inclusion was limited to those patients from whom isolates sent to sbrl were identified as no-1 between 1974 and 1998 . in collaboration with state and territorial public health epidemiologists and hospital infection control practitioners , we gathered relevant clinical records and exposure data to determine the clinical significance of and risk factors for no-1 infection . state epidemiologists , hospital infection control practitioners , or both were notified of cases that occurred in their state or hospital and were requested to submit clinical records for each case , including chart notes , discharge summaries , and clinical laboratory results . using a standardized form , we abstracted clinical data for each patient . information recorded included demographic characteristics , signs and symptoms of illness , treatment , laboratory results , and outcome . we collected information on symptoms including erythema , swelling , drainage , cellulitis , loss of motion , and any other symptoms that treating physicians noted . this protocol was determined to be exempt from human subjects review requirements because the gathering of clinical information to accompany strains was a standard part of reference diagnostic submission , and , therefore , considered surveillance activity for a newly emerging pathogen . data were entered and analyzed with epi info version 6.04 ( cdc , atlanta ga ) . continuous variables were evaluated by using the kruskal - wallis test , and categorical variables were compared using the chi - square test or fisher s exact methods . of the 22 patients from whom no-1 isolates were recovered , 11 ( 50% ) were male with a median age of 22 years ( range , 20 months to 78 years ) . the median age of males was significantly different from that of females ( 9 vs. 25 years , p<0.05 ) . in all 22 cases , the organism was isolated from an animal bite wound site : 17 ( 77% ) from a dog bite wound , 4 ( 18% ) from a cat bite wound , and 1 ( 5% ) with no recorded bite source . fourteen ( 64% ) isolates came from bites on the extremities , 6 ( 27% ) came from face or neck wounds , and for 2 ( 9% ) no anatomic site was specified . we were unable to retrieve 10 ( 45% ) of the 22 medical records for reasons including 1 ) records were lost , destroyed by accident or natural occurrence , or archived off - site , or 2 ) a patient was seen in the emergency room and notations were not in the patient record . the 12 patients whose records were available for review are summarized in table 1 . of these patients , 4 ( 33% ) were male with a median age of 36 years ( range 7 to 78 years ) . eight ( 67% ) had dog bite wounds , and the remaining 4 ( 33% ) had cat bites . eleven ( 92% ) received bite wounds on the extremities , including hands , arms , or legs ; one bite occurred on the face.the median time interval from bite to onset or worsening of symptoms was 17.5 hours ( range 3 to 78 hours ) . ten patients were afebrile ; in two cases , a temperature > 38.9c was recorded . at treatment , 67% of patients reported increased pain associated with erythema and swelling around the wound site . purulent drainage was noted in 50% of cases , and a diagnosis of cellulitis was made for 67% of patients . there was no evidence of sepsis , although blood cultures were attempted in only four cases . for those patients for whom records were retrieved , decreased range of motion was documented in 4 ( 36% ) of the 11 with extremity wounds . other reported symptoms included ecchymosis ( 8% ) , increased local temperature ( 8% ) , tingling sensations ( 8% ) , chills ( 8% ) , adenitis / lymphadenopathy ( 25% ) , and discoloration ( 25% ) including  streaking . hematocrit ( range 36% to 43% ) and platelet counts ( range 140 to 331 k / mm ) were normal . isolates later identified as no-1 were originally described as fastidious gram - negative rods , polymorphic gram - negative rods , or gram - negative bacilli . most of the specimens contained mixtures of two or more bacterial species , although specimens from cases 6 and 11 yielded apparently pure cultures of no-1 . other bacterial organisms isolated from these wounds included weeksella zoohelcum , eikenellla corrodens , pasteurella multocida , staphylococcus aureus , and corynebacterium spp . , coagulase - negative staphylococci , and unidentified gram - positive cocci and enteric gram - negative rods . unk . = unknown ; op = outpatient ; op1 = outpatient visit 1 ; op2 = outpatient visit 2 ; ip = inpatient . incomplete information on condition of infection following treatment . identified as centers for disease control and prevention group nonoxidizer 1 ( no-1 ) . standard cleansing , including irrigation and debridement of wounds followed by dressing , was documented for 8 of 12 patients . no associations were seen between suture therapy and severity of symptoms or duration of recovery . seven ( 58% ) persons were hospitalized for treatment , 5 ( 42% ) were managed as outpatients ( table 1 ) . all 12 patients were given one or more antibiotic treatments within 1 to 3 days of receiving bite wounds . initial therapy for patients included at least a beta - lactam antibiotic ( table 1 ) . five patients ( cases 2 , 4 , 5 , 6 , and 12 ) were initially treated as outpatients and were subsequently admitted for worsening of symptoms . in - hospital treatment for these five patients included either intravenous beta - lactam or intravenous beta - lactam with beta - lactamase inhibitor . eight ( 67% ) of 12 cases , including all 7 inpatients , received intravenous antibiotic therapy . though most patients were released before infection completely resolved , all 10 patients for whom follow - up information was available had documented improvement of the infection . the hospitalized patients had a median stay of 4 days ( range 2 to 11 days ) . a history of asthmatic bronchitis and respiratory allergies , arthritis , and a ventricular septal defect was noted for cases 6 , 4 , and 9 , respectively . no pre - existing conditions or illnesses were documented for the rest of the patients . infections in which no-1 bacteria were isolated appear to be local ( i.e. , abscess and cellulitis ) . following receipt of a bite wound , no-1 infections , without severe disease , can occur in healthy persons with no underlying illness . the most common clinical features associated with no-1 infections included purulent drainage , increased pain with erythema and swelling , and cellulitis , which are clinically similar to features of infections caused by other animal bite - related organisms ( 5 ) . apparently pure cultures of no-1 were obtained from wound specimens of cases 6 and 11 . although case 11 resolved with outpatient dicloxacillin treatment , case 6 required hospitalization and multiple antibiotic treatments . taken together , these facts suggest that no-1 infections can progress from localized to systemic forms . at this time there is no available information on potential virulence factors for no-1 . as described by hollis , et al . , the phenotypic characteristics of no-1 are similar to those observed with asaccharolytic acinetobacter species ( 6 ) . no-1 bacteria fail to acidify carbohydrates and are oxidase , indole , and urease negative . cellular fatty acids and ubiquinone analysis are useful in differentiating no-1 from acinetobacter species ( 6 ) . the patients from whom no-1 were isolated were successfully treated with a variety of antibiotics . in general , intravenous antibiotics my have an advantage over oral antibiotics in preventing bacterial infections associated with bite wounds , including those caused by no-1 , because of more rapid delivery of drug to affected tissues ( 7 ) . previously reported antimicrobial susceptibility testing of 17 of the 22 strains by a standard broth microdilution method showed all stains to be susceptible to aminoglycosides , beta - lactam antibiotics , tetracyclines , quinolones , and sulfonamides . some of the isolates were noted to grow poorly in the broth test for the antimicrobial susceptibility testing , but all control wells had sufficient growth for interpretable results ( 6 ) . most dog and cat bite wounds in young children occur on the face , head , and neck ; by contrast , the extremities tend to be injured in young adults and adults ( 2,8,9 ) . in our study , of the 6 patients who received bite wounds to the face , head , or neck , 4 ( 67% ) were 8 years , 1 ( 17% ) was a 51-year - old woman , and 1 ( 17% ) was of unknown age . of the 14 victims who received bite wounds on an extremity , 1 ( 7% ) was < 10 years . across all ages , 14 ( 64% ) of all 22 isolates came from bite wounds on the extremities , consistent with the distribution of animal bite wounds reported in other studies ( 5,10,11 ) . in addition to other pathogens that are associated with bite wounds , such as staphylococcus spp . anaerobes , and pasteurella multocida , no-1 should be considered in the differential diagnosis of infected bite wounds from cats and dogs . group no-1 organisms have been shown to be similar to two isolates from oral and nasal fluids from dogs called likewise , the association of human no-1 infections with animal bite wounds received from cats and dogs suggests that these animals are a reservoir for no-1 bacteria . at present no surveillance system exists for reporting dog or cat bite wound - associated infections and , therefore , the incidence of no-1 isolated from bite wound infections is not known ; however , these 22 reported cases likely represent only a fraction of the true number of potential no-1 infections . several of the case records noted the gram - negative rods as possible exogenous contaminants ; thus , many more no-1 infections may be unrecognized and undocumented . enhanced awareness of this organism by physicians will improve our understanding of this new zoonotic infection and clarify its clinical significance . with over 4 million animal bites occurring in the united states each year , bacteria associated with dog and cat
from 1974 to 1998 , 22 isolates of an unusual bacterium , designated as cdc group nonoxidizer 1 ( no-1 ) , were sent to the centers for disease control and prevention for identification . 
 the organism 's phenotypic characteristics were similar to asaccharolytic strains of acinetobacter , but differed in their cellular morphology and cellular fatty acid profile . 
 we report here on no-1 's clinical and epidemiologic significance . in all cases , 
 isolates were recovered from an animal bite wound ; 17 ( 77% ) were isolated from a dog bite wound , 4 ( 18% ) from a cat bite wound , and one ( 5% ) from an unspecified animal bite . 
 clinical data were retrieved and reviewed for 12 ( 55% ) of the 22 bite victims . 
 none of the patients had pre - existing conditions associated with immunosuppression . 
 seven ( 58% ) patients were hospitalized for a median stay of 5 days ( range , 2 to 11 days ) . 
 the median time between bite to the worsening of symptoms was 17.5 hours ( range , 3 to 78 hours ) . 
 all patients recovered following antibiotic treatment .