Do you own a spleen?

Dr. M. is a funny woman.  When she interviews potential technicians, she knows not to ask illegal questions, such as marital status, ethnic origin and age.

Yet without blinking an eye, she asks possible hires if they have a spleen.

This was so intriguing to me that of course I had to investigate. Our colleague explained: "I read once in a human morbidity and mortality review that if you do not have your spleen and you are bitten by a dog, the bite has the potential to be fatal. There have been reports of deaths in spleen-less people because of the organ's role in our immunity.  Since I've read this article, I thought I should make sure any potential technician does own a spleen."

Indeed, an old JAVMA article* describes dysgonic fermenter-2 infections. Since then, the "fastidious, gram-negative, opportunistic" bacterium was renamed Capnocytophaga canimorsus.

More recently, Scott Weese, DVM, DACVIM, has written about this topic in his excellent blog (wormsandgermsblog.com). His is an associate professor in the Department of Pathobiology at the University of Guelph, Ontario. Simply said, our internist has become an infectious disease specialist.

Here how he describes the evolution of a minor bite that "barely broke the skin."

"(…) Two days later, Mr. Moore thought he had the flu. The next day, he was worse and went to the hospital. By the time he arrived, his face and body had a bluish tint. He was asked about the scar on his abdomen and he told the hospital staff it was from his spleen having been removed. (…) The medical staff couldn't pinpoint the problem right away, but hopefully Capnocytophaga was a leading thought. Mr. Moore was critically ill by this point with multiple failing organs. He was admitted to ICU, became septic (…) and was put on a ventilator. His hand had to be amputated, as did both legs below the knee and three fingers on the remaining hand. But he survived."

Capnocytophaga can actually be found in the mouth of a many perfectly healthy dogs.

Dr. Weese shares some general advice for people who don't have working spleens:

• Talk to your physician or an infectious disease specialist about the risks associated with animal contact (including pets).
• In general, you do not need to give up your pets. The risk of infection may be increased, but the risks can be minimized in most situations, and the risks are often outweighed by the beneficial aspects of pet ownership.
• Be wary of any possible exposure to an infectious disease, and be diligent about infection control precautions. If you are bitten by an animal of any kind, see a doctor as soon as possible.
• Make sure your pets do not touch any open wounds you may have. In particular, do not let a dog lick skin that is damaged in any way. Since Capnycytophaga is commonly carried in the mouths of healthy dogs, licking in general should be discouraged.
• Don't feed your pet raw meat or raw treats, because this increases the risk exposure to Salmonella from your pet's stool.
• Be very careful when handling stool to avoid contaminating yourself or other objects/surfaces. If you have a cat, ideally its litter box(es) should be changed by someone else.
• Always wash your hands well (and frequently) after contact with pets and pet foods, including dry commercial pet food (kibble).

Dr. Weese concludes: "People who have had their spleens removed or who have non-functional spleens are at much greater risk for various infections, such as Capnocytophaga infections. No one should be allowed to leave a hospital after having their spleen removed without a letter saying, among other things, if you are bitten by a dog, get thee to a physician (pronto)! If you don't have a functioning spleen, make sure you know the risks and how to protect your health."

So please remember: dog bite + no spleen = danger.

* J.R. August."Dysgonic fermenter-2 infections." JAVMA 1988, Vol. 193, N. 12, p. 1506-1508.