RARE PATHOGEN LINKED TO GUILLAIN-BARRÉ SYNDROME AND RESPIRATORY FAILURE

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TOPIC: Critical Care TYPE: Fellow Case Reports INTRODUCTION: Guillain Barre Syndrome (GBS) is a rapidly progressive peripheral neuropathy that presents as diminished deep tendon reflex with ascending symmetrical weakness of the lower extremities, secondary to a gastrointestinal or respiratory illness. Incidence is more common in males and range from 1 to 3 out of 100,000 cases per year. Approximately 10 to 30% of patients required mechanical ventilation. Potential triggering events include trauma, immunization, surgery, and infections by organism such as Campylobacter, Cytomegalovirus, Mycoplasma pneumonia, Epstein Barr virus and HIV. CASE PRESENTATION: A 75-year-old male with medical history of peripheral vascular disease and diabetes mellitus type 2, who arrive to the emergency unit with 1 day evolution of vomiting, bloody diarrhea, and general malaise. He denies fever, chills, chest pain, shortness of breath, cough, abdominal pain, dysuria, sick contacts, or recent travel. The patient refers recent ingestion of street meat tacos. Physical examination remarkable for right lower extremity above the knee amputation, hypotension, and tachycardia. He was admitted to intensive care unit with septic shock and started on broad spectrum antibiotics. The gram stain show gram negative bacilli bacteria, with a gull wing shape, similar in morphology to the Campylobacter species. On fourth day of admission, he developed hypoactivity, hypercapnic respiratory failure requiring mechanical ventilation. His neurological examination was remarkable for generalized areflexia and marked distal more than proximal upper extremity weakness. Lumbar puncture (LP) was performed, and results correlated with this diagnosis of GBS. Final blood and stool cultures showed Anaerobiospirillum succiniproducens. The organism was initially confused with Campylobacter species due to morphological similarities. DISCUSSION: Two known Anaerobiospirillum sp. infect humans, A. thomassi which cause diarrhea and A. succiniproducens which is a motile, gram-negative, spiral anaerobe with flagella and is a rare cause of diarrheal illness and bacteremia in humans. McNeil et al showed that 17 of 22 patient had gastrointestinal symptoms and suggest that the gastrointestinal tract was likely the portal of entry. A. succiniciproducens have been isolated from rectal swabs of cat and dogs but not in humans. The optimal antimicrobial treatment for A. succiniciproducens still remains to be determined. CONCLUSIONS: This case is intended to arise medical awareness of this uncommon organisms, Anaerobiospirillum succiniproducens, which may lead to GBS. Early diagnosis and treatment with immunoglobulins are required to reduced neurological disability and risk of respiratory failure. Nerve conduction testing, along with albuminocytologic dissociation serves as helpful diagnostical studies, still clinical suspicion is important in atypical cases. REFERENCE #1: Epstein DAJ, Anaerobiospirillum succiniproducens bacteremia and pyomyisitis. Journal of Clinical Microbiology 55:665-669 REFERENCE #2: Kelesidis T, Bloodstream Infection with Anaerobiospirillum succiniciproducens: A Potentially Lethal Infection. South Med J. 2011 Mar;104 (3): 205-214 REFERENCE #3: McNeil MM, Martone WJ, Dowell VR, Jr. Bacteremia with Anaerobiospirillum succiniciproducens. Rev Infect Dis1987;9:737–42. DISCLOSURES: No relevant relationships by Onix Cantres-Fonseca, source=Web Response No relevant relationships by Marlene Farinacci Vilaro, source=Web Response No relevant relationships by Vanessa Fonseca Ferrer, source=Web Response No relevant relationships by Luis Gerena Montano, source=Web Response No relevant relationships by SULIMAR MORALES, source=Web Response No relevant relationships by William Rodriguez-Cintron, source=Web Response