Campylobacter jejuni Fatal Sepsis in a Patient with Non-Hodgkin’s Lymphoma: Case Report and Literature Review of a Difficult Diagnosis

Abstract

Campylobacter jejuni (C. jejuni) bacteremia is difficult to diagnose in individuals with hematological disorders undergoing chemotherapy. The cause can be attributed to the rarity of this infection, to the variable clinical presentation, and to the partial overlapping symptoms underlying the disease. Here, we report a case of a fatal sepsis caused by C. jejuni in a 76-year-old Caucasian man with non-Hodgkin’s lymphoma. After chemotherapeutic treatment, the patient experienced fever associated with severe neutropenia and thrombocytopenia without hemodynamic instability, abdominal pain, and diarrhea. The slow growth of C. jejuni in the blood culture systems and the difficulty in identifying it with conventional biochemical phenotyping methods contributed to the delay of administering a targeted antimicrobial treatment, leading to a fatal outcome. Early recognition and timely intervention are critical for the successful management of C. jejuni infection. Symptoms may be difficult to recognize in immunocompromised patients undergoing chemotherapy. Thus, it is important to increase physician awareness regarding the clinical manifestations of C. jejuni to improve therapeutic efficacy. Moreover, the use of more aggressive empirical antimicrobial treatments with aminoglycosides and/or carbapenems should be considered in immunosuppressed patients, in comparison to those currently indicated in the guidelines for cancer-related infections supporting the use of cephalosporins as monotherapy.

Core Genome Multilocus Sequence Typing for Food Animal Source Attribution of Human Campylobacter jejuni Infections

“…In otherwise healthy individuals, C. jejuni infections commonly result in a self-limiting diarrheal disease that is believed to commonly go unreported [4]. In immunocompromised patients, however, untreated C. jejuni infections can progress to sepsis and in rare cases meningitis [5,6]. Further, C. jejuni is associated with several sequelae including reactive arthritis, Guillain-Barre syndrome, Miller-Fisher syndrome and prolonged exposure in infants is associated with growth deficits [7][8][9].…”

Septic Shock with Multi Organ Failure Due to Fluoroquinolones Resistant Campylobacter Jejuni

“…In Europe, bacteremia due to Campylobacter spp was detected in less than 1% of the patients with gastroenteritis [ 1 ]. The low rate of detection could partly be explained by under diagnosis due to bactericidal properties of human serum against the species [ 2 ]. Another possible explanation is that blood cultures are not routinely performed for acute gastroenteritis, even when patients are febrile [ 2 ].…”

“…Septicemia occurs mostly among immunocompromised patients (mainly AIDS) or those with other comorbidities (malignancies and liver disease) [ 3 ]. In Italy, evidence is limited to some case reports [ 2 , 4 ].…”

Flagellotropic Bacteriophages: Opportunities and Challenges for Antimicrobial Applications

“…Campylobacter jejuni is a pathogenic bacterium that is a common cause of bacterial gastroenteritis, known particularly for contaminating poultry products [155][156][157]. Campylobacteriosis can be fatal in rare cases [158,159]. C. jejuni is a microaerophilic, helical, motile bacterium, which swims using a single polar flagellum or two polar flagella [155][156][157].…”