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Persistent Campylobacter jejuni infections in patients infected with the human immunodeficiency virus (HIV)
D M Perlman1, N M Ampel, R B Schifman
1Medical Service, Veterans Administration Medical Center, Denver, Colorado.
Abstract:
We identified Campylobacter jejuni infections in four patients infected with the human immunodeficiency virus (HIV); three had persistent and severe C. jejuni infections. Multiple isolates obtained from each patient had the same biochemical and serotypic characteristics, indicating recurrent infection rather than reinfection with unrelated strains. Serum antibody responses to C. jejuni group antigens by enzyme-linked immunosorbent assay were markedly impaired in the three patients with persistent infection compared with forty-two immunocompetent C. jejuni-infected controls and with the HIV-infected patient who readily cleared the organism. One patient was bacteremic; his blood isolate was killed by normal serum but was resistant to his own serum, whereas a simultaneous stool isolate of a different serotype was sensitive. Failure of two patients to eradicate the organism and long-term administration of erythromycin therapy led to the in-vivo development of resistance to this antibiotic, which is most frequently used to treat C. jejuni infections.
Insights
Human immunodeficiency virus (HIV) infection impairs antibody responses, leading to persistent Campylobacter jejuni infections. This can result in antibiotic resistance, complicating treatment for HIV patients.
Area of Science:
- Infectious Diseases
- Immunology
- Microbiology
Background:
- Campylobacter jejuni is a common cause of bacterial gastroenteritis.
- Human immunodeficiency virus (HIV) infection can compromise immune function, potentially increasing susceptibility to opportunistic infections.
Observation:
- Four HIV-infected patients presented with Campylobacter jejuni infections.
- Three of these patients experienced persistent and severe C. jejuni infections, characterized by recurrent episodes with identical bacterial strains.
- Impaired serum antibody responses to C. jejuni were observed in patients with persistent infections compared to controls.
Findings:
- HIV-associated immunodeficiency significantly impacts the ability to clear C. jejuni infections.
- One patient developed C. jejuni bacteremia, with isolates showing differential susceptibility to normal and autologous serum.
- Prolonged erythromycin treatment in two patients led to the in-vivo development of antibiotic resistance.
Implications:
- HIV infection poses a significant risk factor for severe and persistent C. jejuni infections.
- Impaired humoral immunity contributes to treatment challenges in HIV-positive individuals with C. jejuni.
- The emergence of antibiotic resistance in C. jejuni highlights the need for careful monitoring and alternative therapeutic strategies in immunocompromised patients.