An Unusual Case of Refractory Campylobacter jejuni Infection in a Patient with X-Linked Agammaglobulinemia: Successful Combined Therapy with Maternal Plasma and Ciproftoxacin

Abstract

An unusual hippurate-negative strain of Campylobacter jejuni caused a chronic refractory infection in a patient with X-linked agammaglobulinemia; this infection persisted for > 2 years despite therapy with various antibiotics and immunoglobulins (Igs). To characterize the defense status of this patient, several in vitro studies, including those with T cells and polymorphonuclear leukocytes (PMNLs), were performed. T cell responses specific for C. jejuni were only weak in this patient. Chemiluminescence and bacterial killing studies with PMNLs revealed that the bactericidal activity of PMNLs against Campylobacter was enhanced more vigorously by maternal serum than by commercial Ig preparations. On the basis of these results, combined treatment with ciprofloxacin and maternal plasma was initiated, and the C. jejuni infection was rapidly cured. This case report shows that in vitro immunologic assays may be useful for characterizing immune functions of patients with chronic or refractory C. jejuni infections, thus leading to individual treatment strategies.

Combined Treatment with Oral Kanamycin and Parenteral Antibiotics for a Case of Persistent Bacteremia and Intestinal Carriage with Campylobacter coli

“…There have been eleven case reports of X-linked agammaglobulinemia with Campylobacter bacteremia (12)(13)(14)(15)(16)(17)(18)(19) (18). There have been three reports in which administration of oral antibiotics in addition to intravenous antibiotics were effective in eradicating C. coli from the intestine (12,15,18 …”

Enteric Campylobacter: Purging Its Secrets?

“…Immunocompromised patients may have a severe, prolonged, or relapsing illness with extraintestinal manifestations, and accompanying bacteremia is more frequent (98 -100). In patients with immunoglobulin deficiencies, the organism can take years to eradicate (101), indicating that the humoral immune response is important in combating these infections. The incidence of Campylobacter infection is 40 -100 times greater in persons with AIDS than in the background population (102), and non-C. jejuni species are found in this group (103).…”

Recurrent Campylobacter jejuni bacteremia in a patient with hypogammaglobulinemia

“…[5,15,16] One patient showed persistent positive stool cultures for C. jejuni following imipenem therapy that was eradicated by ciprofloxacin and maternal plasma infusion therapy. [17] Other examples include erythromycin given for 6 weeks to eradicate Campylobacters , [5] clarithromycin given for 3 weeks in a patient with C. jejuni bacteremia, [18] and oral kanamycin in patients with recurrent C. coli bacteremia. [6,19] Our patient received aminoglycosides at the time of each admission.…”