Association of Campylobacter upsaliensis with Persistent Bloody Diarrhea

Abstract

Campylobacter upsaliensis is a zoonotic, emerging pathogen that is not readily recovered in traditional stool culture. This case represents the first report of persistent bloody diarrhea with C. upsaliensis that was confirmed by filtration culture, PCR, and sequencing. CASE REPORTA n 83-year-old male presented to the emergency department (ED) with an acute history of severe bloody diarrhea. His symptoms began with nausea, vomiting, and abdominal cramping, which he mistook for constipation. The patient took a single dose of laxative and shortly thereafter experienced numerous episodes of profuse bloody diarrhea that continued for several hours. He did not have fevers, chills, or sweats. The patient was found by his wife at home, collapsed in a chair, and was brought to the ED for evaluation. The patient's past medical history was significant for irritable bowel syndrome but no history of bloody diarrhea or rectal bleeding. His social history revealed contact with his sisterin-law and two canine pets, all with bloody diarrhea. On arrival in the ED, the patient's physical examination was unremarkable; however, out of concern for a lower gastrointestinal bleed, the patient was admitted for observation and further testing. Stool studies were negative for all gastrointestinal pathogens, including Salmonella, Shigella, Campylobacter, Aeromonas, Plesiomonas, and Vibrio by stool culture, Cryptosporidium, Giardia, and Shiga-toxigenic Escherichia coli (STEC) by enzyme immunoassay (EIA), and Clostridium difficile by PCR. In addition, ovum and parasite exams of the stool were performed and were remarkable only for numerous erythrocytes and leukocytes. These findings were consistent with the grossly bloody stool and a positive fecal lactoferrin EIA. The patient's symptoms gradually improved but did not resolve over the course of 48 h. He remained afebrile and hemodynamically stable and was discharged on hospital day 2 with no known etiologic cause of diarrhea. Five days later, he was treated with ciprofloxacin for continuing diarrhea out of concern for possible person-to-person spread of a still-unidentified gastrointestinal pathogen but only after STEC was ruled out by Shiga toxin EIA.The clinical microbiology laboratory was consulted for additional testing for enteroinvasive or enteroaggregative E. coli, given the widely publicized enteroaggregative/Shiga-toxigenic E. coli O104:H4 outbreak that had recently concluded in Germany. No testing was available for these organisms; however, the stool was filtered through a 0.6-m filter (Pall Life Sciences, Ann Arbor, MI) onto a brucella blood agar plate (Hardy Diagnostics, Santa Maria, CA) and cultured in an increased-hydrogen atmosphere of approximately 6.5 to 12.5% (7) (BioBag Type Cfj; BD, Franklin Lakes, NJ) at 37°C to enhance the detection of hydrogen-requiring Campylobacter spp. (21). For direct stool PCR, the specimen was treated with AL stool lysis buffer (Qiagen, Valencia, CA) and heated at 95°C for 10 min. The DNA was extracted with the Maxwell Cell LEV DNA purification k...

First Case Report of Fatal Sepsis Due to Campylobacter upsaliensis

“…The MICs of antibiotics against the C. upsaliensis strain are shown in Table 1. Antibiotic agents like penicillins, cephalosporins, and macrolides, including AZM, showed low MICs, consistent with previous reports (3)(4)(5). On the other hand, the MIC of fluoroquinolone (levofloxacin) was Ͼ8 g/ml, indicating resistance to fluoroquinolone, as seen in a previous report (4).…”

Survey of Campylobacter spp. in owned and unowned dogs and cats in Northern Italy

“…This is an important finding from a public health standpoint, since C. jejuni is the species most frequently associated with human gastroenteritis (Moore et al, 2005;EFSA and ECDC, 2015). The relatively frequent occurrence of C. upsaliensis should also be considered, since it is increasingly reported as an emerging pathogen in children and immunocompromised people (Lastovica, 2006;Couturier et al, 2012). Conversely, the prevalence of C. coli, C. helveticus, C. lari and C. hyointestinalis subsp.…”

Culture Methods to Determine the Limit of Detection and Survival in Transport Media of <em>Campylobacter Jejuni</em> in Human Fecal Specimens

“…Use a molecular assay that can detect the 16S rRNA gene or other gene of a broad range of Campylobacter species 13 . Confirm that the molecular assay reacts with species such as C. upsaliensis or C. lari that grow poorly on standard antibiotic-containing agar 14 . Follow manufacturer's instructions for extraction of DNA from fecal samples and performing the test.…”