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Helicobacter cinaedi bacteraemia secondary to enterocolitis in an immunocompetent patient
Sofie Larsen Rasmussen1, Iben Ørsted2, Irene Harder Tarpgaard1
1Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18, 9000, Aalborg, Denmark.
Background:
Helicobacter cinaedi are motile, gram-negative spiral rods with a natural reservoir in the intestinal tract of hamsters and rhesus monkeys. In humans, H. cinaedi has been reported in different human infections like fever, abdominal pain, gastroenteritis, proctitis, diarrhoea, erysipelas, cellulitis, arthritis, and neonatal meningitis typically diagnosed by positive blood cultures. Even though H. cinaedi has been detected from human blood and stool the entry of H. cinaedi into the blood stream was undocumented until quite recently. The use of pulse-field gel electrophoresis (PFGE) demonstrated that stool- and blood-derived H. cinaedi strains were consistent.
Case Presentation:
Here, we describe a rare Danish case of H. cinaedi bacteraemia in an immunocompetent 44-year-old male with diarrhoea. We isolated H. cinaedi from a blood culture taken at admission, and from a FecalSwab taken at day six despite ongoing antibiotic therapy. Next, we made a genetic comparison of both isolates by use of Multi-locus sequence typing (MLST)- and Single nucleotide polymorphism (SNP)-analysis. The two isolates were identical with zero SNPs and by use of MLST the isolate was identified as a novel ST20, confirming previous data of the intestinal tract as a route of H. cinaedi bacteraemia. The results of our AST showed a resistance pattern with higher MICs for ciprofloxacin and clarithromycin than for ampicillin, amoxicillin, gentamicin, and imipenem. The patient was cured with targeted therapy with pivampicillin; however, the primary source of transmission was unknown.
Conclusions:
In conclusion, this case of H. cinaedi bacteraemia secondary to enterocolitis in an immunocompetent patient provide clear evidence that one route of infection occurs through translocation from the intestinal tract to the bloodstream. Helicobacter cinaedi from blood and faeces were identical with a novel ST20, resistant to ciprofloxacin and clarithromycin however, the patient was cured with oral pivampicillin.
Insights
Helicobacter cinaedi can cause bloodstream infections originating from the gut. Genetic analysis confirmed identical strains from blood and stool in a rare Danish case, highlighting translocation as an infection route.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Genomics
Background:
- Helicobacter cinaedi, a motile, gram-negative bacterium, resides in animal intestinal tracts.
- Human infections include gastroenteritis, meningitis, and bloodstream infections, often diagnosed via blood cultures.
- The translocation of H. cinaedi from the gut to the bloodstream was previously undocumented.
Purpose of the Study:
- To report a rare case of H. cinaedi bacteremia in an immunocompetent patient.
- To genetically characterize H. cinaedi isolates from blood and stool.
- To investigate the route of H. cinaedi bacteremia.
Main Methods:
- Case report of a 44-year-old male with H. cinaedi bacteremia.
- Isolation of H. cinaedi from blood and fecal samples.
- Genetic comparison using Multi-locus sequence typing (MLST) and Single nucleotide polymorphism (SNP) analysis.
- Antimicrobial susceptibility testing (AST).
Main Results:
- H. cinaedi was isolated from blood and stool samples.
- MLST identified the isolate as a novel ST20, identical to the blood isolate (zero SNPs).
- The strain exhibited resistance to ciprofloxacin and clarithromycin but remained susceptible to ampicillin, amoxicillin, gentamicin, and imipenem.
Conclusions:
- This case provides evidence for H. cinaedi bacteremia occurring via translocation from the intestinal tract.
- Identical H. cinaedi strains (novel ST20) were found in blood and feces.
- The patient recovered with pivampicillin treatment despite resistance to other antibiotics.
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