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Capnocytophaga canimorsus Mycotic Aortic Aneurysm After a Dog Bite
Robert H A Berndsen1, Pim B J E Hulshof2, Maurits P A van Meer3
1Department of Surgery, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centres, Amsterdam, the Netherlands.
Introduction:
Mycotic aortic aneurysm is defined as dilatation of the aortic wall due to infection caused by a variety of microorganisms and is associated with high mortality rates. This case report describes a patient with a rapid growing mycotic infrarenal aneurysm caused by Capnocytophaga canimorsus following a dog bite.
Report:
A 61 year old male professional dog handler presented with a history of progressive abdominal pain and constitutional symptoms. He had been bitten by a Pit Bull Terrier dog that was attacking a young girl three weeks prior to the onset of complaints. Investigations revealed a mycotic infrarenal aortic aneurysm that grew 0.5 cm in only three days. Open surgical repair consisting of an infrarenal aorto-aortic bypass with a 21 mm × 15 cm bovine bioprosthesis was performed successfully. All cultures and biopsies were negative and the subsequent 16S-23S rRNA intergenic spacer region based polymerase chain reaction (IS-pro) technique revealed C. canimorsus, a Gram negative bacterial pathogen that lives as a commensal in the gingival flora of dogs and cats that can cause a variety of severe infections, as the causative agent. Identification made it possible to treat the patient with eight weeks of intravenous followed by four weeks of oral antibiotics. At the last follow up over a year after surgery, the patient was symptom free, without infection and on ultrasound examination there were no signs of complications or aneurysm formation.
Discussion:
This case highlights C. canimorsus as a rare cause of a rapid growing mycotic aortic aneurysm following a dog bite. 16S-23S rRNA profiling (IS-pro) led to the identification of the bacterial pathogen. The use of biological grafts should be considered in the management of mycotic aortic aneurysms.
Insights
A dog bite led to a rapid mycotic aortic aneurysm caused by Capnocytophaga canimorsus. This rare case highlights the importance of identifying bacterial pathogens for effective treatment and management of aortic aneurysms.
Area of Science:
- Infectious Diseases
- Cardiovascular Surgery
- Microbiology
Background:
- Mycotic aortic aneurysms, infections of the aorta, are associated with high mortality.
- Prompt diagnosis and treatment are crucial for managing these life-threatening conditions.
Observation:
- A 61-year-old male presented with symptoms following a dog bite.
- Imaging revealed a rapidly growing mycotic infrarenal aortic aneurysm.
- Surgical repair with a bovine bioprosthesis was successfully performed.
Findings:
- Cultures were negative, but 16S-23S rRNA intergenic spacer region based polymerase chain reaction (IS-pro) identified Capnocytophaga canimorsus as the causative agent.
- Capnocytophaga canimorsus, a Gram-negative bacterium, is a commensal in dogs and cats.
- The patient received a course of antibiotics and recovered fully over a year post-surgery.
Implications:
- This case highlights Capnocytophaga canimorsus as a rare cause of rapidly progressing mycotic aortic aneurysms.
- The IS-pro technique proved vital for pathogen identification when cultures were negative.
- Biological grafts may be a suitable option for managing mycotic aortic aneurysms.
