for 6 years. Enferm Infecc Microbiol Clin. 2018;36(6):352–356. doi: 10.1016/j.eimc.2017.06.005. PubMed DOI

Imohl M, Fitzner C, Perniciaro S, van der Linden M. Epidemiology and distribution of 10 superantigens among invasive streptococcus pyogenes disease in Germany from 2009 to 2014. PLoS One. 2017;12(7):e0180757. doi: 10.1371/journal.pone.0180757. PubMed DOI PMC

Oligbu G, Collins S, Sheppard CL, Fry NK, Slack M, Borrow R, Ladhani SN. Childhood deaths attributable to invasive pneumococcal disease in England and Wales, 2006-2014. Clin Infect Dis. 2017;65(2):308–314. doi: 10.1093/cid/cix310. PubMed DOI

Polkowska A, Toropainen M, Ollgren J, Lyytikainen O, Nuorti JP. Bacterial meningitis in Finland, 1995-2014: a population-based observational study. BMJ Open. 2017;7(5):e015080. doi: 10.1136/bmjopen-2016-015080. PubMed DOI PMC

Que Y-A, Moreillon P. 196 - Staphylococcus aureus (Including Staphylococcal Toxic Shock Syndrome) In: Bennett JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8. Philadelphia: Content Repository Only!; 2015. p. 2237.

Arakaki L, Ngai S, Weiss D. Completeness of Neisseria meningitidis reporting in New York City, 1989-2010. Epidemiol Infect. 2016;144(11):2374–2381. doi: 10.1017/S0950268816000406. PubMed DOI PMC

Fukusumi M, Kamiya H, Takahashi H, Kanai M, Hachisu Y, Saitoh T, Ohnishi M, Oishi K, Sunagawa T. National surveillance for meningococcal disease in Japan, 1999-2014. Vaccine. 2016;34(34):4068–4071. doi: 10.1016/j.vaccine.2016.06.018. PubMed DOI

Rivero-Calle I, Vilanova-Trillo L, Pardo-Seco J, Salvado LB, Quinteiro LI, Martinon-Torres F, Network MR. The burden of pediatric invasive meningococcal disease in Spain (2008-2013) Pediatr Infect Dis J. 2016;35(4):407–413. doi: 10.1097/INF.0000000000001048. PubMed DOI

Sall O, Stenmark B, Glimaker M, Jacobsson S, Molling P, Olcen P, Fredlund H. Clinical presentation of invasive disease caused by Neisseria meningitidis serogroup Y in Sweden, 1995 to 2012. Epidemiol Infect. 2017;145(10):2137–2143. doi: 10.1017/S0950268817000929. PubMed DOI PMC

Stephens DS, Apicella MA. In: 213 - Neisseria meningitidis. In: Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8. Bennett JE, Dolin R, Blaser MJ, editors. Philadelphia: Content Repository Only!; 2015. pp. 2425–2445.e2426.

Zajkowska J, Krol M, Falkowski D, Syed N, Kamienska A. Capnocytophaga canimorsus - an underestimated danger after dog or cat bite - review of literature. Przegl Epidemiol. 2016;70(2):289–295. PubMed

Ehrmann E, Handal T, Tamanai-Shacoori Z, Bonnaure-Mallet M, Fosse T. High prevalence of beta-lactam and macrolide resistance genes in human oral Capnocytophaga species. J Antimicrob Chemother. 2014;69(2):381–384. doi: 10.1093/jac/dkt350. PubMed DOI