The Other Campylobacter Species

Abstract

Purpose: Campylobacter fetus has been documented as a cause of bacteremia, and it is typically diagnosed in immunocompromised patients with a febrile illness or extra-intestinal involvement including vascular infections, abscesses, and cellulitis. Unlike its well-known counterpart, C. jejuni, it is rarely associated with gastrointestinal manifestations. We present an unusual case of C. fetus bacteremia presenting with abdominal pain and diarrhea. An 81-year old female with a history of COPD on chronic steroid therapy and pulmonary embolism presented with complaints of abdominal pain, nausea and loose stools for the past month. Physical exam was significant for RUQ tenderness with guarding. A small bowel series and RUQ sonogram were negative. CT of the abdomen revealed a RUQ inflammatory process, better defined as a duodenal hemorrhage vs. perforation without evidence of free air. An EGD revealed chronic inactive gastritis with normal duodenal anatomy. With conservative management, the patient's symptoms improved, and she was discharged home. Three days after discharge, 2/4 blood culture bottles grew C. fetus, and the patient returned to the hospital for further evaluation. At that time, she complained of intermittent periumbilical pain without diarrhea. She was afebrile and abdominal exam was benign. WBC count was 10. During her hospitalization, the patient suffered from a single temperature spike with recurrence of diarrhea. Repeat blood cultures, stool cultures, and Clostridium difficile toxin were negative. To reassess her symptoms, a repeat CT scan was performed which demonstrated no significant change. The infectious disease specialists' impression was that the Campylobacter bacteremia was likely secondary to a GI source and recommended treatment with Meropenem for 12 days. The patient recovered without further complications, and was discharged home. Conclusion: A literature search on C. fetus yielded reports of appropriate antibiotics use, but limited information regarding clinical presentation and management. We aim to highlight an unusual presentation of Campylobacter fetus bacteremia with abdominal pain and diarrhea. This diagnosis requires a high degree of suspicion in immunocompromised hosts, and requires an adequate length of IV antibiotic therapy since it is rarely self-limited.