A Man Was Kissed By His Dog. This Is What Happened To His Organs.

A Man Was Kissed By His Dog. This Is What Happened To His Organs.

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 thoughts on “A Man Was Kissed By His Dog. This Is What Happened To His Organs.

  1. Always be careful with dog's saliva. Dog is a great companion however they have imperfections that owner needs to be aware on. Keep your dogs clean and healthy is a must.

  2. People making fun of the videos titles… Just stop it. You are embarrassing yourselves. It's nothing invented, guys. Things can escalate REALLY fast, it's very frustrating to see a patient getting worse and sometimes, like this poor gentleman, might be irreversible. Be respectful and keep your comments to yourself.

  3. Old stuff. I watched Peanuts you know. Lucy always exclaimed “Ewh, dog germs!” when Snoopy licked her. I stay away from dogs and cats, at least, far enough so that they cannot lick me.

  4. New sepsis protocol using vitamin C has been shown to be very effective in reducing the mortality. I wonder why this was not incorporated

  5. we muslims r instructed to always be away from dogs and cats, and in case u want a dog don't go near it's tongue, also when it licks something we r to rub sand over the licked area…

  6. Where do you FIND these stoies? That was the WORST. (And oddly enough, one of your best).
    Alright, get down Fido. Get down! Will someone PLEASE take this dog out!

  7. Sorry to be that person, but I just can't resist…

    One bacterium=singular
    Many bacteria=plural

    (and in general, -um/on=singular, -a/ae=plural: millennium-millennia, phenomenon-phenomena)

    Yeah, I really had to 😛

  8. When he started taking about the mitochondria and dna getting destroyed my body started to hurt and my mind floated off 🤢

  9. im sorry i have kissed mine and others animals all my life. I used to chew on chew-eez rawhides when I was younger and am very healthy. im sorry he got sick.

  10. the liver shutting down causing ammonia builds up in the blood then your brain swells- you can die just from the brain swelling.

  11. I was writing my BIO 100 lab exam and a there was a question about IV's, finally I have used knowledge learned from this channel.

  12. My friend if u see this comment do have anyone has the edema or oedema cuz I'm worry about my health and plus had asthma and T2 Diabetes a nasty red flag I need your help to see how to keep my health intact to this next video how to prevent that coming out thank you

  13. Crazy there arent more insightful comments on this guys videos. They're really great and every comment is just making fun of the title

  14. My daughter has thrombocytopenia. I sent her this because she has problems that arise from it and she does own a kitty. Now, my kitty licks me a lot (because she's weird) but I don't have any problems with my immune system. My daughter does. I sent her this video and I am going to make sure she watches it!

  15. You got to work with "Vsauce, Michael here"
    That's really great and awesome.Congratulations 👍😃. I'm eagerly waiting for the video on his channel.
    AS ALWAYS,this video was great. Always nice listening about how all organs can shut down.

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