3083 Campylobacter coli bacteremia: How Common Is It?

Abstract

INTRODUCTION: Campylobacter species are known to cause enteritis, usually self-limited, but with the risk of developing Guillain Barre Syndrome. However, over the past 40-50 years, there have been reports of varying presentations, such as cellulitis, spondylodiscitis, and bacteremia. Of the Campylobacter species, C. jejuni is the most common culprit for causing bacteremia, however, C. coli bacteremia is becoming more prevalent. Here we discuss an unusual case of C. coli bacteremia in a patient with decompensated liver cirrhosis. CASE DESCRIPTION/METHODS: 59 y/o with history of cirrhosis secondary to alcohol abuse complicated by esophageal varices, who presented with black, watery stools in the previous one week with concurrent scrotal swelling. Vital signs were stable with temperature of 97.6 degrees F, heart rate 84 bpm, respiratory rate 16, blood pressure 117/72, and oxygen saturation 99% on room air. Physical exam was remarkable for voluntary guarding, and right upper quadrant tenderness. Lab tests revealed a white blood count of 2300/cm2, hemoglobin 9.9 g/dL, alkaline phosphatase 132 IU/L, aspartate aminotransaminase 65 U/L, alanine aminotransaminase 26 U/L, lactic acid 5.0 mmol/L, magnesium 1.2 mg/dL, and phosphorus 2.2 mg/dL. Computed tomography abdomen/pelvis with contrast showed findings of colitis. Ultrasound of the scrotum showed possible scrotal cellulitis. Stool culture returned positive for Campylobacter antigen, for which doxycycline was initiated. Blood cultures resulted with gram negative rods, which were later confirmed to be C. coli. Blood cultures continued to grow the bacteria and antibiotics were switched to imipenem until the day of discharge. Unfortunately, the patient left the hospital against medical advice and was sent home with ciprofloxacin to complete a total antibiotic course of 2 weeks after the last negative blood culture. Patient was seen at his primary care physician's office 4 days after leaving the hospital and reported complete resolution of his symptoms. DISCUSSION: Campylobacter bacteremia is rare. We must be aware of the possibility of a Campylobacter bacteremia and consider this organism when choosing empiric antibiotics. Additionally, once confirmed of a Campylobacter bacteremia, we must be mindful of resistance and choose treatment wisely. As Campylobacter infections have a wide array of presentations, it is imperative that cases are shared amongst the medical community so that prompt recognition, diagnosis, and treatment can be offered.