First case of bacteremia caused by Helicobacter cinaedi in a patient with liver cirrhosis: a case report and literature review

Abstract

Patients with liver cirrhosis are known to be immunocompromised hosts due to the dysfunction of the cellular and humoral immune systems, allowing easier bacterial translocation from the intestine to the systemic circulation via the portal vein. Sepsis can often be seen in these patients; however, approximately 10 % of patients show negative results with the standard culture period (3-4 days) and their pathogens remain undiagnosed. Here we report the first case of a patient with liver cirrhosis diagnosed with bacteremia due to Helicobacter cinaedi after gastrointestinal symptoms and review 62 cases of H. cinaedi infection in patients with other diseases. The patient showed positive results for H. cinaedi after 10 days of culture. Administration of a carbapenem was effective and clinical symptoms recovered 20 days after admission. H. cinaedi is an enterohepatic bacterial species that causes bacteremia in immunocompromised patients. Due to the difficulty of detection, few cases have been reported to date and to the best of our knowledge, this is the first published case of bacteremia due to H. cinaedi infection in a patient with liver cirrhosis. Since bacteremia in patients with liver cirrhosis can result in fatality, we recommend vigilance for H. cinaedi infection, longer periods of blood culture, polymerase chain reaction analysis, and empirical antibiotic therapy to help improve prognosis.

Other Helicobacters and gastric microbiota

“…In humans, H. cinaedi is associated with bacteremia and the number of infections seems to be increasing. However, the prevalence might still be underestimated due to the limitation of detection sensitivity of the bacterium . Blood cultures should therefore be incubated for at least 5 days using the sensitive Bactec system, followed by a (q)PCR based on 16S rRNA and/or gyrase B genes .…”

“…As H. cinaedi resides in the gastrointestinal tract, lesions such as colonic perforation, cholecystectomy, or diarrhea can weaken the mucosal barrier and promote the development of bacteremia . An infection with H. cinaedi results in diverse clinical manifestations with cellulitis and fever as the most common ones, although arthritis, infection of abdominal aortic aneurysm, intrauterine infections, pyogenic spondylitis and diskitis, erythema, vertebral osteomyelitis, and liver cirrhosis are also described. These manifestations are mostly seen in immunocompromised patients, but immunocompetent patients are also susceptible .…”

“…However, the prevalence might still be underestimated due to the limitation of detection sensitivity of the bacterium. 42 Blood cultures should therefore be incubated for at least 5 days using the sensitive Bactec system, 43 followed by a (q)PCR based on 16S rRNA and/or gyrase B genes. 44 As H. cinaedi resides in the gastrointestinal tract, lesions such as colonic perforation, cholecystectomy, or diarrhea can weaken the mucosal barrier and promote the development of bacteremia.…”

“…45 An infection with H. cinaedi results in diverse clinical manifestations with cellulitis [44][45][46][47][48] and fever 44,45,[48][49][50][51][52] as the most common ones, although arthritis, 46 infection of abdominal aortic aneurysm, 53,54 intrauterine infections, 49 pyogenic spondylitis and diskitis, 50 erythema, 44,51 vertebral osteomyelitis, 55,56 and liver cirrhosis 42 are also described. These manifestations are mostly seen in immunocompromised patients, 42,45,47,48,51,52,55 but immunocompetent patients are also susceptible. 46,49,50,53,54,56,57 Originally, H. cinaedi was described as Campylobacter-like organism 1, isolated from homosexual men with enterocolitis.…”

Oxidative and nitrosative stress defences ofHelicobacterandCampylobacterspecies that counteract mammalian immunity

“…Helicobacter cinaedi, formerly named Campylobacter cinaedi, infects the intestine of humans and is transferred from animals as a zoonosis. The first case was identified in 1984 in homosexual men and several cases have been reported to date in patients suffering from several diseases, such as AIDS, haematological malignancy, diabetes mellitus, chronic liver and renal insufficiency (Kamimura et al 2015).…”