A Man Was Kissed By His Pet Dog. This Is How His Organs Shut Down.

A Man Was Kissed By His Pet Dog. This Is How His Organs Shut Down.

A Man Was Kissed By His Dog. This Is How His
Organs Shut Down. JD is a 63 year old man, presenting to the
emergency room with fever and shortness of breath. He tells the admitting nurse that purplish
spots had developed around his face, starting 3 days ago, and the feeling in his right leg,
started going numb. JD was a healthy 63 year old. He hadn’t
been to the hospital recently, and he hadn’t traveled anywhere. Whatever was happening to him, was something
new. At examination, bruise-like spots were found
all over his legs. There were no cuts or wounds present. If you put these together with fever and shortness
of breath in someone who was fine a few days ago, then this kind of looks like an infection. Good thing he didn’t have a headache with
neck stiffness, because if he did, that could mean meningitis, which is an infection that
affects the brain. A blood test reveals that JD has lymphocytopenia. Lympho derived from Latin lympha, the goddess
of water, and today referring to a type of white blood cell that fights infection. Cyto meaning cell. And Penia meaning deficiency of. A deficiency of white blood cells that fight
infection. This was combined with an increase in blood
markers that indicate that JD has increased inflammation, meaning that his immune system
is now more active than normal. There was definitely something, going on. Additional tests revealed JD had thrombocytopenia. Thrombo from Ancient Greek θρόμβος
(thrombus) meaning piece or lump, referring to a clot of blood. A deficiency of blood clot cells. This makes sense, because more markers reveal
that he has liver dysfunction. The liver is supposed to make blood clotting
factors that stop you from bleeding when you get a cut. A dysfunctional liver, means those
factors aren’t being made properly. And this fits with thrombocytopenia, giving the
medical team some more clues as to what’s happening because It’s found that JD has acute kidney injury.
Muscle proteins were found floating around in his body, meaning that his muscles were
breaking down, actually dissolving away. These muscle proteins get caught in his kidneys
and start to damage the tubules. All of this is only the start of his problems. When you work out, your muscles produce lactic
acid as a metabolic byproduct from increased activity. But for JD, so much lactic acid
was found in him, that he is in acidosis. And there was no indication that he was doing
any strenuous exercise. Meaning that large parts of his body might
not be receiving enough oxygen in compliance with demand for normal function. Without taking
medicines, or any history of other disease, but a fever and skin reaction, this could
point to a possible massive bacteremia, or bacterial presence in blood. The fever. The liver dysfunction. The dissolving
muscles and kidney failure. All of these add up to a medical emergency with impending life
threatening consequences, as JD is admitted in to the hospital. Multiple antibiotics were started empirically.
This means that the medical team doesn’t know exactly what bacteria is floating around
in JD’s body at the moment, so they want to cover as much as they can during this time. The reason this is done is because figuring
out which bacteria is causing his problems, will take days. Samples need to be collected
from the body, and from those samples, bacteria needs to be grown and cultured to get a measurable
amount that can be identified. The days this will take, are days that JD doesn’t have,
because his muscles are dissolving inside of him, and his organs are shutting down. As the hours pass, JD’s mental status starts
to decline. He becomes disoriented and confused. This encephalopathy means that his liver isn’t
just dysfunctional, he’s now in acute liver failure. More monitoring finds that his kidneys are
worsening. His intestines are now obstructed because
the muscles of his GI tract have become paralyzed as the bruising on his skin become a deeper
purple color. As the night continues. A code is announced on the hospital speakers.
JD’s heart has stopped beating. Doctors, nurses, and pharmacists immediately
converge on his room to try and bring him back. Several minutes pass. A heart beat comes back
and he’s resuscitated. But his blood pressure is still low. A tube is placed down his throat and he’s
put on mechanical ventilation. Medicines are administered to him to both
constrict his blood vessels, and to promote the force of his heart contractions. All of this is done because if his organs
are not perfused with blood because of that low blood pressure, the bad things happening
to him, will worsen. But as time continues, those bad things, continue to worsen. The kidneys are supposed to filter blood.
If they don’t, metabolic waste begins to build up. And because he isn’t getting any better, his kidney failure continues
to decline and he’s put on a machine that does that filtering for him, something called
dialysis. If JD was previously healthy, what is even
happening? How can he go from living normal life one day, to having his heart stop in
a hospital bed a few days later? Blood culture results from the lab return
to the medical team. A gram negative rod shaped bacteria identified as Capnocytophaga canimorsus
was found. This bacteria lives in the mouths of pet dogs and cats. It doesn’t affect
canine or feline lifeforms. It doesn’t live natively inside humans. If a human comes in
contact with this bacteria, the immune system almost always destroys it, protecting our
bodies from infection. But if a human gets a bite from those animals,
and that person is immunocompromised, meaning their immune system isn’t working properly,
then this bacteria can proliferate and spill into bloodstream. And when the body issues
a generalized response to this bacteria in the blood stream, the uncontrolled reaction
by the immune system, shuts down the entire body. When you get a cut, the surrounding area becomes
swollen, red and warm. This inflammation is the immune system sending white blood cells,
sending chemical and protein signals to the site of injury. The walls of the blood vessels
are forced to relax by these mediators so that more immune cells can enter the site,
as fluid rushes in, causing the swelling. This is similar to what’s happening to JD,
except instead of a small localized region, his entire body’s blood vessels are forced
to relax, causing his blood pressure to drop. Without adequate pressure to push the blood
through the organs, it results in Tissue Ischemia. Isch from an old greek word meaning to restrain Emia meaning presence of blood. A restrained presence of blood, in the tissues. As less oxygen from blood reaches the organs,
their dysfunction begins to set in. The inner lining of the blood vessels in these
organs start to develop lesions. This is because activated white blood cells bind to the cells
of this lining, forcing the release of reactive chemicals (Reactive oxygen species, lytic
enzymes and NO, endothelia, PDGF, etc), injuring them and forming lesions all along this lining. The result of this cellular insult means that
the blood vessel narrows, making it even harder for blood to pass through the organs. When
combined with a low pressure to push that blood through, the organs aren’t just dysfunctional
anymore, they’re all starting to fail. As less oxygen is delivered to the organs,
mitochondrial dysfunction starts to happen in the cell. Respiratory enzymes that make
the mitochondria the powerhouse of the cell become inhibited, meaning energy is no longer
produced properly. Stress begins to build up, as mitochondrial DNA begins to break down.
The same chemical that dilates the blood vessels (Nitric Oxide btw) in inflammatory response,
approaches the inner membrane and the matrix proteins of the mitochondria, and begins to
dissolve the mitochondrial ultrastructure. Instead of a powerhouse, the mitochondria
degrades into a sludge that promotes cellular death, And causing all of his organs to shut down.
This is called sepsis, and the resulting low blood pressure, is septic shock. If the Capnocytophaga canimorsus bacteria
is swarming around in his blood and forcing his immune system to react this way, then
where did it come from? And how did it enter his body? Closer examination of JD finds no dog bite
marks, no scratch marks, so those are ruled out. He was previously healthy, meaning he has
no history of immunodeficiency or history of taking medicines that could compromise
his immune system. His family confirmed that JD did love his
pet dogs. He was very close with them. The spleen is an organ that recycles old red
blood cells, but it also stores white blood cells, which are integral to the immune system.
If someone doesn’t have a spleen, then they could be predisposed to an infection from
Canocytophaga, but JD’s spleen was functional, MEANING that all of this points to misfortune
and a freak accident, because without a bite mark, or any predisposing factors that would
indicate immunocompromise, it means some degree of licking and puppy kisses delivered Capnocytophaga
Canimorsus from the dog’s mouth, to some entrance in his body, whether through his
mouth or through the pores of his skin, as this zoonosis was spread all throughout his
body. A Capnocytophaga infection, is rare. In the
United States millions of people have dogs, and the infection isn’t even tracked. In
the Netherlands, a record of 0.67 cases per 1 million people happen per year, meaning
JD is less than 1 in a million. And among those who do have a Capnocytophaga infection,
the fatality rate is around 25%, meaning because he is 1 in a million, there’s a chance he
could be 1 in 4, too. Additional antibiotics were added to his regimen.
As days pass, JD’s fever clears. Repeat blood tests find improvements in some markers,
but worsening in others. On the 8th day of hospitalization, a fungus
named Candida albicans was found in his blood. Fungus has nothing to do with the dog. Where
did that come from? Well, some clinical implications need to be
accounted for here. Candida is present in your gut microbiome.
This would be all the microscopic organisms that live inside your stomach and intestines
to help you digest. When broad spectrum antibiotics are given, like in JD’s case, lots of the
bacteria in that microbiome are incidentally eliminated. But candida is a fungus. Antibiotics
don’t affect fungus that way. It starts to take over, reproduce en masse, and cause
a fungal overgrowth. Because JD was in the intensive care unit,
a central line was placed. This gives the medical team access in to his body. Candida
lives on your skin. It’s not affecting you right now because you’re probably not admitted
in the intensive care unit. But as the catheter has a connection directly to a central vein
for JD, through his skin, it introduces a vector for the fungus, to enter his body,
and to colonize, increasing his risk for infection the longer that it’s in place. An antifungal medicine was added to JD. His
skin started blistering and 10 days after the initiation of antibiotics, signs of systemic
infection were still present. Blood tests seemed to normalize in him. His
thrombocytopenia seemed to resolve. His muscles didn’t seem to be dissolving anymore. But the next day, the nurse alerts everyone
that JD’s fever has returned. More tests find that inflammatory markers were rising,
again. Typically, if a patient is starting to improve
but the fever returns in the intensive care unit, this could indicate a hospital acquired
infection. But in the ICU, most of these parameters can be controlled, so another antibiotic was
added again to JD. A CT scan of his chest revealed possible pneumonia.
This time from a new fungus, aspergillus fumigatus, as was detected in secretions from his trachea.
Antifungal medicine was changed and his antibiotic regimen was simplified. For the next few days,
JD was improving, again. But 4 days later, an abdominal CT scan revealed
that the blood flow to his spleen is now obstructed. This infarction, a Latin word meaning to stuff
or pack into, means that something caused a blood clot to be stuffed into a vessel of
his spleen. The scan confirms a complete infarction meaning that all blood flow was obstructed,
as the organ begins to necrose. As doctors look at JD, they see that all 4
of his limbs have developed gangrene, meaning that the blood supply has been cut off from
them, and that the tissue is no longer viable. If he survives this, it’s likely that he
won’t have his original limbs to use for the remainder of his life. Sepsis has been known to humans for several
thousand years now. The ancient Egyptians used these glyphs to describe a principle,
something, that couldn’t be seen by the eye, that was contained near what we know
now as the intestines. This principle, could travel up to the heart and cause death. We
know this principle today as bacteria because we’re able to see it with microscopes, but
Ancient Egyptians didn’t have microscopes, meaning they knew something from the gut,
can cause very bad problems. The interesting thing about these glyphs,
is that the fifth one, is not pronounced. It indicates that the word or idea presented
by the immediate previous glyphs are describing something disgusting. In the Ancient Egyptian
hieroglyph for the brain, that same final glyph is present, meaning that the Ancients,
thought the brain was something disgusting. But the Greeks developed the Egyptian idea
of self-intoxication from something disgusting stemming from the intestines and the brain.
They used the word sepsis (σ̃ηψιζ) which implied a bad smell, and it was contrasted
with pepsis which described a concoction of some sort. Hippocrates wrote that sepsis was
the process by which flesh decays, swamps generate foul airs and smells, and the process
by which wounds fester. Clearly he knew something he couldn’t see with eyes, was the cause
of all these problems. In western civilization, it took 2000 years
to further develop these ideas. In 1684 an Italian physician Frencesco Redi ran an experiment
to see if sepsis really produced small creatures spontaneously, as written by Aristotle. He took pots filled with meat, fish or cheese
and let them rot in the open. Flies gathered and laid eggs, creating maggots. He repeated
the experiment, this time with a fine gauze covering the meat, fish or cheese. Flies gathered,
but this time, could only lay their eggs on the gauze. No maggots grew on the baits, meaning
that small creatures don’t spontaneously generate from the process of sepsis. Today, we know the idea behind these hieroglyphs
is bacteria. And even more recently, Capnocytophaga canimorsus used to be called DF-2 (dysgonic
fermenter) in pre 1990 literature, because it hadn’t been classified as a new species.
The first case report was in 1961 California when a 17 year old boy who had undergone splenectomy
3 years earlier for a football injury had sustained a dog bite, and fell ill days later.
Several reports describing DF-2 are in literature before 1989, when it was finally given it’s
name. And while germ theory of disease gave a basis
for bacteria causing sepsis, it didn’t explain why patients’ organs still shut down, in
cases when the target bacteria was successfully eliminated from the body. This multi-organ
failure, is the same one that’s happening to JD. Another CT scan is done on his head. In his
brain, severe hypoxia, or low oxygen, was found along with a swelling of fluid. Because
the brain is enclosed in the skull, there isn’t much room for it to expand when there
is a swelling of fluid, meaning that permanent brain damage is happening to JD. The medical team meets with his family, and
it’s determined that therapy will be de-escalated. If he comes back from this, he will have permanent
brain damage. He won’t have his original arms and legs to use anymore. There there
will be likely loss of normal function for all his organs. In septic shock, sometimes it’s not just
the bacteria itself that causes the problem, it’s how the body responds. Starting with the Tissue Ischemia, almost
everything described in the process of the organs shutting down, was not just caused
by the bacteria but also by the human immune system. The Nitric Oxide dilation of the blood
vessels caused low blood pressure. The white blood cells caused endothelial damage to the
lining of the blood vessels and caused microcirculatory lesions, narrowing the vessel, worsening the
decrease in blood flow, in the face of severe hypotension. Capnocytophagia canimorsus is one of the most
lethal sepsis pathogens described. It’s right up there with Neisseria meningitidis
and Streptococcus pneumoniae. Those names tell you what they cause. Capnocytophaga can
live inside white blood cells after it has been phagocytosed, or eaten by them. So as
the immune system tries to destroy the bacteria, they hide inside instead. They can do this
because they create an enzyme that breaks down hydrogen peroxide that would have otherwise
destroyed them inside the immune cells. Something called catalase. And as they reproduce, break
out and diffuse through the blood stream, the immune system reacts systemically as Capnocytophaga
spills everywhere. Small blood clots form as the complement system
is activated from inflammation before the liver shuts down. These clots lodge into the
extremities, cutting off blood flow to them. Causing gangrene to develop as the tissue
starts to necrose. Just like what happened to JD. On day 16 of his admission, the therapy was
finished. Days later, he was returned home to family for processions. The point of this case, is not to scare anyone
of their animals. The infection is rare enough that it’s not tracked
in the United States. If you aren’t immunocompromised, and are a healthy person with a strong immune
system, getting kissed by your dog or cat probably isn’t going to be a problem. But the point of this case is to say if you
have pets, and are very close with them physically, if you develop flu like symptoms that’s
worse than a simple viral infection, you want to get that checked out immediately. These
flu-like symptoms include things like an intense fever with bruise-like spots developing under
the skin in places that you haven’t bumped. Big dark spots that rapidly develop. Or something like a severe shortness of breath,
don’t wait. Get it checked out immediately. I think most folks know of someone in their
life, who had a fever, and a couple of days later, passed in the hospital. There’s a
good chance that that was some degree of sepsis from either waiting too long, or from a freak
accident. And for anyone watching who is in clinical
practice or comes into contact with patients, you know that the clinical course for a patient
with bacteremia and sepsis, can decline in just a couple of hours, and I’m sure you’ve
heard or seen situations where when you come back for your next shift, that patient is
no longer with us. Even if the incidence is less than 1 person
per million, there’s more than 300 million here in the United States, so statistically,
around 300 people can get an infection from a dog licking them, biting them, or anything
involving a dog’s mouth, just like in JD’s case. So take care of yourself. And Be well.

100 comments / Add your comment below

  1. And this is why I get supremely upset when people bring their dogs into a restaurant or store with food in it… and this is happening more frequently lately. Repulsive!

  2. Talk about a cascade of health issues.
    This seems to be a common theme. One thing leads to another when it comes to medical problems. Like a heart attack leads to a stroke.

  3. This one was pretty sad. Crazy how someone can drive themselves to the hospital thinking "I'm not feeling well, better go get these bruises and tingly leg checked out" and instead of leaving that night, end up in ICU and then dead 2 weeks later. And his poor dog was probably waiting for him to come home the whole time.

  4. I wonder if ozone therapy or a vitamin C iv would have helped. Dr Marik developed an iv therapy recently, aside from old school methods. Probably the hospital wouldn't allow it.

  5. Intro music:
    Pillars Of Pepper – Lifeformed
    Frozen Hot Sauce – Lifeformed
    Background music:
    Upside Down Stalagmite – Lifeformed

  6. I thought immunology hadn't taught me anything, and here I am all like, "yo, I know complement pretty good. I heard that word and now I feel special"

  7. I love your videos! And Mr. Emu has a point. Near the end when he says if you think you have the flu, but its worse than any virus you've had before, get it checked out", he's not kidding. When I was in high school, I developed purple dots on my left hand. A few hours later, I had them all over both arms. The next day, I had A (single) severe chest pain, the purple dots were all over my body, and I had a fever. I go to emerge, and it turns out I had pneumonia that went septic. It caused elevated liver enzymes, Myocarditis, kidney protein in urine, and high inflammation (which was the cause of the dots). All of this could have been avoided if I had gotten my shortness of breath checked out earlier, and didnt contribute it to "Just my asthma acting up". If you feel sick, and its worse than anything you have ever had or lasts a few days without improvement, GET IT CHECKED OUT!

  8. Huge fan of the channel, but god was this video rough. It till fascinates and terrifies me that such tiny organisms can kill a person like that.

  9. I just heard that the new music director for the church I used to sing at died really suddenly of meningitis. He complained of sinus pain and headache in rehearsal, they took him to emergency, who said it was just a regular sinus infection. He went back to the church to get some work done, and they found him dead the next day. Infections are nasty, unpredictable things.

  10. Wait… but the immune system normally handles it no problem, and he had no history of immune deficiency… What caused his immune system to fail at the start of all this?

  11. Thanks for the great video! we cant get cyborg bodies fast enough, I dnt want it to literally cost me an arm and a leg to pet a dog lol. youd think after how long humans and dogs have lived together we wud be less susceptible to something like this, even tho its alredy low odds, 1 in a million, there are about 7700 million of us and growing.

  12. While watching this case my mind keeps going: "oh, no", "oh, gee", "oh, dear"…
    I want a cat so much ??

    Why does blood pressure always drop down when the patient has critical condition ?
    I always have low blood pressure, if I have medical problem, I might die faster ? ?

  13. I had sepsis shock, and almost died. I was 36. I lost my leg. I had it again four years later, resulting in hepatic encephalitis. That bout wasn’t as bad as the first so I was not on a ventilator. I don’t have memory of several days, but as I got better I do have a vague memory of the doctors asking me simple questions (name, year, my location), and I struggled and struggled to find the answers in my brain. And when I did answer I knew I was wrong but I couldn’t express that. Thankfully other then the loss of my leg in the first bout, and most likely loss of brain cells in the second I’ve come through okay.

    This happened to me because I have Lupus and take immunosuppressants. I remember a few years ago my ID doc freaking out when she heard my cat sometimes managed to break my skin with her teeth while playing. I’ve taken her seriously, but sometimes the cat just goes nuts and gets me. I guess I will be even more careful now. I am very watchful of EVERY fever I get, so trust me, I’d be in the ER the minute my temp went over 100. Sounds extreme? I’d rather be told to go home, then die because I waited too long. Sepsis is very serious, and more people die of it then you think. A cancer patient may develop an infection, and eventually sepsis, and may die. Everyone will say they died of cancer, but they didn’t. They died of an infection leading to septic shock due to being immunosuppressed from cancer treatment. The cancer did not kill them, the sepsis did. Visit the Sepsis Alliance to learn more about the dangers of sepsis, and what you can do to help recognize the signs in yourself or a loved one. Awesome video, but sad outcome. RIP JD.

  14. “Returned to his family for processions”
    Well shit, I thought he was gonna pull through despite the quadruple amputations and brain damage.

  15. Just want to emphasize that I have volunteered at a dog shelter and kissed 18+ dogs per week for at least four years with no adverse effects. I’ve been nipped by dogs and kitties hundreds of times and am perfectly ok. Please don’t let this video make you fear providing care and love for your pets or other animals in your life. This represents a very extraordinary situation, and animals aren’t automatically harmful to you.

  16. "returned to his family for… 'processions'"?
    Like, funeral processions? He dieded? So he was returned with palliative care and for his relatives to say goodbye? I wasn't entirely clear on his fate. Anyway, sounds like a shitty cascade of health issues. A "shitty health cascade", if you will.

  17. My mom passed a few months ago of sepsis in blood, she only lasted 3 days….she was a liver transplant survivor and her inmune system was low, for 5 years she did so good until she contracted a bacteria that she couldn’t fight. This video was so accurate ?

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