Capnocytophaga canimorsus Meningitis: Diagnosis Using Polymerase Chain Reaction Testing and Systematic Review of the Literature
Open Access
- 31 January 2019
- journal article
- review article
- Published by Springer Science and Business Media LLC in Infectious Diseases and Therapy
- Vol. 8 (1), 119-136
- https://doi.org/10.1007/s40121-019-0233-6
Abstract
Introduction Capnocytophaga canimorsus infections are associated with dog bites, especially in asplenic or immunocompromised patients, and typically manifest as sepsis and/or bacteremia. Meningitis has been rarely described, and its diagnosis may be delayed due to poor or slow growth using traditional culture techniques. We provide our experience using polymerase chain reaction (PCR) to establish the diagnosis and perform a comprehensive review of C. canimorsus meningitis cases to provide summary data on the clinical manifestations, diagnosis, and outcomes of this unusual infection. Methods A systematic review of the peer-reviewed English literature (PubMed, Embase, Ovid Medline) from January 1966 to March 2018 was conducted to identify cases of C. canimorsus meningitis. Data collected included demographics, risk factors, cerebrospinal fluid (CSF) findings, PCR results, treatments, and outcomes. Descriptive statistics are presented as numbers (percentages) and medians (ranges). Results A total of 37 patients were reviewed with a median age of 63 years (12 days to 83 years) with a male predominance (76%). A relatively low proportion had an immunocompromised state (16% splenectomy and 5% steroid use); the most common risk factor was alcoholism (19%). Fifty-nine percent reported a dog bite (all within ≤ 14 days prior to presentation), while 22% reported a non-bite dog exposure, 3% reported cat bite, and 3% reported both dog and cat exposures; 11% reported no animal contact. CSF parameters included a median white count of 1024 cells/mm3, 81% had neutrophilic predominance, median protein of 190 mg/dl, and median glucose CSF/serum ratio 0.23. In 54% of cases, blood cultures were positive for C. canimorsus (median, 4 days) and 70% had positive CSF cultures (median, 5 days). PCR established the diagnosis in eight (22%) cases. Antibiotic therapy was given for a median of 15 days (range, 7 to 42 days). Prognosis was overall favorable with only one (3%) death reported and adverse neurologic and/or physical sequelae in 19% of the survivors. Conclusion C. canimorsus meningitis is a rare but increasingly important clinical entity occurring in patients of all ages, typically after dog exposure. While classically considered an infection among immunocompromised patients, most cases have occurred in previously healthy, immunocompetent persons. Diagnosis may be rapidly established by PCR, and this test should be considered in culture-negative cases with associated exposures. Outcome was generally favorable after a median antibiotic duration of 15 days.Keywords
This publication has 38 references indexed in Scilit:
- Etiologic diagnosis of Capnocytophaga canimorsus meningitis by broad-range PCREuropean Journal of Clinical Microbiology & Infectious Diseases, 2006
- Meningitis due to Capnocytophaga canimorsus: Contribution of 16S RNA ribosomal sequencing for species identificationScandinavian Journal of Infectious Diseases, 2006
- Broad‐Range Bacterial Polymerase Chain Reaction for Early Detection of Bacterial MeningitisClinical Infectious Diseases, 2003
- Subdural Empyema after Tooth Extraction in which Capnocytophaga Species was IsolatedScandinavian Journal of Infectious Diseases, 2000
- Capnocytophaga canimorsus Septicemia in Denmark, 1982-1995: Review of 39 CasesClinical Infectious Diseases, 1996
- CAPNOCYTOPHAGA MENINGITIS IN A CANCER PATIENTThe Pediatric Infectious Disease Journal, 1996
- DYSGONIC FERMENTER-2 MENINGITIS SIMULATING VIRAL MENINGITISThe Lancet, 1989
- Septicaemia and meningitis caused by dysgonic fermenter-2 (DF-2).Journal of Clinical Pathology, 1986
- Meningitis caused by dysgonic fermenter type 2 (DF 2) organism in a previously healthy adult.BMJ, 1982