A Man Was Kissed By His Pet Dog

A man was kissed by his dog. This Is how his organs shut down.
JD is a 63 year old man, presenting to the emergency room with fever and shortness of breath. He tells the admitting nurse that purplish spots had developed around his face, starting 3 days ago, and the feeling in his right leg.

He hadn’t been to the hospital recently, and he hadn’t travelled anywhere. Whatever was happening to him, was something new.

At examination, bruise-like spots were found all over his legs. There were no cuts or wounds present. If you put these together with fever and shortness of breath in someone who was fine a few days ago, then this kind of looks like an infection.

Good thing is that he didn’t have meningitis which is an infection that affects the brain.A blood test reveals that JD has lymphocytopenia. Lympho means white blood cell, Cyto meaning cell and Penia meaning deficiency. That indicate that JD has increased inflammation, means his immune system is now more active than normal.

Additional tests revealed JD had thrombocytopenia. Thrombocytopenia is a condition in which you have a low blood platelet count. This makes sense, because more markers reveal that he has liver dysfunction. The liver is supposed to make blood clotting factors that stop you from bleeding when you get a cut. A dysfunctional liver, means those factors aren’t being made properly.

Muscle proteins were found floating around in his body, meaning that his muscles were breaking down. These muscle proteins get caught in his kidneys and start to damage the tubules.ll of this is only the start of his problems.

When you work out, your muscles produce lactic acid as a metabolic byproduct from increased activity. But for JD, so much lactic acid was found in him, that he is in acidosis. And there was no indication that he was doing any strenuous exercise.Meaning that large parts of his body might not be receiving enough oxygen. He was facing fever and skin reaction, massive bacteremia, or bacterial presence in blood. The fever, liver dysfunction and kidney failure. All of these add up to a medical emergency with impending life threatening consequences.

JD admitted in to the hospital and antibiotics were started. the medical team doesn’t know exactly what bacteria is floating around in JD’s body at the moment, so they want to cover as much as they can during this time.

The reason this is done is because figuring out which bacteria is causing his problems, will take days. Samples need to be collected from the body, and from those samples, bacteria needs to be grown and cultured to get a measurable amount that can be identified. The days this will take, are days that JD doesn’t have, because his muscles are dissolving inside of him, and his organs are shutting down.

As the hours pass, JD’s mental status starts to decline. He becomes disoriented and confused. This encephalopathy means that his liver isn’t just dysfunctional, he’s now in acute liver failure. More monitoring finds that his kidneys are worsening. His intestines are now obstructed because the muscles of his GI tract have become paralyzed as the bruising on his skin become a deeper purple colour.

As the night continues, JD’s heart has stopped beating. Doctors, nurses, and pharmacists immediately converge on his room to try and bring him back. Several minutes pass. A heart beat comes back and he’s resuscitated. But his blood pressure is still low.

A tube is placed down his throat and he’s put on mechanical ventilation. Medicines are administered to him to both constrict his blood vessels, and to promote the force of his heart contractions. All of this is done because if his organs are not perfused with blood because of that low blood pressure, the bad things happening
to him, will worsen.

But as time continues, those bad things, continue to worsen. The kidneys are supposed to filter blood. If they don’t, metabolic waste begins to build up. And because he isn’t getting any better, his kidney failure continues to decline and he’s put on a machine that does that filtering for him, something called dialysis. If JD was previously healthy, what is even happening? How can he go from living normal
life one day, to having his heart stop in a hospital bed a few days later?

Blood culture results from the lab return to the medical team. A gram negative rod shaped bacteria identified as Capnocytophaga canimorsus was found. This bacteria lives in the mouths of pet dogs and cats. It doesn’t affect canine or feline lifeforms. It doesn’t live natively inside humans.

If a human comes in contact with this bacteria, the immune system almost always destroys it, protecting our bodies from infection. But if a human gets a bite from those animals, and that person is immunocompromised, meaning their immune system isn’t working properly, then this bacteria can proliferate and spill into bloodstream.

When you get a cut, the surrounding area becomes swollen, red and warm. This inflammation is the immune system sending white blood cells, sending chemical and protein signals to the site of injury.

Without adequate pressure to push the blood through the organs, it results in Tissue Ischemia. The inner lining of the blood vessels in these organs start to develop lesions. As less oxygen is delivered to the organs, mitochondrial dysfunction starts to happen in the cell.

Closer examination of JD finds no dog bite marks, no scratch marks. He has no history of immunodeficiency or history of taking medicines that could compromise
his immune system.

it means some degree of licking and puppy kisses delivered Capnocytophaga Canimorsus from the dog’s mouth, to some entrance in his body, whether through his mouth or through the pores of his skin.

In the United States millions of people have dogs, and the infection isn’t even tracked.

On the 8th day of hospitalization, a fungus named Candida albicans was found in his blood.Candida lives on your skin. It’s not affecting you right now because you’re probably not admitted in the intensive care unit. But as the catheter has a connection directly to a central vein for JD, through his skin, it introduces a vector for the fungus, to enter his body, and to colonize, increasing his risk for infectionthe longer that it’s in place.

His skin started blistering and 10 days thrombocytopenia seemed to resolve. But the next day, the nurse alerts everyone that JD’s fever has returned.

A CT scan of his chest revealed possible pneumonia. This time new fungus aspergillus fumigatus was detected. After four days of improvement CT scane reaveled that his spleen is now obstructed. The scan confirms the organ begins to necrose.

Doctors found that all four of his limbs have developed gangrene, meaning that the blood supply has been cut off from them, and that the tissue is no longer viable.Another CT scan is done on his head. In his brain, severe hypoxia, or low oxygen, was found along with a swelling of fluid. There will be likely loss of normal function for all his organs.

Starting with the Tissue Ischemia, almost everything described in the process of the organs shutting down, was not just caused by the bacteria but also by the human immune system.

Capnocytophagia canimorsus is one of the most lethal sepsis pathogens. It can live inside white blood cells after it has been phagocytosed.

Small blood clots form as the complement system is activated from inflammation before the liver shuts down. These clots cause gangrene to develop as necrose.

The point of this case, is not to scare anyone of their animals. The infection is rare enough. If you aren’t immunocompromised, and are a healthy person with a strong immune system, getting kissed by your dog or cat probably isn’t going to be a problem. But the point of this case is to say if you have pets, and are very close with them physically, if you develop flu like symptoms that’s worse than a simple viral infection, you want to get that checked out immediately.

These flu-like symptoms include things like an intense fever with bruise-like spots developing under the skin in places that you haven’t bumped, big dark spots that rapidly develop or something like a severe shortness of breath, don’t wait get it checked out immediately.