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Published on: March 10, 2020
Campylobacter fetus Cellulitis
Lia Bastos1, Ricardo Gomes2, Sara Pocinho1
1Infectious Diseases and Tropical Medicine, Centro Hospitalar de Lisboa Ocidental, Lisbon, PRT.
Abstract:
Campylobacter fetus, a bacteria of the Campylobacter genus that are a group of bacteria known to cause intestinal infections, is a particular microbial agent due to its most common presentation being as a non-intestinal systemic infection and rarely as a focal infection, most frequently cellulitis. C. fetus's main reservoirs are cattle and sheep. Humans are usually infected by consuming raw milk and/or meat. Infection in humans is rare and generally related to immune deficiencies, malignancy, chronic liver disease, diabetes mellitus and elderly age, among other factors. Diagnosis is usually achieved by blood cultures due to the lack of focalized signs/symptoms and the pathogen's endovascular tropism. The authors present a case of cellulitis due to Campylobacter fetus, a microbial agent that affects susceptible patients with a mortality rate of up to 14%. We aim to emphasize the importance of potential bacterial seeding sites secondary to bacteremia given the agent tropism for vascular tissue. The medical diagnosis was performed by the identification of bacteria in blood cultures. Campylobacter spp. infections are more frequently related to undercooked poultry or meat, but in this case, the consumption of fresh cheese was considered the most likely source of infection. A literature review showed that, in patients with previous antibiotic cycles, a combination of carbapenem and gentamicin had better outcomes and lower relapse rates. Due to typical surface antigenic variation, immune control may not be attainable and may account for relapsing infections, even after appropriate therapy. The duration of treatment has yet to be well established. Based on other reported cases, we considered a four-week treatment to be sufficient, given clinical improvement and absence of recurrence in the follow-up time.
Insights
Campylobacter fetus, a rare cause of cellulitis, can lead to severe systemic infections in vulnerable individuals. Early diagnosis via blood culture and appropriate antibiotic treatment are crucial for patient outcomes.
Area of Science:
- Medical Microbiology
- Infectious Diseases
- Bacteriology
Background:
- Campylobacter fetus is a bacterial species known for causing systemic infections, often presenting outside the gastrointestinal tract.
- Human infections are infrequent and typically occur in immunocompromised individuals or the elderly, with cattle and sheep serving as primary reservoirs.
Observation:
- This report details a rare case of cellulitis caused by Campylobacter fetus in a susceptible patient.
- Diagnosis was confirmed through blood cultures, highlighting the pathogen's tendency for endovascular invasion.
Findings:
- The likely source of infection in this case was consumption of fresh cheese, differing from common associations with undercooked poultry or meat.
- A combination of carbapenem and gentamicin demonstrated improved outcomes and reduced relapse rates in patients with prior antibiotic exposure.
Implications:
- The study underscores the importance of considering Campylobacter fetus in non-intestinal infections, especially in at-risk populations.
- Effective treatment involves a combination antibiotic regimen and a four-week duration, though further research on optimal treatment duration is warranted due to antigenic variation contributing to relapses.
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