Fatal Campylobacter jejuni infection in a patient splenectomised for thalassaemia.

Jackson, Nicholas; Zaki, Mona S.; Rahman, Andey; Nazim, Mohammed Nadeem; Win, M N; Osman, Sana Mohammed Ahmed

doi:10.1136/jcp.50.5.436

Cited by 12 publications

(4 citation statements)

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“…However, there are no previous reports on any association between thalassemia and/or splenectomy and infection with C. fetus . One previous report described a fatal infection with C. jejuni in a post‐splenectomy thalassemic patient who presented with fever and rapidly progressed to septicemic shock [3].…”

Section: Discussionmentioning

confidence: 99%

Campylobacter fetus pericarditis in a patient with β-thalassemia: case report and review of the literature

Kanj

Araj

Taher

et al. 2001

Clinical Microbiology and Infection

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A case of pericardial effusion due to Campylobacter fetus in a patient with thalassemia is presented. The patient failed to respond to ceftriaxone and clarithromycin despite in vitro susceptibility, but improved after pericardiectomy and ampicillin. Pericarditis due to C. fetus has rarely been reported. A high index of suspicion is essential to recognise this organism, because of its special microbiological characteristics.

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Section: Discussionmentioning

confidence: 99%

Campylobacter fetus pericarditis in a patient with β-thalassemia: case report and review of the literature

Kanj

Araj

Taher

et al. 2001

Clinical Microbiology and Infection

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“…Therefore, splenectomy appears to have been a major risk factor for this bacteremia. There are a few reports of Campylobacter bacteremia in asplenic patients [ 12 , 13 ]. Considering the common inhabitance of enterohepatic Helicobacter and Campylobacter spp., splenectomy would appear to be a risk factor for H. cinaedi bacteremia.…”

Section: Discussionmentioning

confidence: 99%

“…Gram-negative rods are also involved in the development of infections in asplenic patients, and these infections are often fatal because of lipopolysaccharide-mediated inflammation [ 15 ]. It is also likely that splenectomized patients are immunocompromised because of multiple blood transfusions, chronic viral infections, iron overload, and diabetes mellitus [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

A Case ofHelicobacter cinaediBacteremia in an Asplenic Patient

et al. 2012

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Helicobacter cinaedi is an enterohepatic species. It can cause bacteremia, gastroenteritis, and cellulitis, particularly in immunocompromised individuals, such as those with acquired immunodeficiency syndrome, malignancy, or alcoholism. There are no previous reports of H. cinaedi infection in Korea. A 71-yr-old man was admitted to the emergency room because of dyspnea on November 9, 2011. He had undergone splenectomy 3 yr ago because of immune hemolytic anemia. Chest plain radiography revealed bilateral pleural effusion. He developed fever on hospital day (HD) 21. Three sets of blood cultures were taken, and gram-negative spiral bacilli were detected in all aerobic vials. The isolate grew in tiny colonies on chocolate agar after 3-day incubation under microaerophilic conditions. This organism tested positive for catalase and oxidase, and negative for urease. The 16S rRNA gene sequence of this isolate exhibited 99.8% homology with the published sequence of H. cinaedi CCUG 18818T (GenBank accession no. ABQT01000054) and 98.5% homology with the sequence of Helicobacter bilis Hb1T (GenBank accession no. U18766). The patient was empirically treated with piperacillin/tazobactam and levofloxacin, and discharged with improvement on HD 31. To our knowledge, this is the first report of H. cinaedi bacteremia in an asplenic patient. Asplenia appears to be a risk factor for H. cinaedi bacteremia.

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“…The organism was not recovered from respiratory secretions. Additional reports discuss isolation of C. jejuni solely from blood culture in the context of adult respiratory distress syndrome (9) and pneumonia (10,11) from patients with underlying thalassemia and/or previous splenectomy. In contrast, reports of pleuritis in a hemodialysis patient (12) and empyema secondary to food aspiration (13) described isolation of C. jejuni from pleural fluid.…”

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confidence: 99%

Answer to November 2017 Photo Quiz

et al. 2017

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T he S-shaped Gram-negative bacilli were catalase positive and exhibited darting motility. Off-label performances of a Campylobacter jejuni/C. coli PCR assay (Prodesse ProGastro SSCS; Hologic, San Diego, CA) (1) on a suspension of isolated growth and on a 1:3 dilution of primary pleural fluid yielded organism-specific fluorescent output (cycle threshold values of 24.8 and 40.5, respectively). Subsequent manipulations of the isolate demonstrated optimal growth under microaerophilic conditions (85% N 2 , 5% O 2 , 10% CO 2) at 42°C. Growth was favored on CDC anaerobic blood agar (see Fig. 1B in the photo quiz) versus routine blood agar (see Fig. 1A in the photo quiz) when the isolate was incubated in that environment for 24 h. The isolate was definitively identified as Campylobacter jejuni via DNA sequence analysis of the 16S rRNA gene. Although the isolate was initially recovered via 37°C anaerobic incubation, subsequent subcultures of the isolate failed to grow under anaerobic conditions and did not exhibit luxurious growth in a 37°C microaerophilic environment. Kassem et al. (2) reported that differential expression of genetic respiratory determinants enables C. jejuni to survive in a variety of thermal or oxygen concentration niches. The differential expression also affects host-pathogen interaction. Such data may explain both the recovery of the primary isolate on CDC anaerobic blood agar at 37°C and its inability to reproduce on that medium ex vivo. The gastrointestinal tract was thought to be the antecedent source for the pleuritic isolate of C. jejuni, as a fecal specimen collected on hospital day 4 was positive for Campylobacter jejuni/C. coli by the same PCR assay (cycle threshold, 35.0). Campylobacter bacteremia is a rare disease, with susceptible hosts being those with liver disease, hypogammaglobulinemia, HIV infection, or other immune deficiency (3). Early literature reported C. jejuni bacteremias to be less common than those of C. fetus etiology (4). Blaser et al. (5) reported C. jejuni to be serum sensitive (complement-dependent antibody-mediated killing), with Campylobacter fetus bacteremias being largely serum resistant. A recent Spanish case series (6) reporting incidences of 66% for C. jejuni and 19% for C. fetus over a 23-year period may convey a paradigm shift, possibly reflective of advances in the capability of treating immunocompromised patients. Although inoculated blood culture vials failed to yield any indication of growth on Bactec FX following 5 days of incubation, the diffuse B-cell lymphoma hypothetically provided a portal of entry into the bloodstream to facilitate extraintestinal C. jejuni disease. A definitive role for C. jejuni in respiratory disease is not well characterized, largely because attempts to isolate the organism from those sites are rare. An Australian case series (7) identified nine HIV-positive patients with C. jejuni bacteremia. Seven of these nine patients were diagnosed with both pneumonia and diarrhea. Klebsiella pneumoniae was isolated from respiratory secretio...

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Fatal Campylobacter jejuni infection in a patient splenectomised for thalassaemia.

Cited by 12 publications

References 5 publications

Campylobacter fetus pericarditis in a patient with β-thalassemia: case report and review of the literature

Campylobacter fetus pericarditis in a patient with β-thalassemia: case report and review of the literature

A Case ofHelicobacter cinaediBacteremia in an Asplenic Patient

Answer to November 2017 Photo Quiz

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