A Campylobacter species was isolated from blood from a febrile patient with precursor T-cell acute lymphoblastic leukemia, and after antibiotic treatment, a similar bacterium was isolated from blood 37 days later. Although phenotypic testing did not definitively identify the organisms, molecular analysis indicated that they were the same strain of Campylobacter fetus subsp. fetus and were of reptile origin. CASE REPORTA 20-year-old man presented to the hospital with a productive cough for 2 weeks and fever of 40.6°C for 1 day. Seven months earlier, a computerized tomographic scan of the chest showed a 7-cm-diameter mediastinal mass compressing the trachea. Peripheral blood flow cytometry at that time was diagnostic of precursor T-cell acute lymphoblastic leukemia. Because of pneumocystis pneumonia, which was treated, the patient then received trimethoprim-sulfamethoxazole prophylaxis three times a week on a continuing basis. Numerous courses of chemotherapy led to neutropenia, complicated by Candida tropicalis fungemia and then Streptococcus mitis bacteremia, which both resolved with treatment. Two weeks prior to admission, the patient received chemotherapy with methotrexate and 6-mercaptopurine.On the day the patient was admitted to the hospital, he reported worsening cough, fever, and epigastric pain. On examination, he appeared to be moderately ill with a temperature of 39.4°C, pulse of 110 beats/min, blood pressure of 110/48 mm of Hg, and respiratory rate of 14 breaths/min; his physical examination was otherwise normal. The leukocyte count was 3,900/mm 3 , with an absolute neutrophil count of 2,650/mm 3 and a platelet count of 52,000/mm 3 . He had 6.6 g of hemoglobin per dl. The chest X-ray was normal. After cultures were obtained, he was given cefepime intravenously. Two days after admission, one of four blood culture bottles was reported as growing Campylobacter species. Cefepime was changed to imipenem-cilastatin. He also was noted to have erythema and tenderness of the right arm in an area near a prior phlebotomy site. Vancomycin was added for presumed cellulitis and was continued for 1 week, with complete resolution of erythema. Multiple stool cultures (obtained after antibiotics were begun) were negative for Campylobacter species. Twelve days after admission to the hospital, the bloodstream Campylobacter isolate was noted to be resistant to trimethoprim-sulfamethoxazole but susceptible to levofloxacin, and the patient was discharged on oral levofloxacin (500 mg per day for 2 weeks).The patient recovered and was readmitted 3 weeks later for elective chemotherapy with cytarabine and etoposide. Four days after admission to the hospital, he developed abdominal pain and a temperature of 38.9°C. The chest X-ray was normal. After blood cultures were obtained, the patient was empirically treated with cefepime and metronidazole, which was changed 4 days later to intravenous levofloxacin and metronidazole. The absolute neutrophil count at that time was 11,300/mm 3 , which subsequently decreased to a nadir of Ͻ50...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.