Critical because of pet cat bite
Recently, Tam Anh General Hospital in Ho Chi Minh City announced that it had successfully treated a patient with NXH (44 years old, Binh Thanh, Ho Chi Minh City) who was at risk of septic shock and multiple organ failure due to “flesh-eating bacteria”. Before being discharged from the hospital, Mr. H was tested for liver function, kidney function, blood clotting ability, etc. and all recovered well.
ICU nurse is adjusting the automatic injection machine for Mr. H. (Photo by BVCC).
According to the patient, 7 days before being hospitalized, he took his pet cat to Tay Ninh to play. The cat was frightened by three dogs barking at him in a strange place and bit his left index finger.
Thinking that the cat had been vaccinated against rabies, Mr. H. did not wash his hands or disinfect the wound immediately. In less than 2 hours, his finger was red, swollen, had pus, was painful, and occasionally his finger muscles twitched. He waited until morning to get vaccinated against rabies and tetanus, and bought antibiotics to take. The swelling had gone down, but his finger was still painful.
3 days later, Mr. H. started having a low fever, which increased at night with body aches. Every 5 minutes, he had to turn over because he couldn't stand the pain. He took fever-reducing medicine and slept fitfully, waking up every 15 minutes. At 5am, his wife took him to Tam Anh General Hospital in Ho Chi Minh City.
Doctor CKI Trinh Hoang Nguyen, ICU department, Tam Anh General Hospital, Ho Chi Minh City, said the patient was admitted to the hospital with a high fever, muscle and joint pain in the limbs, back pain, a swollen and pus-filled wound on the left index finger, and difficulty breathing...
Because the cat had been vaccinated against rabies, and the patient himself had also been vaccinated against rabies and tetanus, Dr. Nguyen thought a lot about the possibility that the patient had a blood infection caused by a bacterial or viral attack, not excluding Bartonella gram-negative bacteria infection that often appears in people who have been scratched or bitten by cats.
To prevent the infection from getting worse, Mr. H. was immediately treated with antibiotics, IV fluids, and oxygen. At the same time, he received a blood culture, liver and kidney function tests, and blood clotting tests. The blood culture results revealed infection with the “flesh-eating bacteria” Burkholderia Pseudomallei, which causes Whitmore’s disease, resulting in severe infection, decreased liver and kidney function, blood clotting disorders, and thrombocytopenia. At the same time, thanks to the test, the doctor discovered that Mr. H. had type 2 diabetes.
Dr. Nguyen said that Mr. H.'s uncontrolled high blood sugar caused the infection to progress rapidly. If treatment was delayed by more than 1 day, Mr. H. was at risk of falling into a coma, septic shock, multiple organ failure, intestinal necrosis, and even death.
Despite early active treatment with antibiotics, blood sugar adjustment, and intravenous fluids on the first day of hospitalization, due to the Burkholderia bacteria remaining in the blood for a long time and attacking the body beforehand, Mr. H suffered complications of multiple organ damage, blood clotting disorders, etc.
On the second day after admission, the ICU and Internal Medicine doctors consulted and agreed that emergency plasma exchange was needed. After only one plasma exchange (US centrifugation method), his condition became more stable, and his inflammatory test results and organ function gradually recovered.
High risk of death without treatment
Dr. Trinh Hoang Nguyen said that the bacteria Burkholderia pseudomallei is the cause of Whitmore's disease (Melioidosis). In places with good medical resources, where the disease can be detected and treated early, the risk of death is 10%. In places where medical conditions are difficult, the risk of death from this disease is more than 40%. The US Centers for Disease Control and Prevention (CDC) has listed Whitmore's as a top dangerous disease that causes severe infection, multiple organ necrosis, septic shock, multiple organ failure and death if not treated promptly.
Cat bite wound on Mr. H's left index finger (Photo courtesy of BVCC).
Dr. Nguyen explained that the bacteria Burkholderia pseudomallei exists in contaminated water and soil, mainly concentrated in countries with tropical climates, especially in Southeast Asia and northern Australia. Anyone can be infected with Whitmore disease through inhaling or drinking contaminated water, dust, especially through scratches on the skin.
Rarely, people get Whitmore disease from other people. Besides humans, many animals are susceptible to Whitmore disease, including sheep, goats, pigs, horses, cats, dogs, cattle, etc. In Mr. H's case, he did not disinfect immediately after being bitten by a cat, but continued to carry things and come into contact with the surrounding soil and water. It is possible that he got the disease because the surrounding environment contained the source of the disease, not from the cat. Cats are only intermediate hosts that bite and create wounds for bacteria to enter. Doctor Nguyen advises people that when bitten by cats, dogs, etc., they need to wash the wound immediately, change the bandage every day, and protect the wound when working.
To prevent Whitmore disease, Dr. Nguyen advises people with skin wounds, diabetes, chronic kidney failure, liver failure, immunodeficiency, etc. to avoid direct contact with soil and stagnant water. Farmers should wear boots when going into the fields to help prevent infection through the feet. Medical staff should use masks, gloves, and gowns when in contact with people infected with Whitmore.
Le Trang
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