Rapid diagnosis of Capnocytophaga canimorsus septic shock in an immunocompetent individual using real-time Nanopore sequencing: a case report

Rapid diagnosis of Capnocytophaga canimorsus septic shock in an immunocompetent individual using real-time Nanopore sequencing: a case report

Rapid diagnosis and appropriate treatment is imperative in bacterial sepsis due increasing risk of mortality with every hour without appropriate antibiotic therapy. Atypical infections with fastidious organisms may take more than 4 days to diagnose leading to calls for improved methods for rapidly d...

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Bibliographic Details
Published in:BMC infectious diseases 2019-07, Vol.19 (1), p.660-5, Article 660
Main Authors: Bialasiewicz, Seweryn, Duarte, Tania P S, Nguyen, Son H, Sukumaran, Vichitra, Stewart, Alexandra, Appleton, Sally, Pitt, Miranda E, Bainomugisa, Arnold, Jennison, Amy V, Graham, Rikki, Coin, Lachlan J M, Hajkowicz, Krispin
Format: Article
Language:eng
Subjects:
Aged women
Alcoholism
Bites (Injuries)
Blood tests
Capnocytophaga canimorsus
Case Report
Development and progression
Diagnosis
DNA sequencing
Droplet digital PCR
EDTA
Elderly women
Genetic aspects
Genomes
Genomics
Health aspects
Immunotherapy
Infection
Mortality
Nanopore sequencing
Nucleotide sequencing
Patient outcomes
Polymerase chain reaction
Risk factors
Sepsis
Septic shock
Shock
Tazobactam
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Summary:Rapid diagnosis and appropriate treatment is imperative in bacterial sepsis due increasing risk of mortality with every hour without appropriate antibiotic therapy. Atypical infections with fastidious organisms may take more than 4 days to diagnose leading to calls for improved methods for rapidly diagnosing sepsis. Capnocytophaga canimorsus is a slow-growing, fastidious gram-negative bacillus which is a common commensal within the mouths of dogs, but rarely cause infections in humans. C. canimorsus sepsis risk factors include immunosuppression, alcoholism and elderly age. Here we report on the application of emerging nanopore sequencing methods to rapidly diagnose an atypical case of C. canimorsus septic shock. A 62 year-old female patient was admitted to an intensive care unit with septic shock and multi-organ failure six days after a reported dog bite. Blood cultures were unable to detect a pathogen after 3 days despite observed intracellular bacilli on blood smears. Real-time nanopore sequencing was subsequently employed on whole blood to detect Capnocytophaga canimorsus in 19 h. The patient was not immunocompromised and did not have any other known risk factors. Whole-genome sequencing of clinical sample and of the offending dog's oral swabs showed near-identical C. canimorsus genomes. The patient responded to antibiotic treatment and was discharged from hospital 31 days after admission. Use of real-time nanopore sequencing reduced the time-to-diagnosis of Capnocytophaga canimorsus in this case from 6.25 days to 19 h. Capnocytophaga canimorsus should be considered in cases of suspected sepsis involving cat or dog contact, irrespective of the patient's known risk factors.
ISSN:1471-2334
1471-2334