Campylobacter jejuni Bacteremia in Human Immunodeficiency Virus (HIV)‐ Infected and Non‐HIV‐Infected Patients: Comparison of Clinical Features and Review

Abstract

Clinical and bacteriologic features and clinical outcomes of culture-confirmed campylobacter bacteremia in 21 patients (including nine human immunodeficiency virus [HIV]-infected subjects and 12 non-HIV-infected subjects) were retrospectively evaluated and compared. This study highlights differences between HIV-infected and non-HIV-infected individuals. Campylobacter jejuni bacteremia in HIV-infected patients was found to often be a severe, debilitating febrile illness requiring multiple and prolonged courses of antibiotic therapy. Extraintestinal features, particularly pulmonary involvement, were often observed. Cellulitis occurred in one patient. By contrast, in non-HIV-infected patients, the illness was generally an acute onset of fever associated with self-limiting enteritis, with fever resolving rapidly with antibiotic treatment. Travel history (42% of cases) appeared to be a common risk factor in the latter group. Two of these patients had cutaneous manifestations, thus suggesting that some strains may be more invasive. This study suggests that campylobacter bacteremia is an important cause of morbidity and mortality in HIV-infected individuals; the overall mortality rate among HIV-infected patients with bacteremia in this study was 33%. This is not the case for immunocompetent patients, in whom death rarely occurs.

Clinical Features of Bacteremia due to <i>Campylobacter jejuni</i>

“…The lack of gastrointestinal symptoms in patients with bacteremia due to Campylobacter species, mostly C. jejuni and C. coli, has been reported with an incidence widely ranging between 21 and 60% (3)(4)(5)(6)(7)(8)(9). The lowest incidence (21%) was demonstrated in a recent Finnish study in which 70% of patients had no underlying diseases, as mentioned above (9).…”

“…Previous studies have consistently shown chronic liver diseases (mainly liver cirrhosis), malignancies, immunosuppressed states (including human immunodeficiency virus infection), and alcoholism to be risk factors for C. jejuni bacteremia (3)(4)(5)(6)(7)(8)(9). Hypogammaglobulinemia has also been reported to be associated with a higher risk of developing C. jejuni bacteremia as well as greater severity and greater likelihood of recurrence and secondary soft tissue infection (3,8,14).…”

“…Bacteremia due to Campylobacter species has been considered rare; it was detected in less than 1% of patients with gastroenteritis due to these species (2). Therefore, the clinical features of bacteremia due to Campylobacter species have been the focus of several investigators and have yet to be fully elucidated (2)(3)(4)(5)(6)(7)(8)(9)(10). Most previous reports are from European countries and included data obtained from cases of bacteremia due to not only C. jejuni but also other Campylobacter species.…”

Campylobacterbacteremia: A rare and under-reported event?

“…For example, in a hospital-based study, Tee and Wijch reported a prevalence of 1.6% for bacteremia in persons infected with Campylobacter [60]. However, in background population-based studies, Campylobacter bacteremia was observed to be 5-10 times less abundant, with reported mortalities being between 2 and 13% [56].…”

“…However, in Finland there were only four cases of C. fetus-related bacteremia reported in a 10-year surveillance study [55], suggesting that there may be geographical differences in C. fetus-related bacteremia. In fact, in the majority of clinical studies, C. jejuni and C. coli have been the predominant Campylobacter species isolated from Campylobacter-related bacteremia, and the risk of death has been higher in those patients that did not receive appropriate antibiotic therapy, or were prescribed a thirdgeneration cephalosporin [58][59][60][61][62].…”