c We encountered a rare case of severe fatal infection in a 70-year-old woman due to Campylobacter upsaliensis, identified by PCR amplification and sequencing analysis of the 16S rRNA gene using DNA extracted from the isolates. To our knowledge, fatal sepsis due to this organism has never been described to date.
CASE REPORTA 70-year-old woman was admitted to the emergency department complaining of loss of consciousness. On admission, her vital signs showed lethargy, hypothermia (35.1°C), hypotension (systolic blood pressure of 80 mm Hg), and tachycardia (pulse rate of 160 per minute). She did not have any recent episodes of diarrhea or enterocolitis, as assessed at her periodic visits to our hospital. Prolonged hypoglycemia with treatment resistance was also observed, and glucose was administered more than once. She had a history of left ureteral cancer, thyroid cancer, ectopic Cushing's syndrome, hypertension, and atrial fibrillation. Laboratory examination showed a normal white blood cell count, thrombocytopenia, a high serum transaminase level, and acute kidney injury (estimated glomerular filtration rate of 15.4 ml/min/liter). Severe metabolic acidosis and lactic acidosis were also observed. Enhanced computed tomography imaging led to a diagnosis of Stanford type A dissecting aortic aneurysm with cardiac tamponade. Enteritis and abscesses were not observed. Although pericardiocentesis was performed for the cardiac tamponade caused by the dissecting aortic aneurysm, the patient chose not to have artificial blood vessel replacement performed. Large amounts of vasopressors (noradrenaline and dopamine) and glucose were administered while the patient was in the intensive care unit. Cefazolin (2 g per day) was administered to prevent surgical site infection following pericardiocentesis rather than as a treatment for the original infection. However, severe hypotension, hypoglycemia, and liver failure worsened without improvement. The patient died due to multiorgan failure 2 days after admission.Bacterial isolates from the blood of the patient, which was taken at admission for the evaluation of hypertension, were positive in Bactec aerobic bottles alone (BD, Franklin Lakes, NJ, USA). Subculture of the positive blood culture bottle yielded growth after 72 h of microaerobic incubation at 37°C (2 days after the patient's death). Bacterial identification using API Campy (Sysmex-bioMérieux, Tokyo, Japan) did not yield a definitive identification. Therefore, PCR amplification and sequencing were performed to analyze the 16S rRNA gene using DNA extracted from the isolates. Genomic DNA from all strains grown were extracted by physical extraction using zirconia beads (Mora extraction kit; AMR Co., Gifu, Japan), according to the manufacturer's instructions. The universal primers 8UA (5=-AGAGTTTGATCMTGGCTCAG-3=) and 1485B (5=-ACGGGCGGTGTGTRC-3=) were used as described previously (1). We performed sequencing analysis using a GenBank BLAST search and EzTaxon (http://www.ezbiocloud.net /eztaxon/). The sequence of the 16S rRNA gen...