Dear Editor

In the article by Wareham et al. (1) the authors discuss a case report of atypical endocarditis following innoculation of Capnocytophaga canimorsus from a dog bite, and briefly review the history and management of C. canimorsus infections. There are numerous reports describing the association between the normal flora, gram-negative rod, C. canimorsus and human cardiovascular pathology (2-6). A recent report suggests that C. canimorsus may escape the immune system by interfering with TNF-alpha expression and NO induction resulting in an insufficent proinflammatory response (7).

Yet infections aside, dog bites account for 12th leading cause of non -fatal injuries (all ages) in the United States (8). Thus, the human suffering alone (17 deaths, 6000 hospitalizations, > 330,000 emergency department visits a year) and the associated economic impacts justify further efforts to prevent dog bites (9).

In conclusion, the first documented report of a C. canimorsus infection in a rabbit inflicted with a dog bite (10) further highlights the need for developing a comprehensive bite prevention program (11), and better laboratory methods for accurate diagnosis (12).

References:

1. Wareham DW, Michael JS, Warwick S, Whitlock P, Wood A, Das SS. The dangers of dog bites. J Clin Pathol. 2007 Mar;60(3):328-329.

2. Sandoe JA. Capnocytophaga canimorsus endocarditis. J Med Microbiol. 2004 Mar;53(Pt 3):245-8. Review.

3. Butler T, Weaver RE, Ramani TK, Uyeda CT, Bobo RA, Ryu JS, Kohler RB. Unidentified gram-negative rod infection. A new disease of man. Ann Intern Med. 1977 Jan;86(1):1-5.

4. Frigiola A, Badia T, Lovato R, Cogo A, Fugazzaro MP, Lovisetto R, Di Donato M. Infective endocarditis due to Capnocytophaga canimorsus. Ital Heart J. 2003 Oct;4(10):725-7.

5. Shankar PS, Scott JH, Anderson CL. Atypical endocarditis due to gram-negative bacillus transmitted by dog bite. South Med J. 1980 Dec;73(12):1640-1.

6. Lion C, Escande F, Burdin JC. Capnocytophaga canimorsus infections in human: review of the literature and cases report. Eur J Epidemiol. 1996 Oct;12(5):521-33. Review.

7. Shin H, Mally M, Kuhn M, Paroz C, Cornelis GR. Escape from immune surveillance by Capnocytophaga canimorsus. J Infect Dis. 2007 Feb 1;195(3):375-86.

8. Sosin DM, Sacks JJ, Sattin RW. Causes of non-fatal injuries in the United States, 1986. Accid. Anal. Prev. 1992; 24:685-687.

9. Quinlan KP, Sacks JJ. Hospitalizations for Dog Bite Injuries [letter] JAMA 1999; 281:232-233.

10. van Duijkeren E, van Mourik C, Broekhuizen M, Leuven M, Gaastra W, Houwers D. First documented Capnocytophaga canimorsus infection in a species other than humans. Vet Microbiol. 2006 Nov 26;118(1-2):148-50.

11. AVMA Task Force on Canine Aggression and Human-Canine Interactions. A community approach to dog bite prevention. JAVMA 2001; 218: 1732-1749.

12. Janda JM, Graves MH, Lindquist D, Probert WS. Diagnosing Capnocytophaga canimorsus infections. Emerg Infect Dis. 2006 Feb;12(2):340 -2.