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This week in BMJ Case Reports: Infection from pet dog, pinworms, Indian herbal remedy


Woman admitted to intensive care after infection from pet dog

An elderly woman was admitted to intensive care due to organ failure following a rare, yet potentially life-threatening infection believed to be transmitted by her household pet, an Italian greyhound.

Writing in the online journal BMJ Case Reports, doctors who treated the 70-year-old patient explain that she developed acute kidney failure after a few days of being admitted to hospital.

Paramedics discovered her slumped in a chair, with decreased consciousness, after she had slurred speech and became unresponsive while on the telephone to a relative.

Upon admission to hospital, her symptoms temporarily improved, but on the fourth day, she developed confusion, headache, diarrhoea, and rigors, along with high fever. She was transferred to intensive care for kidney failure.

Blood cultures revealed Capnocytophaga canimorsus, a rare yet significant cause of sepsis. It is a bacterium frequently isolated in the oral cavities of cats and dogs.

After two weeks of intensive care and antibiotic treatment, the patient made a full recovery.

Only 13 cases of sepsis related to C. canimorsus have been reported in the UK since 1990. Mortality rates of 26%, with 60% of cases reporting a dog bite and 24% reporting other dog contact, have been documented.

"This is an interesting case", the doctors explain, "because neither scratch nor bite was established, although close petting including licks was reported."

Diseases which can be transmitted to humans from animals are frequently missed diagnoses, explain the doctors, and they summarise important infections transmitted by cats and dogs (see table 1).

Pinworms found in teenage girl's appendix **video available**

A teenage girl admitted to hospital with suspected appendicitis was found to have pinworms in her appendix (see video footage), according to an article published in the online journal BMJ Case Reports.

The 15-year-old patient was admitted to the paediatric department in the UK following abdominal pain with nausea, but without vomiting. Her pain was located on the right hand side of her hip, a common sign of appendicitis.

Even though blood tests, a urine sample and abdominal ultrasound were inconclusive, surgeons decided to operate because appendicitis is a common and potentially life threatening condition.

After removal of the pinworms during surgery, the girl along with her family, were treated with medications to kill any of remaining parasites and eggs. Her pain disappeared and she made a full recovery.

After surgery, microscopic examination confirmed the presence of pinworms and absence of appendicitis.

Parasitic worms are one of the most common infections worldwide. Estimates suggest that up to 50% of British children may have a related infection.

Concerns over traditional Indian herbal remedy

A 26-year-old student developed lead poisoning from taking Indian Ayurvedic herbal medicine, write doctors in the online journal BMJ Case Reports.

During a trip to India, he took the herbal medications to treat his low back pain. On returning to the USA, he began to use them regularly, but developed pain in the upper central region of his abdomen, weight loss, dark stools, nausea and vomiting.

A blood test showed he was suffering from anaemia and a high level of lead in his blood.

No other source of lead exposure was evident, so doctors advised him to discontinue use of his four different types of Ayurvedic medications. He was given morphine and medications for nausea and vomiting.

Treatment to remove excess iron, known as chelation therapy, was initiated, and within months the patient's symptoms resolved.

"This case follows similar reports in the USA of acute lead toxicity from Ayurvedic medications produced in India," writes Dr Judith Green-McKenzie, University of Pennsylvania Perelman School of Medicine.

"Concern regarding the use of Ayurvedic herbal medicines originates from their easy availability, increasingly international use and global reach, lack of focused scientific research and the possibility of abuse in an unregulated industry," she concludes.


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