Capnocytophagia Pulmonary Abscess Demonstrates Clinical Resistance to Cephalosporin

Document Type

Abstract

Publication Date

1-1-2018

Publication Title

Journal of Investigative Medicine

Volume

66

Issue

1

First page number:

197

Abstract

Case report Capnocytophagia is a known but rare cause of pulmonary infection and abscesses in children which can be encountered in both immunocompetent and immunocompromised hosts. Although traditionally thought of as a cause of sepsis from canine bite, it can also be an indolent organism which may not respond to traditional pneumonia treatment. A 12-year-old male presented with four days of high fever and dyspnea. One month prior, he had been hospitalised with significant hypoxia and sepsis. Initially, he received two days of vancomycin, azithromycin, and ceftriaxone, and had substantial improvement, so he was transitioned to third generation cephalosporins alone. He was treated for fourteen days for lobar pneumonia with pleural effusion. He had persistent cough and dyspnea for two weeks before again becoming febrile. His chest X-ray was concerning for cavitary lesion, which was confirmed by CT Chest. He was started on clindamycin in addition to ceftriaxone. Bronchoscopy revealed purulent material and bronchoalveolar lavage sample identified predominant Capnocytophagia species. On review, the patient had shared a meal with a pet dog at a picnic two weeks prior to the initial illness. He was treated for four weeks with both antibiotics for complicated pneumonia and recovered well. This case clinically demonstrates Capnocytophagia’s increasing resistance to cephalosporins, and the need for alternative therapy. Capnocytophagia species produce unique beta-lactamases highly resistant to cephalosporins. By contrast, Capnocytophagia demonstrates sensitivity to clindamycin and azithromycin, and intermediate resistance to vancomycin. Partial treatment likely explains our patient‘s initial improvement, followed by repeat deterioration. Capnocytophagia should be strongly considered as a cause of necrotizing pneumonia not responding to cephalosporin therapy.

Disciplines

Medicine and Health Sciences

Language

English

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