Campylobacter fetus subsp, fetus

LETTRES

A L'EDITEUR

Mdd Mal Infect. 1998 ; 28 : 216-24

Bact6ri6mie avec p6ricardite Campylobacter fetus subsp, fetus chez une femme avec b&a-thalass6mie majeure,a

woman was admitted to the Clinical Hospital of Ribeir~o Preto (S~o Paulo State, Brazil) with a fifteen days history of chills, fever, odynophagia and localized thoracic pain, Past history was significant because the patient suffered betathalassemia major since the age of 3, being splenectomized at the age of 4 and thereafter, chronically transfused and treated with desferrioxarnine. Two days before symptoms started, she received her last blood transfusion.

C. LEVY**, E.M. MAMIZUKA**, C. ZAPATA***I et H. FERNANDEZ ****b

CAMPYLOBACTER FETUS SUBSP. FETUS BACTEREMIA AND PERICARDITIS IN A WOMAN WITH BETA-THALASSEMIA MAJOR

SUMMARY

The authors report a case of bacteremia and pericarditis, due to Campylobacterfetus subsp, fetus in a 24-year-old woman with a history of beta-thalassemia major, periodically transfused. Gentamicin treatment was successful, bat a pericardiac thickness is still observed. Key-words: Cmnpylobacterfems subsp, fetus - Bacteremia Pericarditis - Beta-thalassemia. Mots-el~s : Campylobacterfetus subsp, fetus - Bactrrirmie Prricardite - B~ta-thalassrmie.

Campylobacter fetus subsp, fetus is a zoonotic, Gram negative, curved rod-shaped bacteria, recognized as an opportunistic pathogen for human beings. It has been identified as the etiologic agent o f a wide range of extraintestinal infections, showing a peculiar tendency to infect the vascular endothelial system, especially in debilitated, immunosuppressed or elderly patients. Bacteremia is the most common manifestation of C. fetus subsp, fetus infection. However, trombophlebitis, endocarditis, mycotic aneurysm, over infection of aortic a n e u r y s m s and pericarditis are other infectious clinical entities produced by this pathogen, probably related to their vascular tropism (i-3). We report the case of a young female patient with a history of beta-thalassemia major, who presented with bacteremia and pericarditis due to C. fetus subsp, fetus. A 24 year white * Requ le 14.11.96. Acceptation d6finitive le 2.4.97. ** Department of Clinical Analysis, Faculty of Farmaceutical Sciences, University of Sao Paulo, Silo Paulo, Brazil. *** Institute of Hematology, Universidad Austral de Chile. ~- In memoriam, deceassed august 23, 1996. **** Institute of Clinical Microbiology, Universidad Austral de Chile, PO Box 567, Valdivia, Chile. a Financial support: Grant S-95-45, Research Bureau, Universidad Austral de Chile. b Corresponding author.

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Physical examination revealed a tachydyspneic patient with decolourized mucous membranes and pulse rate of 150/rain, respiratory rate 30/min, blood pressure 120/70 mm Hg and axillar temperature of 38,5~ Abdominal examination was unremarkable and the patient did not refer abdominal pain and diarrhea. Stertors of small bubbles were heard over both lung bases. Heart auscultation showed two rythmical and hypophonetic bubbles, positive systolic murmur (IVI6) in the base focusses and mesocardium. Jugular stasis was detected. Thoracic x-rays showed cardiomegaly with right chambers predominance and mild lung congestion. Electrocardiogram revealed synus rhythm with cardiac frequency of 150/min, axis in the first quadrant and the presence of fight atrium and ventricle overload. Dopplerechocardiography showed signs of important pericardiac effusion and cardiac tamponade. The clinical diagnosis was pericarditis with descompensated congestive heart. Four blood cultures were taken on the admission day and empiric treatment with intravenous penicillin G (16 million U/day) was started. Five days later, all the blood cultures yielded C. fetus subsp, fetus. The therapy was changed to gentamicin intramuscularly (60 mg every 12 hours, for 30 days). The same day, pericardic punction and drainage were carried out with the obtention of about 400 ml of a purulent liquid. Gram stain performed from this liquid showed Campylobacter-like Gram negative curved rods. The patient gradually improved with the antibiotic therapy, however signs of perieardiac thickness were observed when she was discharged 35 days after her admittance. The typical host in almost all the infections produced by C. ferns subsp, fetus are middle-aged to elderly patients with some degree of immunossuppresion (i-3). Our patient however was a young woman with beta-thalassemia major which is considered a risk factor for C. fetus infections, as other underlying conditions, such as splenectomy and repeated transfusions ( I , 2). On the other hand, this hematologic disease itself increases the risk of serious infection, especially by the iron-overload and treatment with chelating agents (desferrioxamine) that make host iron more bioavailable for infectious agents. Iron excess immunologically compromises the host and enhances bacterial growth. These observations are well documented in beta-thalassemic patients suffering Yersinia enterocolitica

infections (4), In some Campylobaeter species, iron enhances their growth and pathogenic properties (5). The mode of acquisition of C. fetus subsp, fetus infection i n v o l v e s a n i m a l exposure as w e l l as the ingestion o f contaminated water or foods ( | , 2). Considering that the patient denied animal contact, diarrhea and abdominal pain prior to the infectious onset, we are unable to suggest a probabie route o f infection. Nevertheless, because of the patient's peri-urban extraction, the previously cited routes can not be ruled out. Since fever began two days after a b l o o d ~ransfusion, this m a y be c o n s i d e r e d as an other transmission possibility, h o w e v e r no references of posttransfusional C. fetus infection were found in the available literature. B a c t e r e m i a ~s the m o s t c o m m o n clinical manifestation in C. fetus subsp, fetus infections, normally associated to a localized focus (1-3). In this case, bacteremia was associated with pericarditis and the etiologic agent -a Gram negative curved rod- was isolated from blood cultures. Identificatiort as C. fetus subsp, fetus was m a d e b y c o n v e n t i o n a l tests (positive nitrate reduction, eatalage, oxidase and g r o w t h at 25~ a n d 37~ tests; negative for indoxil acetate hydrolysis, hippuricase and growth at 42~ susceptible to 30/ag of cephalothin and resistant to 30 ~tg of nalidixic acid). The susceptibility tests were p e r f o r m e d on Mueller-Hinton agar with 5 % sheep's blood incubated at 37~ for 24 hours in microaerophilic conditions. The strain was susceptible in vitro to gentamicin, tetracycline, erythromycin, ampicillin and cloramphenicol and resitant to penicillin. Treatment was done with gentamiein, the drag of choice for serious systemic infections (2), during 30 days in order to insure the resolution of the infection. The patient gradually improved remaining a pericardiac thickness at d i s c h a r g e , as s e q u e l a o f the pericarditis. This is the first case, to our knowledge, of bacteremia and pericarditis due to C.fetus subsp.fetus in a patient with betathalassemia major. Campylobacterfetus subsp, fetus -among other opportunistic bacteria- must be considered in patients with beta-thalassemia when signs of systemic infection m'e present. REFERENCES

i. 2.

3. 4.

5.

FRANCIOLI P., HERZSTEIN J,, GROB J.P., VALLOTTON J.L, MOMBELL[ G., GLAUSER M.P. - Campylobacterfetu.v subspecies fetus bactercmia, Arch Intern Med. 1985; 145 : 289-92. MARTY A.T., WEBB T.A., STUBBS K.G., PENKAVA R.R. Inflammatory abdominal aortic aneurysm infected by Campylobacter fetus. JAMA. I983; 249 : 1190-2. SCHMIDT U., CHMEL H,, KAMINSKI Z., SEN P, - The clinical speetmrn of Campylobacterfetus infections: report of five cases and review of the literature. Q J Med. 1980; 49 : 431-42. GREEN N.S, - Yershliainfections in patients with laomozygousbetathalassemia associated with iron overload and its treatment, Pediatr Hematol Oncol. t992; 9 : 247-54. SIDDIQUE A.B., AKHTAR S.Q. - Study on the pathogenicity of Campylobacterjejuni by modifying the medium. 3 Trop Med Hyg. 1991; 94 : 175-9.

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Septic&nie et rnrningite Capnocytophaga canimorsus* Ph. LECOCQ**, P. M I K O L A J C Z A K * *, E. WYDERKIEWICZ**, G. GERBEAU** et C. CATTOEN***

SUMMARY

CAPNOCYTOPHAGA CANIMORSUS SEPTICEMIA COMPLICATED BY MENINGITIS

Capnocytophaga canimorsus is a Gram negative bacterium, that belongs to the normal oral flora of dogs ,and cats. Human infections, usually following dog bites, are associated with underlying conditions and alcoholism in most cases. The authors report a new case of septicemia complicated by meningitis that developped in an alcohol-addict, but had a favorable outcome. K e y - w o r d s : Septicemia - Meningitis - Capnocytophaga

canimorsus. M o t s - c l 6 s : S e p t i c r m i e - M r n i n g i t e - Capnocytophaga

canimorsus. Capnocytophaga canimorsus est un bacille ~t Gram ndgatif commensal de la flore buccale des chiens et des chats. Ce germe est responsable d'infections humaines varires touchant particuligrement les sujets immunod~primgs. Nous rapportons un cas de septicrmie avec mrningite chez un sujet alcoolique. M r B... J.C., 50 ans, est hospitali~d pour confusion f~brile ~voluant depuis 24 heures. I1 s'agit d'un patient 6thylique chronique, hospitalisg antrrieurement pour crises comitiales g6nrralisres survenues fi I'occasion de prriodes de sevrage alcoolique. I1 n ' a pas d'autres antrc~dents et ne prend aucun traitement. Le sevrage drfinitif n ' a jamais 6t6 obtenu. A l'entrfie, le patient est conscient, mais drsorient6. II n'est pus agitd, ne prrsente pus d'hallucinations. I1 existe une raideur de nuque franche, sans anomalie de l'examen neurologique. La temp6rature est ~t 39~ le pouls ~ 110/ran, la tension artdrielle ~ 130/80 mmHg. Le reste de l ' e x a m e n retrouve un foyer de rgles crrpitants de la base droite. II n ' y a p a s de dyspnre, de toux, de cyanose. L'auseultation cardiaque est normale. 21 existe enfin une l~grre hrpatomrgalie sans splrnomrgalie, Los examens biologiques rrv~lent : leucocytes, 11,6 10.9/1, 97 % PNN, 3,3 % lymphocytes, Hb : 12,4 g/dl, Na : 127 mEq/l, K : 3,7 m E @ , crratinine : 8 rag/l, CRP : i47 mgA (N > 10) A S A T : 85 UI/1, A L A T : 33 UI/1, GGT : 130 UI/1, recherche de toxiques nggative. Des hfimocultures * Re~u le 1912.96. Acceptation d6finitive le 18.3.97. ** Service de Mrdecine interne et Maladies infectieuses, Centre Hospitalier de Denain, 25 bis rue Jean Jaur~s - F-59723 Denain Codex. *** Service de Microbiologie, Centre Hospitalier de Valenciennes, avenue Desandrouins - F-59300 Valenciennes.