We report a case of Campylobacter fetus (C. fetus) meningitis that manifested a chronic clinical course in an asplenic diabetic patient. The patient had eaten raw beef liver, and after 1 week, he suffered from headache and fever, with repeated remissions and deterioration. Four weeks after onset, neck stiffness was observed, and he was diagnosed with meningitis due to Campylobacter fetus. The cerebrospinal fluid (CSF) sample showed leukocytosis (3760/ll; neutrophils 91 %, lymphocytes 9 %). The infection responded to meropenem and ampicillin. A review of the literature between 1976 and 2013 revealed that C. fetus meningitis in adults is still a rare entity, and about one-third of case reports written in English are from Japan. We specifically reviewed the case reports of C. fetus meningitis in adults written in Japanese between 1979 and 2013 to examine the clinical features and influence of underlying disease, especially diabetes mellitus. Unexpectedly, most patients with C. fetus meningitis manifested a chronic clinical course, and CSF samples showed lymphocyte-predominant leukocytosis in at least 25 out of 43 cases. Antibiotic treatment, especially with carbapenem, was effective, and the overall prognosis of C. fetus meningitis was good, but 3 out of 43 patients had after effects. Two of the patients had diabetes mellitus as an underlying disease.A 70-year-old man suffered from a headache that lasted for 1 week. He had eaten raw beef liver in a steakhouse 1 week before the headache began. He consulted a physician at an outpatient clinic. He was diagnosed with a cold. However, his headache worsened, so after 2 weeks, he saw a doctor again. A blood sample revealed that he had diabetes. One week later, he was admitted to Mitsui Memorial Hospital for diabetes education. On admission, his BMI was 18.5 kg/m 2 , and the initial laboratory findings were fasting blood glucose of 201 mg/dl, C-peptide reactivity of 1.50 ng/ml and HbA1c of 9.6 %. He had undergone a splenectomy and distal pancreatectomy when he was 40 years old because of a traffic accident.When he was admitted, 5 weeks had passed since he had eaten raw beef liver. On admission, he did not have a headache or fever. However, 1 week after admission, he had fever (37.2°C) and a headache. Neck stiffness was observed. Leukocytosis (10200/ll) with a left shift was noted, and the blood serum levels of C-reactive protein (CRP) were elevated (4.4 mg/dl). The brain CT did not show any abnormal findings, but the cerebrospinal fluid (CSF) sample showed leukocytosis (3760/ll; neutrophil 91 %, lymphocyte 9 %). The CSF findings are summarized in Table 1. Both blood and CSF cultures yielded C. fetus after 6 days.Immediate empiric antibiotic therapy was instituted with meropenem (MEPM) 6 g daily intravenously. The next day, the headache had improved, and the fever lasted only 2 days. The organisms isolated from the blood and CSF
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