Man in critical condition after being bitten by cat due to "flesh-eating bacteria" infection

Critically ill after being bitten by a pet cat

Recently, Tam Anh General Hospital in Ho Chi Minh City announced that it had successfully treated patient NXH (44 years old, Binh Thanh District, Ho Chi Minh City), rescuing him from the risk of septic shock and multiple organ failure caused by "flesh-eating bacteria". Before being discharged, Mr. H's liver and kidney function tests, blood clotting ability, etc., all showed good recovery.

The ICU nurse is adjusting the automatic injection machine for Mr. H. (Photo courtesy of BVCC).

According to the patient, 7 days before being admitted to the hospital, 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 the cat had been vaccinated against rabies, Mr. H. didn't wash his hands or disinfect the wound immediately. Less than two hours later, his finger became swollen, red, and pus-filled, causing pain, and his finger muscles twitched intermittently. He waited until morning to get rabies and tetanus vaccinations, and also bought antibiotics to take. The swelling subsided, but his finger remained 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 5:00 a.m., 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...

Since the cat had been vaccinated against rabies, and the patient himself had also been vaccinated against rabies and tetanus, Dr. Nguyen suspected the patient had sepsis caused by a bacterial or viral infection, but did not rule out Bartonella infection, a gram-negative bacterium commonly found in people scratched or bitten by cats.

To prevent the infection from worsening, Mr. H. was immediately treated with antibiotics, intravenous fluids, and oxygen. He also underwent blood cultures, liver and kidney function tests, and coagulation tests. The blood culture results revealed an infection with Burkholderia Pseudomallei, the "flesh-eating bacteria" that causes Whitmore's disease, leading to severe infection, impaired liver and kidney function, coagulation disorders, and thrombocytopenia. Simultaneously, the tests revealed 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. would be 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, because the Burkholderia bacteria had existed in the blood for a long time and had attacked the body before, Mr. H suffered complications of multiple organ damage and blood clotting disorders...

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 if left untreated

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, concentrated mainly 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.

Whitmore's disease is rarely transmitted from other people. Besides humans, many animals are susceptible to Whitmore's disease, including sheep, goats, pigs, horses, cats, dogs, and cattle. In Mr. H.'s case, he did not disinfect the wound immediately after being bitten by the cat but continued to carry things and come into contact with the surrounding soil and water. It's possible he contracted the disease from the surrounding environment, not from the cat. The cat was merely an intermediary, creating a wound that allowed bacteria to enter. Doctor Nguyen advises people bitten by cats, dogs, etc., to wash the wound immediately, change the bandage daily, and protect the wound while working.

To prevent Whitmore's disease, Dr. Nguyen advises people with open wounds, diabetes, chronic kidney disease, liver failure, or weakened immune systems to avoid direct contact with soil and stagnant water. Farmers should wear boots when working in the fields to prevent infection through the feet. Healthcare workers should use masks, gloves, and gowns when in contact with patients infected with Whitmore's disease.

Le Trang

Source: https://www.congluan.vn/chu-quan-khi-bi-meo-can-nguoi-dan-ong-nguy-kich-vi-nhiem-vi-khuan-an-thit-nguoi-post272601.html