Capnocytophaga canimorsus blebitis: case report and review of literature

Abstract

Background: Capnocytophaga canimorsus is a facultative anaerobic, slow-growing, capnophilic, Gram-negative bacillus, that is commonly found in the microflora of canine and feline oral cavities. Capnocytophaga infections are an emerging zoonotic disease that can cause fatal systemic infections in immunocompromised individuals. Localized ocular Capnocytophaga infections, including keratitis, blepharitis, and endophthalmitis, can lead to severe eye threatening situations. To our knowledge, there is currently no documented case of Capnocytophaga canimorsus blebitis with bleb perforation after trabeculectomy.

Case presentation: Our case report and literature review features a novel case of Capnocytophaga blebitis that occurred after trabeculectomy, associated with close dog contact (i.e. face licking). The patient had underwent trabeculectomy 10 years prior and presented with conjunctival injection, perforated bleb, and hypotony. Overall, patient was medically treated subconjunctival vancomycin, gentamicin and moxifloxacin drops. Trabeculectomy revision was performed with good visual outcome. Bacterial cultures grew Capnocytophaga canimorsus.

Conclusions: We discuss the strategies for diagnosis, treatment, and common risk factors for ocular Capnocytophaga infections. At-risk patients with ocular infections should be asked about close contact with dogs and cats; and treated promptly with the proper antibiotic regimen.

Keywords: Bleb perforation; Bleb-associated infections; Blebitis; Capnocytophaga canimorsus; Case report; Trabeculectomy.

Fig. 1

Capnocytophaga blebitis, preoperative clinical image. Significant injection, cystic bleb, with associated bleb leakage

Fig. 2

Capnocytophaga blebitis, intraoperative images of trabeculectomy revision. a Seidel positive, indicating bleb leakage. b Limbus dissection. c Flap closure with 10–0 Prolene suture, interrupted. d Placement of scleral patch graft secured with 8–0 Vicryl sutures. e Conjunctival closure with 10–0 Vicryl sutures, running. f Watertight closure confirmed with Seidel negative

Fig. 3

Capnocytophaga blebitis, 4 weeks postoperative clinical image. Status post bleb closure, excision of necrotic tissue and scleral patch graft. No bleb leakage, dissolving running suture visualized at limbus

Fig. 4

Capnocytophaga canimorsus Gram stain image. Gram negative rods, fusiform cells generally 1–3 μm in length. Sample culture image obtained with permission from Microbe-Canvas team