Infection of humans with Campylobacter fetus BARBARA L. ROBINSON, MD, FRCP[C]

After therapy with ampicillin and Campylobacter fetus, previously clas- togenously, from organisms present sified as Vibrio fetus, is a familiar normally in small quantities in an gentamicin was begun the temperature organism to veterinarians but an un- area of the body such as the mouth immediately returned to normal and usual cause of infection in humans. or gastrointestinal tract. Since most remained there. Recovery was comApproximately 100 cases of C. fetus cases of C. fetus bacteremia have oc- plicated by the development, 20 days admission, of 5th and 6th cranial infection in humans have been re- curred in patients with other diseases after nerve paresis on the left, which imported since 1947, when the first this organism is considered an oppor- proved slowly. After discharge the pasuch case was described.1 The first tunist in humans, and the possibility tient became forgetful and experienced case in a human in Canada was that it may become more common grand mal seizures. With therapy for described by McDonald and Maut- should be entertained.5 The features the seizures his condition remained ner in 1970. In cattle and sheep of C. fetus infection are characteristic stable. this organism is a common cause of and should become better known to abortion and is transmitted venere- clinicians and microbiologists since Bacteriologic details ally by the male animal. Bulls car- early diagnosis and treatment reduce When first seen on a Gram-stained smear from a broth the organism was rying C. fetus must be identified and morbidity and mortality. Described below is a recent case a short, slightly curved, gram-negative excluded as donors for semen banks. The 8th edition of "Bergey's Ma- of bacteremia due to C. fetus subsp. rod reminiscent of V. cholerae. On nual of Determinative Bacteriology" intestinalis that illustrates some im- blood agar it grew best anaerobically at 370C, producing small, grey describes three subspecies of C. portant features of these infections. colonies in 48 hours. The colonies were fetus: fetus, intestinalis and jejuni.' smaller when grown in 5% carbon Case report In most cases of C. fetus bacteremia dioxide and did not grow at all in the in humans the organisms belong to Clinical course and findings presence of oxygen. Smears of the colthe subspecies intestinalis. Diarrhea A 57-year-old man was admitted to onies showed long, curved, gram-negadue to subspecies jejuni has recently hospital complaining of fever of 2 tive rods with a tendency to form been described.4 Other authorities weeks' duration, headache, vomiting, spirals. Sensitivity testing by the disc have used different classifications low back pain and anorexia. He had diffusion method indicated that the orand the literature in this regard is been admitted previously on many oc- ganism was resistant to penicillin but confusing. Subspecies differences, al- casions because of alcoholism or abdo- sensitive to ampicillin, tetracycline, kanamycin and gentathough significant to the veterinary minal pain and had undergone a partial erythromycin, micin. The Laboratory for Disepidemiologist, are probably not so gastrectomy in 1950 and repair of a ease Control in Ottawa Centre confirmed that deviated nasal septum 2 months before important for the medical microbiolthe organism was C. fetu.v and the current admission. ogist since most infected humans theThere were no physical abnormalities animal pathology laboratory of the have no association with infected but his temperature was 380C. Three Department of Agriculture in Vancouanimals. Instead, the infections in blood cultures grew, after 4 days, gram- ver typed it as C. fetus subsp. intestinhumans are most likely acquired au- negative bacilli that were later identi- alis. fied as C. fetus. The cerebrospinal fluid From the department of laboratory services (pathology), Shaughnessy Hospital, Vancouver, and the division of medical microbiology, faculty of medicine, University of British Columbia Reprint requests to: Dr. Barbara L. Robinson, Department of laboratory services (pathology), Shaughnessy Hospital, 4500 Oak St., Vancouver, BC V6H 3N1

(CSF) was cloudy and contained 370 mg/dL of protein, 20 mg/dL of glucose and 160 mg/dL of chloride; the leukocyte count was 0.440 x 10'/L (57% lymphocytes and 43% polymorphonuclear leukocytes). Culture of the CSF

was sterile, as were cultures of material from both nostrils and from the right maxillary antrum.

Discussion Bacteremia with C. fetus is a distinct clinical entity with many interesting features. Most of the cases described in the literature have occurred in alcoholics, in women during the 3rd trimester of pregnancy, or in patients with another disease.

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Insidious onset and a prolonged course are often features of the infection, as is illustrated by our case: 2 weeks elapsed between the onset of symptoms and admission and 3 weeks between admission and the development of cranial nerve palsies. Neurologic involvement and vascular complications such as phlebitis, endocarditis and subarachnoid hemorrhage are common.68 Jnfarcts in the cerebral hemispheres associated with fibrin clots in the small cerebral arteries have been described at autopsy.6 The organism's survival in the bloodstream may be associated with the presence of a glycoprotein coat around the bacterial cell that has antiphagocytic properties. as described by McCoy and colleagues in C. fetus subsp. intestinalis. The ability to resist phagocytosis would enhance the virulence of the organism and allow it to persist. Not all strains have this coat. It would be interesting to determine if the presence of the glycoprotein coat was associated with differences in clinical presentation or success of therapy. In many cases infection has recurred when therapy was discontinued, despite evidence that the organism was fully sensitive to the drug. There appear to be two distinct clinical entities caused by C. fetus. bacteremia and diarrhea. Bacteremia is associated with subspecies fetus and diarrhea is associated with subspecies jejuni. Bacteremia is serious, often resulting in death or disability. In the case we have reported, associated alcoholism made the assessment of neurologic function difficult, but the increased forgetfulness and the development of grand mal seizures after resolution of the illness suggest that some neurologic damage occurred. Prompt, specific antibiotic therapy is indicated as soon as the organism is identified. All reported strains are sensitive to several antibiotics, and patients have been successfully treated with ampicillin, tetracyline, clindamycin and a combination of penicillin and streptomycin. Butzler, Dekeyser and Lafontaine" studied seven strains from humans and found that all were sensitive to gentamicin and erythromycin. Ampicillin was effective against five strains but penicillin was effective against only one. All strains were 1088

resistant to carbenicillin and cephalothin. Conclusions C. fetus infection should be considered when an alcoholic or a person with another debilitating disease has a fever and evidence of neurologic or vascular involvement, and a fastidious gram-negative rod is grown in a blood culture. The distinctive appearance of the organism with Gram-staining is almost diagnostic. It first appears to be comma-shaped but rapidly forms an elongated spiral as the culture matures. It grows best anaerobically or in 5% carbon dioxide. Treatment should be started as soon as possible with gentamicin or erythromycin until results of complete sensitivity testing are available, and should be continued for a long period since recurrence of the infection is common. I am indebted to Dr. Peter Stovell, animal pathology laboratory, Department of Agriculture, Vancouver, for

his study of the organism in this case. References 1. VINZENT R, DUMAS J, PICARD N: Septic.mie grave au cours de la grossesse due . un vibron. Avortement

cons.cutif. Bull Acad Nati Med 131: 90, 1947 2. MCDONALD 5, MAUTNER LS: A case of human vibriosis. Can Med Assoc J

103: 951, 1970 3. SMIBERT RM: Campylobacter, part 6,

family I, genus II, in Bergey's Manual of Determinative Bacteriology, 8th ed, BUCHANAN RE, GIBBoNS NE (eds),

Baltimore, Williams & Wilkins, 1974, pp 207-12 4. SKIRROW MB: Campylobacter enteritis: a "new" disease. Br Med J 2:

9, 1977

Myeos.atiIi Vaginal Cream plus Oral Tablets

Amost effective way to treat recurrent vaginal candidiasis. MYCOSTATIN VAGINAL CREAM MYCOSTATIN VAGINAL TABLETS Indications: Vaginal infections caused by Candida (Monilia) species. Dosage: Cream: Usual dosage is 4 g (100,000 units) once or twice daily. Tablets: Usual dosage is 1 tablet (100,000 units) once or twice daily. In most cases 2 weeks ot therapy will be sufticient but in some cases more prolonged treatment may be necessary. Administration should be continued tor at least 48 hours atter clinical cure to prevent relapse. Instructions br the patient are enclosed in each package. Supply: Cream: Tubes 01120 g with applicator designed to deliver a 4 g dose. Each gram contains 25,000 units ot nystatin in a cream base. Tablets: Packages otiS and 30 tablets with applicator. Each tablet contains 100,000 units ot nystatin and 0.95 g ot lactose.

MYCOSTATIN ORAL TABLETS Indications: Prevention and treatment ot infection caused by Candida (Monilia) species in the intestinal tract and for protection against candidal overgrowth during antimicrobial or corticosteroid therapy. Dosage: Usual prophylactic and therapeutic dose is 1 tablet (500,000 units) 3 times daily. Administration should be continued for at least 48 hours after clinical cure to prevent relapse. Supply: Bottles of 100 tablets of 500,000 units per tablet.

5. FRANKLIN B, ULMER DD: Human in-

fection with Vibrio fetus. West I Med 120: 200, 1974 6. GUNDERSON CH, SACK GE: Neurology of Vibrio fetus infection. Neurology (Minneap) 21: 307, 1971 7. VESELY D, MACINTYRE DS, RATZAN

KR: Bilateral deep brachial vein thrombophiebitis due to Vibrio fetus. Arch Intern Med 135: 994, 1975 8. LOEB H, BETTAG JL, YUNG NK, et al:

Vibrio fetus endocarditis. Report of 2 cases. Am Heart 1 71: 381, 1966 9. McCoy EC, DOYLE D, BURDA K, et al: Superficial antigens of Campylobacter (Vibrio) fetus: characterization of an antiphagocytic 'component. infect Immun 11: 517, 1975 10. BUTZLER JP, DEKEYSER P, LAFON-

TAINE T: Susceptibility of related vibrios and Vibrio fetus to twelve antibiotics. A ntimicrob A gents Chemother 5: 86, 1974

CMA JOURNAL/MAY 6, 1978/VOL. 118

ALL DOSAGE FORMS ContraindIcation: Hypersensitivity to nystatin. Precaution: Use of the vaginal applicator may not be considered desirable during pregnancy. Adverse Reactions: Mycostatin is virtually nonsensitizing and nontoxic and is well tolerated, even on prolonged administration. Large oral doses may produce diarrhea and GI. distress. If irritation or hypersensitivity should occur following intravaginal or topical use, discontinue medication. Product Monograph available to physicians and pharmacists on request.

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Infection of humans with Campylobacter fetus.

Infection of humans with Campylobacter fetus BARBARA L. ROBINSON, MD, FRCP[C] After therapy with ampicillin and Campylobacter fetus, previously clas-...
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