A 56-year-old man presented with one day of high fevers to 104°F, myalgias, and non-productive cough. His past medical history is significant for polycystic liver disease leading to liver transplant, and metastatic neuroendocrine tumor managed with intravenous somatostatin. Two weeks prior to admission, he began a taper of his immunosuppressive medication. On the day prior to admission, the patient noted the above symptoms. Due to the persistent high fever, he presented to the emergency department. He denied sick contacts, travel, and animal exposure. On presentation, he was febrile to 103° and tachycardic to 109bpm. Physical exam was notable for mild cervical lymphadenopathy, with firm and non-tender lymph nodes. Initial labs were unrevealing. Respiratory virus panel was negative. Several hours after presentation, the patient had significant watery diarrhea, and a Gastrointestinal Pathogen PCR panel was obtained, which was positive for Campylobacter jejuni. He was subsequently started on levofloxacin. Blood culture results subsequently returned positive for C. jejuni bacteremia, with sensitivity to levofloxacin, ciprofloxacin, and erythromycin. With a two-week course of levofloxacin, the patient clinically improved and infection resolved.
Discussion:
Campylobacter infections are most commonly associated with inflammatory diarrhea, usually due to a foodborne source. Campylobacter bacteremia is a rarely reported finding, though it has been increasingly discovered in immunocompromised patients. Though epidemiologic studies are sparse, the incidence is estimated near 0.47 per 100,000 inhabitants per year. Amongst the rarely reported cases, common underlying conditions in affected patients included liver disease, HIV infection, malignancy, solid organ transplantation, and hypogammaglobulinemia. There is a low rate of mortality associated with Campylobacter bacteremia, though the most important risk factor related to mortality is HIV infection. Further, there is no clear consensus on the optimal antimicrobial regimen for Campylobacter bacteremia, but most patients are treated given the high incidence of underlying immune compromise. About one-third of Campylobacter isolates have been shown to be resistant to fluoroquinolones, though the reported patient’s infection was susceptible to levofloxacin.
Conclusions:
Campylobacter jejuni is an infrequent cause of bacteremia, but is most often associated with immunocompromised patients. Since there is no established guideline on the treatment of Camplyobacter bacteremia, sensitivity studies are important as they can provide insight regarding adequate antimicrobial treatment. Further, given the immunocompromised nature of many patients with Campylobacter bacteremia, prompt treatment is crucial.