Capnocytophaga gingivalis Bacteremia After Upper Gastrointes | Figure 1

Capnocytophaga gingivalis Bacteremia After Upper Gastrointestinal Bleeding in Immunocompromised Patient

Odontogenic bacteremia, most commonly involving gram-positive oral flora, can result from daily self-care practices or professional dental procedures. Though usually transient and quickly cleared by the immune system, the presence of periodontal disease increases the frequency of exposure and risk of persistence of oral-systemic infections. Comorbidities such as asplenia, alcoholism, and immunocompromise increase the risk of complications of hematogenous spread and severe systemic illness. Capnocytophaga is a genus of anaerobic fastidious gram-negative bacilli, which is a common member of human oral flora, and its density is proportional to mass of dental plaques and periodontal diseases. Capnocytophaga spp that colonize humans are less virulent and are uncommon causes of bacteremia when compared with the Capnocytophaga typical of canines. C gingivalis has been rarely reported as a cause of disease in immunocompromised or immunocompetent hosts. In this article, we present a case of an immunocompromised 70-year-old man with poor oral hygiene, on methotrexate and prednisone for rheumatoid arthritis and sarcoidosis, who was admitted for chronic obstructive pulmonary disease exacerbation and developed C gingivalis bacteremia and septic shock after an episode of upper gastrointestinal bleeding. Poor oral hygiene in our patient is believed to have increased his risk as an immunocompromised patient to developing C gingivalis bacteremia. This case highlights the importance of oral care in immunocompromised patients especially while hospitalized, and those about to receive transplant, chemotherapy, or on immune modulators.

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Castleman Disease

Castleman disease (CD) is a rare disease of lymph nodes and related tissues. It is a heterogeneous group of lymphoproliferative disorders that are sometimes associated with human herpesvirus 8 (HHV-8) infection in immunocompromised individuals, such as those with human immunodeficiency virus (HIV) infection. Treatment varies depending on the type of Castleman disease: unicentric or multicentric. Surgical removal of the involved node is usually curative in unicentric disease, but is rarely curative in multicentric Castleman disease (MCD). The interleukin-6 inhibitor siltuximab is approved for MCD in patients who are negative for HIV and human herpesvirus–8. The exact cause of Castleman disease is unknown. An increased production of IL-6 by lymph nodes appears to have a role in the development of Castleman disease.

Freshwater Exposure and Infections

Freshwater exposure is associated with a diverse range of infections from pathogens present in soil and water. This includes skin and soft tissue infections and wound infections, gastrointestinal infections, and central nervous system infections acquired through recreational exposure or trauma. Case reports of freshwater-associated infections typically focus on waterborne pathogens as the cause of illness; however, patients who experience significant physical trauma during freshwater exposure may also be at increased risk for infection with their own flora if the nature of the injury allows entry of bacteria through a mechanism such as mucosal injury. Here, we present a case of a healthy 18-year-old man who rapidly developed bacteremia with oral flora following several falls submerging his face into lake water while water skiing, as well as acute polymicrobial sinusitis and subsequent pre-septal cellulitis. Shortly after his water skiing falls, the patient developed sinusitis that rapidly progressed to headaches, emesis, and significant periorbital swelling. Blood cultures grew Prevotella salivae, a bacterium naturally found in the oral cavity. Sinus cultures grew Klebsiella aerogenes and Listeria monocytogenes, which may be associated with lake water. The infection improved with antibiotic therapy, and the patient was discharged on a regimen of amoxicillin/clavulanic acid and trimethoprim-sulfamethoxazole. Reports of bacteremia with oral flora following freshwater injury are not typically reported, and to our knowledge, this is the first report describing bacteremia with P salivae.

Case Summaries

  1. Case 1: A 52 y old patient complaining of this tender mass above the corner of the mouth more than a month ago there is no other lesion. The mass didn't get larger in size. Patient has no systemic diseases but is a smoker with poor oral hygiene.
  2. Case 2: 2nd case of ? Pyogenic granuloma in about 1 month. Patient a 55-year-old female complained of swelling of about 10 years duration. Swelling is slow-growing, painless, non-tender, pedunculated. No dental pathology involved in this case. No history of discharge. Patient thought a blow was responsible for onset. Oral hygiene poor. X-rays requested with biopsy in view.
  3. Case 3: A 28-year-old woman presented with a 3-day history of intense pruritus over the lower back. She reported no recent travel or exposure to new environments. She cares for a small kennel with approximately eight dogs rescued from the streets. Physical examination revealed multiple small vesicles, some clustered and others scattered, predominantly involving the lumbar region and the left gluteal area.
  4. Case 4: A 4-month-old male infant presented with skin lesions localized to the chin for the past 3 days. Physical examination revealed multiple small pustules with surrounding inflammatory signs on the chin, along with a few scattered papules on the chest.
  5. Case 5: Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, there are questions on whether there are features in this EKG that would warrant further work-up or if this is just a pediatric EKG.