Fatal fulminant sepsis due to a cat bite in an immunocompromised patient

Tödliche fulminante Sepsis nach einem Katzenbiss bei einem immunkompromittierten Patienten

Zusammenfassung

Durch P. multocida ausgelöste Infektionen können sich beim Menschen als lokalisierte Infektionen des die Läsion umgebenden Bindegewebes, als Infektionen im Respirationstrakt oder als systemische Infektionen mit langsamer oder fulminanter Entwicklung präsentieren. Über 90% der humanen Infektionen sind Wundinfektionen oder Abszesse, die sich in Folge von Bissen, Kratzern oder Ablecken von Hautläsionen durch Hunde oder Katzen entwickelt haben. Schwere systemische Erkrankungen wie Pneumonie, Lungenabszess, Peritonitis, Endokarditis, Meningitis und Sepsis sind vor allem auch bei Patienten mit vorbestehenden Erkrankungen wohl bekannt. In der vorliegenden Arbeit berichten wir über einen immunkomprimittierten Patienten, der von einer ihm unbekannten Katze gebissen worden war, und der in sehr kurzer Zeit eine fulminante Sepsis entwickelte. Der Patient verstarb schließlich 70 Stunden nach dem Katzenbiss, trotz Intensivbehandlung und Reanimationsversuchen. Leider hatte er zu spät medizinische Hilfe aufgesucht. Wir möchten an Hand dieses Falles darauf hinweisen, dass es schon für die Erstversorgung wichtig ist, infektionsgefährdete Patienten besser über die Infektionsgefahr durch den Kontakt mit Tieren zu informieren. Sie sollten vor möglichen Konsequenzen von Verletzungen, auch durch eigene Haustiere, gewarnt werden.

Summary

Pasteurella multocida infections in humans can present as localized infections of soft tissues surrounding the lesions, as respiratory tract infections or as systemic infections with slow or fulminant development. Over 90% of human infections are cases of wound infections or abscesses related to a bite, scratch, or licking of skin lesions by a cat or dog. Severe systemic diseases such as pneumonia, lung abscess, peritonitis, endocarditis, meningitis and sepsis are also well known, especially in patients with underlying medical conditions. In this paper we report on an immunocompromised patient who was bitten by an unknown cat and very quickly developed fulminant sepsis, dying 70 hours after the cat bite, despite all the intensive care, therapy and reanimation he was given. Unfortunately, he asked for medical help too late. We emphasize the need for primary healthcare to provide more information to patients at risk of infections from contact with animals and to warn them about the possible consequences of injuries, even when the animals are pets.

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Correspondence to Ivana Harsanji Drenjancevic.

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Drenjancevic, I., Ivic, D., Drenjancevic, D. et al. Fatal fulminant sepsis due to a cat bite in an immunocompromised patient. Wien Klin Wochenschr 120, 504–506 (2008). https://doi.org/10.1007/s00508-008-0992-7

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Keywords

  • Pasteurella multocida
  • Septic shock
  • Cat bite
  • Liver cirrhosis
  • Immunosuppression