SINGAPORE - Two people here have contracted the C. canimorsus infection since 2017 but both have since recovered.

The rare disease made headlines on Wednesday (Nov 27) when a German man died from the infection after being licked by his dog.

The 63-year-old man went to a hospital in Germany with a burning sensation in his left leg and muscle pain in both. His flu-like symptoms were severe, with laboured breathing for three days.

He had petechiae, or rounds spots on the skin that look like rashes as a result of bleeding capillaries, which made his legs look discoloured.

He died after 16 days of care, according to doctors.

The infection could be severe or even fatal for people with poor immune systems, said Dr Shawn Vasoo, acting clinical director at the National Centre for Infectious Diseases (NCID).

"The man, who was reported to be healthy, may have had an undiagnosed medical condition which predisposed him to this infection, or a less robust immune system," added Dr Vasoo.

The C. canimorsus bacteria is part of the normal "flora" of a dog's mouth and it probably entered the man's body or blood stream through a break in his skin, which may have been unnoticed, when his dog licked him.

There is no risk of the affliction becoming a problem here as severe infection from the Capnocytophaga canimorsus bacteria is uncommon in people with intact immune systems, he added.

People who can have a severe form of the disease usually have poor immune systems.

This includes people with poorly controlled diabetes, patients on chemotherapy or who have had transplants and those on immuno-suppressive medication.

Patients who do not have a spleen or have a spleen that has not been functioning are particularly at risk, said Dr Vasoo, as are people with liver disease.

Their spleen may have been surgically removed due to an injury or accident or it may not be functioning well because of other diseases that affect it or due to excessive alcohol consumption.

Some symptoms of the severe C. canimorsus disease include blood poisoning with fever, a rash that is usually purple and blotchy and low blood pressure.

"Patients who have more localised disease from this bacteria may (have) pain and redness due to a skin or soft tissue infection, called cellulitis, around the area of a dog bite," he said.

Animal Ark senior veterinarian Eugene Lin said that people with impaired immune systems such as HIV-positive people and patients with liver or kidney insufficiencies need to take extra precautions.

However, the bacteria is not a cause for concern for most people, he said.

"Most of us do not need to worry about dogs or cats licking us, even if we have wounds on our body. A healthy person should be able to resist infection by this bacteria," said Dr Lin.

Mount Elizabeth Novena Hospital infectious disease physician Leong Hoe Nam agreed: "(It) is a relatively rare infection and I am not aware of anyone having died from it."

He added that the death of the German man was a rare situation. "You can imagine that he would have patted (the dog) or (have been) licked by the animal many times, and this was one incident.

"I suspect many individuals may have had mild versions of the infections, but they were easily treated by the family physicians with an easily available oral antibiotic."

Pet owners can take precautions by brushing and cleaning their pet's teeth regularly to reduce the concentration of the bacteria in its mouth, said Animal Ark's Dr Lin.

NCID's Dr Vasoo said that owners should not allow pets to bite or scratch them, or lick areas of broken skin: "If you have broken skin, cover those areas with a dressing.

"If you get bitten or scratched, perform first aid immediately by washing the wound thoroughly with soap and water, and seek medical attention. This is particularly important for those with poor immune systems."

This article was first published in The Straits Times. Permission required for reproduction.