Jan 5, 1988 - A new case of Campylobacter hyointestinalis-associated diarrhea in a human is ... Campylobacter laridis, Campylobacter fetus subsp. fetus,.
JOURNAL OF CLINICAL MICROBIOLOGY, Dec. 1988, p. 2659-2660 0095-1137/88/122659-02$02.00/0 Copyright © 1988, American Society for Microbiology
Campylobacter hyointestinalis:
Vol. 26, No. 12
an
Opportunistic Enteropathogen?
J. MINET,»* B. GROSBOIS,2 AND F. MEGRAUD3 Service de Bactériologie' and Service de Médecine Interne Hématologie,2 Hôpital Sud, 16, Boulevard de Bulgarie, 35022 Rennes Cédex, and Centre d'Etude des Campylobacters, Hôpital des Enfants, 33077 Bordeaux Cédex,3 France
Received 5 January 1988/Accepted 7 September 1988
A new case of Campylobacter hyointestinalis-associated diarrhea in a human is reported. The medical history of the patient was significant for immunodeficiency because of an evolutive chronic myeloid leukemia. The diarrhea rapidly stopped after administration of oral erythromycin. No other enteropathogenic agent was found by routine examination of stools. Although neither serology nor autopsy was available, this observation appears to be suggestive of the possible enteropathogenicity of C. hyointestinalis for patients at risk.
The bacteriological diagnosis of diarrheal disease includes the culture of bacteria from the genus Campylobacter. Two species belonging to the genus are commonly found in feces, Campylobacterjejuni and, to a lesser extent, Campylobacter coli. The following species have been found occasionally: Campylobacter laridis, Campylobacter fetus subsp. fetus,
triple sugar iron medium, grew anaerobically in 0.1% trimethylamine N-oxide hydrochloride (TMAO), and was identified as C. hyointestinalis. The identification was subsequently confirmed by DNA hybridization (D. Chevrier, D. Larzul, F. Mégraud, and J. L. Guesdon, in B. Kaijser, ed., Campylobacter IV, in press). At the same time, the blood cultures (brain heart infusion broth, incubated aerobically, and Schaedler broth, incubated anaerobically) were found to be sterile. The patient received erythromycin (Erythrocine) (Abbott Laboratories, North Chicago, Ill.) (1.5 g daily), and the diarrhea stopped. The coproculture carried out on October 16 was negative for Campylobacter spp. Nevertheless, the patient died on October 18 with a fever of unknown etiology (seven blood cultures remained negative) and shock. C. hyointestinalis was described in 1983 as a bacterium associated with porcine adenomatosis (3) in conjunction with Campylobacter mucosalis. It has also been isolated from feces of healthy pigs (4). Only five reports of isolation from humans have been published since 1986, all in the United States and from patients at risk (homosexuals, infants, and elderly persons) (1, 2). Our strain was the only one of this species among 388 strains received from the network for surveillance of Campylobacter infections in France in 1986
"Campylobacter upsaliensis," Campylobacter fennelliae, and Campylobacter cinaedi (the last two have been isolated almost exclusively from homosexuals [6, 8]). Very few reports have mentioned Campylobacter hyointestinalis in human feces (1, 2). We describe here a case of diarrhea in a patient suffering from chronic myeloid leukemia; this bacterium was the only pathogen found. The patient, a 52-year-old woman, had chronic myeloid leukemia treated with hydroxyurea (Hydrea; E. R. Squibb & Sons, Princeton, N.J.) since 1981. In September 1986, the chronic myeloid leukemia became more acute and the patient was hospitalized on 26 September with a fever (39.5°C) and nonbloody, watery diarrhea. The total leukocyte count was 12,600/mm3, polymorphonuclear cell count was 9,990/ mm3, platelet count was 50,000/mm3, and hemoglobin count was 5.4 mmol/liter. A coproculture was performed on October 1. Cultures remained negative for Salmonella, Shigella, Staphylococcus, and Yersinia species, members of the family Vibrionaceae, and fungal colonization. Direct examination showed no parasite. The search for rotaviruses, by using latex particle agglutination, was negative. Stools were not examined for any other viral agent. For Campylobacter search, stools were seeded in Rogol broth enrichment medium (7) and incubated for 24 h at 42°C under microaerophilic conditions in a closed jar with GasPak (BBL Microbiology Systems, Cockeysville, Md.) without catalyst. Broth (10 ,ul) was then plated on Columbia blood agar base (A.E.S. Laboratoire, Combourg, France) supplemented with 5% horse defibrinated blood and the dried antibiotic supplement of Skirrow (SR69; Oxoid Ltd., Oxford, England). After 48 h at 42°C in microaerophilic atmosphere, a Campylobacter sp. grew on the plate. This species was a gram-negative, curved rod which was positive for oxidase and catalase, resistant to nalidixic acid (30 ktg per disk), and sensitive to cephalothin (30 ,ug per disk). It reduced nitrates, did not hydrolyze hippurate, did not grow on 3.5% NaCl medium, strongly produced H2S in *
(5).
In the laboratory, C. hyointestinalis closely resembles C. fetus subsp. fetus; the use of a triple sugar iron medium to study the production of H2S is of value in differentiating these species. Other confirmatory tests include anaerobic growth with TMAO. Absence of growth on a medium containing 3.5% NaCl rules out the diagnosis of "C. faecalis," another catalase-positive and strongly H2S-producing Campylobacter species. These tests can be helpful in identifying C. hyointestinalis in a clinical laboratory. The arguments in favor of the possible etiologic role of C. hyointestinalis were that routine examination of stools revealed no other enteropathogen and that the diarrhea stopped rapidly with erythromycin treatment. However, neither reliable serology studies (because of patient premature death) nor an autopsy (because of family disapproval) was available. Direct plating of stools on primary Campylobacter-selective medium is not in routine use in our laboratory, and the amount of growth of C. hyointestinalis by first coproculture can not be evaluated. This recently described Campylobacter species will have to be considered in forthcoming observations to define its pathogenic potential for
Corresponding author. 2659
2660
J. CLIN. MICROBIOL.
NOTES
humans, especially those with underlying diseases, as in the case reported here.
4. Lambert, M. J., M. W. Jones, and S. A. Lister. 1984. Isolation of
LITERATURE CITED 1. Edmonds, P., O. M. Patton, P. M. Griffin, T. J. Barrett, G. P. Schmid, C. N. Baker, M. A. Lambert, and D. J. Brenner. 1987. Campylobacter hyointestinalis associated with human gastrointestinal disease in the United States. J. Clin. Microbiol. 25:685691. 2. Fennel, C. L., A. M. Rompalo, P. A. Totten, K. L. Bruch, B. M. Flores, and W. E. Stamm. 1986. Isolation of Campylobacter hyointestinalis from a human. J. Clin. Microbiol. 24:146-148. 3. Gebhart, C. J., P. Edmonds, G. E. Ward, H. J. Kurtz, and D. J. Brenner. 1985. "Campylobacter hyointestinalis" sp. nov.: a new species of Campylobacter found in the intestines of pigs and other animals. J. Clin. Microbiol. 21:715-720.
5. 6. 7.
8.
Campylobacter hyointestinalis from pigs in the United Kingdom. Vet. Rec. 115:128-129. Mégraud, F. 1987. Réseau de surveillance nationale des infections à Campylobacter. Bilan de l'année 1986. Bull. Epidémiol. Hebdomadaire 37:145-147. Penner, J. L. 1988. The genus Campylobacter: a decade of progress. Clin. Microbiol. Rev. 1:157-172. Rogol, M., B. Shpak, D. Rothman, and I. Sechter. 1986. Enrichment medium for isolation of Campylobacter jejuni-Campylobacter coli. Appl. Environ. Microbiol. 50:125-126. Totten, P. A., C. L. Fennel, F. C. Tenover, J. M. Wezenberg, P. L. Perine, W. E. Stamm, and K. K. Holmes. 1985. Campylobacter cinaedi (sp. nov.) and Campylobacter fennelliae (sp. nov.): two new Campylobacter species associated with enteric disease in homosexual men. J. Infect. Dis. 151:131-139.
