Table 1.
Summary of Capnocytophaga canimorsus meningitis cases in the published literature, n = 37
| Case no. | First author, year [reference] | Age/sex | Medical conditions | History of splenectomy, y/n | Animal contact | Symptoms | Serum WBC (cells/mm3) | Blood cultures, positive y/n, time to result |
|---|---|---|---|---|---|---|---|---|
| 1 | Bobo, 1976 [8] | 42/M | Alcoholism | N | Dog bites (two) 6 and 7 days before | Fevers, seizures, headache | 8,900 | Yes, 3 days |
| 2 | Butler, 1977 [2] | 26/M | Splenectomy | Y | Dog bite 4 days prior | NR | NR | Yes; time not reported |
| 3 | Butler, 1977 [2] | 25/M | Splenectomy | Y | Dog bite 3 days prior | NR | NR | Yes; time not reported |
| 4 | Butler, 1977 [2] | 17/M | Splenectomy | Y | Dog bite several days prior | NR | NR | Yes; time not reported |
| 5 | Ofori-Adjei, 1982 [9] | 66/F | None | N | Dog exposure but no history of bites | Fever, myalgias, headache, photophobia, vomiting, neck stiffness, macular rash confined to trunk | 10,800 | Negative |
| 6 | Chan, 1986 [10] | 63/M | Hypertension | N | Dog bite, 14 days before | Fevers, rigors, arthralgia and erythematous rash on trunk | 14,500 | Yes, 2 days |
| 7 | Carpenter, 1987 [11] | 26/M |
Splenectomy, Hodgkin’s lymphoma in remission |
Y | Cat bite, scratches | Fevers, myalgias, malaise, photophobia, headache | 13,400 | Yes, 3 days |
| 8 | Westerink, 1989 [12] | 26/M | None | N | Dog exposure | Fevers, headaches, myalgias, vomiting, erythematous and pruritic rash starting on back and spreading to extremities, confluent, blanching maculopapular rash over forehead, back and anterior dorsal aspects of upper and lower extremities, dorsum of hands and feet; petechial rash on lower extremities. Palms/soles spared. | 11,500 | Yes, 4 days |
| 9 | Imanse, 1989 [13] | 39/F | None | N | Dog and cat exposure | Fever, malaise, headache, vomiting, dizziness, complete hearing loss, gait instability | 11,300 | Yes, 5 days |
| 10 | Herbst, 1989 [14] | 47/F | Alcoholism | N | Dog exposure | Unresponsive, febrile, hypotensive, widespread purpuric rash; purple-red patches in reticulated pattern arms/abdomen/thighs/lower legs/feet with petechiae at periphery | 20,700 w/significant left shift | Yes, time not reported |
| 11 | Krol-van Straaten, 1990 [15] | 75/F | Splenectomy | Y | Dog bite 9 days earlier | Fevers, change of mental status | 25,000 | Negative |
| 12 | Blanche, 1994 [16] | 57/M | None | N | Dog bite, 9 days earlier | Fevers | NR | Yes, 5 days |
| 13 | Kristensen, 1996 [17] | 74/M | Heart failure | N | Dog bite, several days earlier | Fever, confusion | NR | Negative |
| 14 | Pers, 1996 [18] | 74/M | CAD | N | Dog bite 7 days prior, received unknown abx prophylactically | Meningitis, symptoms not specified | NR | NR |
| 15 | Pers, 1996 [18] | 80/M | CAD | N | Dog bite 3 days prior | Meningitis, symptoms not specified | NR | NR |
| 16 | Pers, 1996 [18] | 83/M | Rheumatoid arthritis | N | No known animal exposure | Meningitis, symptoms not specified | NR | NR |
| 17 | Pers, 1996 [18] | 42/M | None | N | No known animal exposure | Meningitis, symptoms not specified | NR | NR |
| 18 | Pers, 1996 [18] | 74/M | None | N | Dog exposure with no history of bites | Meningitis, symptoms not specified | NR | NR |
| 19 | Lion, 1996 [3] | 54/M | Alcoholism | N | Dog bite, 10 days earlier | NR | NR | Yes, 3 days |
| 20 | Risi, 2000 [19] | 65/F | None | N | Possible second hand exposure → procedure performed by radiologist had 3 dogs and tech had 2 dogs | Chills, myalgias, fatigue, confusion | Not reported | NR |
| 21 | Le Moal, 2003 [20] | 45/M | Alcoholism | N | Dog bite 9 days prior | Fevers, headache, confusion, photophobia, meningismus | 15,700 | Negative |
| 22 | Rosenman, 2003 [21] | 12 days/F | Recent steroid use, gonadal dysgenesis | N | Abrasion from dog tooth | Fevers, poor feeding, irritability | 23,900 | Negative |
| 23 | Gottwein, 2006 [22] | 56/M | Alcoholism | N | Dog bite, 10 days earlier | Headache, fever, chills diarrhea, vomiting, arthralgia | 12,900 | Yes, 7 days |
| 24 | Meybeck, 2006 [23] | 65/M | Pulmonary embolism | N | Dog bite, 5 days earlier | Fever, headache, confusion | 8,000 | Yes, 2 days |
| 25 | de Boer, 2007 [24] | 69/M | COPD on steroids | N | Dog bite, 4 days earlier | Fevers, chills, confusion | 20,500 | Yes, 9 days |
| 26 | de Boer, 2007 [24] | 58/M | None | N | None | Headache, fever, malaise, nausea | 13,700 | Yes, 9 days |
| 27 | Gasch, 2009 [25] | 64/M | None | N | Dog bite 7 days earlier | Fever, headache, severe hearing loss, dizziness | Normal (# not reported) | Negative |
| 28 | Monrad, 2012 [26] | 66/M | Alcoholism | N | Recent dog bite | Confusion, tachycardia, fever; neck stiffness and bilateral hearing loss noted after 48 h | NR | Negative |
| 29 | Monrad, 2012 [26] | 67/F | Splenectomy | Y | 2 dogs in household; no bites | Fever, headache, confusion, transient right arm paresis | NR | Negative |
| 30 | Monrad, 2012 [26] | 79/M | None | N | Dog bite 7 days prior | Unconscious at home | NR | NR |
| 31 | Beernink, 2016 [27] | 52/M | None | N | Dog licked scratches on knee several days prior to admission | Headache, dizziness | 12,000 | NR |
| 32 | Van Samkar, 2016 [28] | 78/M | None | N | Dog bite 4 days prior | Neck stiffness, altered mental status | NR | Positive, 3 days |
| 33 | Van Samkar, 2016 [28] | 37/M | Alcoholism | N | Dog bite 4 days prior | Headache, fever, nausea, generalized rash | NR | Negative |
| 34 | Van Samkar, 2016 [28] | 60/M | None | N | No known animal exposures | Headache, fever, altered mental status, generalized rash | NR | Positive, 5 days |
| 35 | Bertin, 2018 [4] | 69/F | HTN | N | Dog bite 3 days prior | Fever, dyspnea, fatigue | NR |
Positive, days to growth not reported PCR+ |
| 36 | Bertin, 2018 [4] | 65/M | HTN | N | Dog bite 3 days prior | Headache, nuchal rigidity | NR | Positive, 1 day |
| 37 | Current Case | 71/F | Lung cancer s/p resection, HTN, hypothyroidism, chronic subdural hematomas | N | Dog exposure, ongoing; no reported bites | Altered mental status, fever, headache | 19,900 | Positive, 4 days |
| Case no. | Brain imaging | CSF white count (cells/mm3) | CSF protein (mg/dl) | CSF glucose-to-serum ratio (value in mg/dl) | CSF gram stain and culture, time to result (days) | Antibiotics, type and duration (days) | Outcome |
|---|---|---|---|---|---|---|---|
| 1 | NR | 2,300 (30% PMN) | 722 | 0.17 | Gram stain with GNRs, culture positive, 3 days | Ampicillin, gentamicin, chloramphenicol and carbenicillin → Ampicillin (14 days total) | Recovered |
| 2 | NR | NR | NR | NR | NR | NR | Recovered |
| 3 | NR | NR | NR | NR | NR | NR | Recovered |
| 4 | NR | NR | NR | NR | NR | NR | Recovered |
| 5 | NR | 575 (90% PMN) | 240 | 0.24 | Gram stain GNR; culture positive 5 days | Penicillin (7), Chloramphenicol (10); (10 days total) | Recovered |
| 6 | NR | 1,121 (80% PMN) | 175 | 37.8; 0.45 | Gram stain GNRS; culture positive, 2 days | Chloramphenicol, Ampicillin (7 days total) | Recovered |
| 7 | CT normal | 520 (70% PMN) | 143 | 0.2 | Gram stain negative; culture positive; time NR | Penicillin G and cefotaxime (14 days total) | Recovered |
| 8 | NR | 0 | 31 | 0.53 | Gram stain negative; culture positive, 4 days | Chloramphenicol (4 d) → Pen (10 d); (14 days total) | Recovered |
| 9 | CT normal | 480 (70% PMN) | 32 | NR | Culture negative | None | Survived with persistent deafness |
| 10 | CT with multiple brain infarctions | 820 (74% PMN) | 465 | CSF 39.24 mg/dl; 0.08 | NR | Imipenem/cilastatin → Penicillin (14 days total) | Survived; bilateral below-knee amputations, persistent neurologic deficits |
| 11 | NR | 6000, “mainly PMN) | NR | NR | Culture positive, 4 days | Chloramphenicol IV for 5 days and po for 6 days (11 days total) | Recovered |
| 12 | NR | 43 (74% lymph) | 153 | 0.3 | Culture positive, 5 days | Amoxicillin (21 days total) | Recovered |
| 13 | NR | 240 (80% PMN) | NR | NR | Gram stain GNRs; culture positive, time NR | Penicillin (15 days total) | Recovered |
| 14 | NR | ~ 240 (> 80% PMN) | NR, elevated | NR, low | Positive culture, time NR | Erythromycin → Penicillin | Died, cardiac arrest 10 days after discharge |
| 15 | NR | > 1700 (> 80% PMN) | NR, elevated | NR, low | Positive culture, time NR | Ampicillin | Recovered |
| 16 | NR | ~ 245 (> 80% PMN) | NR, elevated | NR, low | Positive culture, time NR | Penicillin → Ampicillin, Gentamicin | Recovered |
| 17 | NR | > 1700 (> 80% PMN) | NR, elevated | NR, low | Gram stain GNRs, culture negative | Penicillin → Ceftazidime, Metronidazole | Recovered |
| 18 | NR | > 1700 (> 80% PMN) | NR, elevated | NR, low | Positive culture, time NR | Ceftriaxone, Ampicillin → Ampicillin, Netilmicin, Metronidazole → Penicillin | Recovered |
| 19 | NR | NR | NR | NR | Culture positive, 4 days | Cefotaxime, Amoxicillin | Recovered |
| 20 | CT normal | 11,138 (99% PMN) | 192 | <0.01 | Gram stain GNR, culture positive, time NR, also partial 16 s rRNA sequencing (PCR) | Cefepime, ampicillin, metronidazole (total duration not provided) → Ceftriaxone (14 days total) | Recovered |
| 21 | CT normal | 1240 (65% PMN) | 165 | 0.21 | Gram stain GNRs; culture positive, 2 days | Cefotaxime (9 d) → Amoxicillin (12 d); (21 days total) | Recovered |
| 22 | CT normal | 15,630 (92% PMN) | 146 | CSF glucose 20 → 0.14 | Gram stain negative; culture positive, 5 days | Ampicillin, gentamicin, cefotaxime; (21 days total) | Recovered |
| 23 | NR | 1001 (82% PMN) | 169 | 0.3 | Gram stain negative, culture positive, 5 days; PCR+ | Ceftriaxone (13 days total) | Recovered |
| 24 | CT and MRI normal | 1226 (96% PMN) | 328 | 0.24 | Gram stain GNRs; culture positive, time NR | Cefotaxime and gentamicin (1 d) → Cefotaxime and metronidazole → amoxicillin; (15 days total) | Recovered |
| 25 | NR | 1024 (100% PMN) | 173 | 0.43 | Gram stain GNRs; culture positive, 9 days | Ceftriaxone | Recovered |
| 26 | CT normal | 1566 (54% PMN) | 130 | 0.5 | Gram stain GNRs; culture negative | Ceftriaxone | Recovered |
| 27 | CT normal | 730 (22% PMN) | 1342 | 0.125 | Gram stain negative, culture positive at 2 days | Ampicillin (14 days total) | Survived with near total deafness |
| 28 | CT normal | 1814 (74% PMN) | 276 | 0.03 | Gram stain GNR; culture positive at 9 days; PCR+ | Penicillin (48 h) → ceftriaxone and ampicillin (6 d) → ceftriaxone additional 14 d; (22 days total) | Survived with persistent bilateral sensorineural hearing loss |
| 29 | NR | 2120 (81% PMN) | 191 | 0.24 | Gram stain GNR; culture positive at 5 days; PCR+ | Ceftriaxone → meropenem (21 d); (21 days total) | Survived with persistent hearing loss |
| 30 | CT normal | 234 (85% PMN) | 221 | 0.02 | Gram stain GNR; culture positive at 6 days; PCR+ | Ampicillin, ceftriaxone, acyclovir → meropenem 3 days → ceftriaxone 21 days; (24 days total) | Recovered |
| 31 | No imaging | 5,210 | 515 | CSF glucose 0 | GNR on gram stain, culture neg, PCR+ | Ceftriaxone, amoxicillin × 2 days → penicillin × 12 days (14 days total) | Recovered |
| 32 | CT normal | 901 | 346 | CSF glucose 25.2 → 0.07 | Culture positive, 3 days | Amoxicillin (10 d), ceftriaxone (14 days total) | Recovered |
| 33 | CT normal | 2,376 | 261 | CSF glucose 66.6 → 0.26 | Culture positive, 5 days | Amoxicillin (3 d), ceftriaxone (20 d), acyclovir 3 d (23 days total) | Survived with headache, disorientation |
| 34 | No imaging | 828 | 190 | CSF glucose 54 → 0.28 | Culture positive, 5 days | Amoxicillin (14 d), ceftriaxone (1 d), meropenem (12 d); (27 days total) | Recovered |
| 35 | CT with 3 ischemic lesions | NR | NR | NR | NR | Vancomycin, piperacillin-tazobactam (28 days total) | Survived; amputations of extremities of bilateral upper and lower limbs |
| 36 | CT normal on admission. MRI at 8 days with cerebritis | 443 | 97 | 0.24 | Gram stain GNR; culture positive, 1 day; PCR+ | Ceftriaxone, ampicillin 2 weeks → ampicillin-sulbactam, moxifloxacin 4 weeks; (42 days total) | Recovered |
| 37 | MRI stable bifrontal subdural hematomas, acute occipital and parietal lobe infarcts | 590 (95% PMN) | 413 | 0.11 | Gram stain and culture negative; PCR+ | Vancomycin, ceftriaxone, ampicillin (4 d) → Meropenem (17d); (21 days total) | Recovered |
CAD coronary artery disease, COPD chronic obstructive pulmonary disease, CSF cerebrospinal fluid, CT computed tomography, D days, F female, GNR gram-negative rod, HTN hypertension, M male, MRI magnetic resonance imaging, N no, NR not reported, PCR polymerase chain reaction, PMN polymorphonuclear cell, WBC white blood cell, Y yes