Infection with Campylobacter species is a predominant cause of food-borne gastroenteritis in the industrialized world. Bacteremia is detected in <1% of patients with diarrhea, mainly in immunocompromised hosts or those in the extremes of age. Reported here is the case of a 78-year-old, immunocompromised male patient with Campylobacter jejuni subsp. jejuni bacteremia complicated by cellulitis. The infection was characterized by a protracted course with several recurrences and refractoriness to multiple antibiotic regimens, responding only to a prolonged course of meropenem treatment. The frequency of cellulitis as reflected in previously reported series of Campylobacter bacteremia and the clinical characteristics of this difficult-to-treat infection are reviewed.
Abstract. Leptospirosis is re-emerging in developed countries as a travel-related infection. In this nationwide study of travel-related leptospirosis in Israel, all cases diagnosed at the Central Reference Laboratory for Leptospirosis, during 2002Leptospirosis, during -2008 were retrospectively reviewed and only travel-related cases were included. During the study years, 20 (42%) of 48 leptospirosis cases in Israel were travel-related. Exposure occurred in Southeast Asia in 15 (75%) of 20 cases. The estimated yearly incidence of travel-related leptospirosis was 1.78/100,000 travelers compared with an incidence of endemic cases of 0.06/100,000 inhabitants (risk ratio = 29.6, 95% confidence interval = 16.7-52.4). Most patients (89%) were infected during water-related activities. Severe disease was present in 10 (55%) of 18 patients; 7 of them were presumptively infected with the Icterohaemorrhagiae serogroup. Thus, travel-related leptospirosis is becoming increasingly important in the epidemiology of leptospirosis in Israel. Leptospirosis should be suspected in any traveler with undifferentiated febrile illness, especially when water exposure is reported.
A 43-year-old man was hospitalized because of a three-day history of epigastric pain, pain in the right upper quadrant, and constipation. The pain was intermittent and not associated with nausea, vomiting, fever, or eating.The patient had been born in Israel to parents of Libyan origin. His job as a merchant often took him abroad, especially to Spain and Egypt. He had had type 2 diabetes mellitus for six years, for which he took 5 mg of glyburide per day. Approximately 13 months before the present admission, he had been hospitalized at another facility for several days for right-lower-lobe pneumonia, from which he recovered completely. His family history was unremarkable.On examination he reported agonizing epigastric and right-upper-quadrant pain. His blood pressure was 150/90 mm Hg, his pulse was regular (110 beats per minute), and his temperature was 36°C. The heart sounds were normal, and the lungs were clear. There was severe tenderness of the right upper quadrant and epigastric region, with mild guarding but no rebound tenderness. Murphy's sign was absent, peristalsis was slightly diminished, and there was no hematoma on the abdominal wall. No neurologic deficit was found. The rectal examination was normal.
A 27-year-old man was hospitalized in late September 1998 with a three-day history of lowgrade fever and malaise accompanied by a nonproductive cough, without dyspnea, chills, dysuria, or diarrhea. He also had a pruritic rash covering the gluteal region. The rash and itching had started about two weeks earlier, during the last week of a month-long vacation on the coast of Thailand, and had increased in intensity despite topical treatment with fusidic acid (Fucicort) cream and calamine lotion. Two days before the patient was admitted, a dermatologist in Israel had diagnosed folliculitis and prescribed 2 g of cephalexin daily. One day before admission, a chest x-ray film obtained because of the cough showed fine reticulonodular infiltrates in both lower lung fields and over the right middle lobe, with mild enlargement of both hilar regions. Treatment with 300 mg of roxithromycin daily was initiated.Before his trip to Thailand the patient had had all the recommended vaccinations but had not received the recommended prophylaxis against malaria. While there, he had had sexual relations with several partners. A girlfriend who was with him in Thailand reported having a similar pruritic rash but no fever or cough. The patient's medical history included mild vesicourethral reflux, with no episodes of urinary tract infection, and surgery for left varicocele and for deviation of the nasal septum.The patient was in good general condition, with no dyspnea. His oral temperature was 37.6°C, his blood pressure was 120/80 mm Hg, and his pulse was 80 beats per minute and regular. There was no tenderness over the sinuses, and no abnormalities were noted in the throat, nose, or ears. The heart sounds were normal, with no murmurs, and the lungs were clear. Neither the liver nor the spleen was palpable, and there was no lymphad-enopathy. A diffuse, red, papular rash was noted over the entire gluteal region (Fig. 1).It seems at this point that the patient's symptoms are mainly pulmonary. With regard to the leukocy-The New England Journal of Medicine Downloaded from nejm.org at UNIVERSITY OF SUSSEX on August 10, 2015. For personal use only. No other uses without permission.
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