Correspondence

Capnocytophaga canimorsus Sepsis

N Engl J Med 1999; 340:1513-1514May 13, 1999

Article

To the Editor:

In their contribution to Images in Clinical Medicine (Dec. 17 issue),1 Alberio and Lämmle describe a man with odontogenic infection complicated by thrombophlebitis of the internal jugular vein, sepsis, and metastatic foci of infection. This is an excellent description of postanginal septicemia,2 which is usually attributed to infection with Fusobacterium necrophorum. 3 Further information is needed to determine whether infection with F. necrophorum was adequately excluded in this case. The authors do not mention whether cultures were studied, and if so, what anatomical sites were sampled. Was the organism identified on morphologic grounds alone? Both F. necrophorum and Capnocytophaga canimorsus (formerly described as dysgonic fermenter type 2 by the Centers for Disease Control) are long, thin, fusiform, gram-negative rods, often arranged in end-to-end pairs. They can be distinguished in culture because F. necrophorum is indole-positive and strictly anaerobic, whereas C. canimorsus can grow under microaerophilic conditions and is indole-negative.

Detection of sepsis caused by fusobacteria should lead clinicians to suspect postanginal septicemia, to ask patients about preceding pharyngeal pain or periodontal disease, and to look for suppurative thrombophlebitis of the internal jugular vein. Like fusobacteria, capnocytophaga species are commensals of the oral cavity of humans and other mammals.

Stuart Ray, M.D.
Johns Hopkins University School of Medicine, Baltimore, MD 21205

3 References

1. 1

   Alberio L, Lammle B. Capnocytophaga canimorsus sepsis. N Engl J Med 1998;339:1827-1827
   Full Text | Web of Science | Medline

2. 2

   Lemierre A. On certain septicaemias due to anaerobic organisms. Vol. 1. Lancet 1936:701-3.
   

3. 3

   Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore) 1989;68:85-94
   Web of Science | Medline

Author/Editor Response

The authors and a colleague reply:

To the Editor: Dr. Ray raises the question of whether infection with F. necrophorum, typically involved in postanginal sepsis, was adequately excluded in our patient. On the day of hospitalization, C. canimorsus was grown in six blood cultures (BacT/Alert, Organon Teknika). Identification was based on capnophilic aerobic growth, metabolic characteristics, and colistin resistance, findings that excluded F. necrophorum. No bacterial growth was observed in urine, ascites fluid, or bile that were also obtained after antibiotic treatment had been started.

Whether our patient's condition fulfills the criteria for postanginal septicemia1 is a matter of definition. There was no history of angina, but there probably was a periodontal infection; the identified bacterium was C. canimorsus and not F. necrophorum; and even though adult respiratory distress syndrome developed, necessitating mechanical ventilation, pulmonary abscesses were not identified.

Bernhard Lämmle, M.D.
Lorenzo Alberio, M.D.
University Hospital

Lukas Matter, M.D.
University of Bern, CH-3010 Bern, Switzerland

1 References

1. 1

   Sinave CP, Hardy GJ, Fardy PW. The Lemierre syndrome: suppurative thrombophlebitis of the internal jugular vein secondary to oropharyngeal infection. Medicine (Baltimore) 1989;68:85-94
   Web of Science | Medline