Helicobacter canis Bacteremia in a Patient with Fever of Unknown Origin

Abstract

A 57-year-old woman with common variable immune deficiency and liver failure of unknown etiology presented with recurrent fevers over a 5-month period. She was found to have Helicobacter canis bacteremia. Immunocompromised hosts with exposure to cats or dogs may be at risk for infection with this organism, which may be challenging to diagnose. CASE REPORTA 57-year-old woman from Montana was referred to our institution for Infectious Diseases consultation for recurrent fever and chills for 3 months. She had common variable immunodeficiency (for which she received intermittent intravenous immune globulin infusions), and presumed pulmonary sarcoidosis (treated intermittently with prednisone), and had undergone prior splenectomy. She had a 2-year history of elevated alkaline phosphatase. She had developed intermittent fever 3 months prior to consultation and had been previously hospitalized locally for fever and clinical sepsis with negative blood cultures. Laparoscopic liver biopsy had shown mildly active steatohepatitis with periportal fibrosis, and had been procedurally complicated by intra-abdominal hemorrhage. She had been hospitalized for fever on several subsequent occasions and had received multiple courses of empirical antibacterial therapy despite negative blood cultures and no clear definition of an infectious process.Upon presentation for initial Infectious Diseases consultation, fevers were described as low grade and intermittent and were accompanied by chills and sweats. She had taken prednisone (20 mg daily) for the previous 3 months for abdominal pain ascribed to possible gastrointestinal sarcoidosis. She reported a 1-year history of diarrhea and a 2-year 160-pound weight loss. A colonoscopic biopsy 5 months prior had shown findings consistent with common variable immunodeficiency. Stool studies showed no evidence of enteric infection. She had two dogs and three cats. The patient's blood cultures, serologic testing for HIV, blood PCR for cytomegalovirus, and chest X-ray were negative. Serum IgG was 408 mg/dl (767 to 1,590 mg/dl), and IgA was 2 mg/dl (61 to 356 mg/dl). Total bilirubin was 0.4 mg/dl (0.1 to 1 mg/dl), alkaline phosphatase 566 units/liter (46 to 118 units/liter), and alanine transaminase 155 units/liter (7 to 45 units/liter). Computed tomography of the chest, abdomen, and pelvis was notable only for a fluid collection around the liver. Aspiration of this collection was attempted, but no fluid was obtained, and the finding was ascribed to a resolving hematoma. A positron emission tomography scan was unremarkable. She was empirically treated with ciprofloxacin and metronidazole for 5 days. Fever resolved and she was discharged home.She was admitted to a local hospital 2 months later for recurring fevers and worsening cholestasis. Total bilirubin was 21.6 mg/dl (0.1 to 1 mg/dl), alkaline phosphatase 359 units/liter (46 to 118 units/liter), and alanine transaminase 384 units/liter (7 to 45 units/liter). She was subsequently transferred to our hospital, at which time she was afebrile in the a...

First nationwide seroepidemiology and risk factors report of Helicobater pylori in Jordan

“…Based on a recent review which discussed water as source of H pylori, it was concluded that even if confirmed as a reservoir for H pylori, water most likely would be only be a secondary route of transmission. 2 Our study did not show any 22 Other Helicobacter spp of animal origin such as Helicobacter canis (from dogs and cats), 23 Helicobacter pullorum (from poultry), 24 and Helicobacter suis (from pigs) 25 were found to cause infection in human.…”

“…On the other hand, higher seroprevalence was reported in children with sheep contact compared to children without sheep contact in Poland . Other Helicobacter spp of animal origin such as Helicobacter canis (from dogs and cats), Helicobacter pullorum (from poultry), and Helicobacter suis (from pigs) were found to cause infection in human.…”

The Family Helicobacteraceae

“…H. canis DNA has also been detected in the feces of children shown to be transiently positive for H. pylori (Haggerty et al 2005). It has also been isolated from a number of immuno-deficient patients with bacteremia, including a patient with X-linked hypogammaglobulinemia (Gerrard et al 2001), a patient with gastric lymphoma (Alon et al 2010) and a woman with common variable immune deficiency and liver failure (Abidi et al 2013). H. canis has also been isolated from two immune-competent patients, one with bacteremia (Leemann et al 2006), and the other a 7-month old child with bacteremia (Prag et al 2007).…”

Enterohepatic Helicobacter spp. in cats with non-haematopoietic intestinal carcinoma: a survey of 55 cases

“…H. canis has been identified in Bengal cats with diarrhoea (Foley et al, 1999), dogs with hepatitis (Fox et al, 1996a) and diarrhoea (Castiglioni et al, 2012;Stanley et al, 1993) and humans with gastroenteritis , autoimmune hepatitis (Casswall et al, 2010), inflammatory bowel disease (Tankovic et al, 2011) and bacteriemia (Abidi et al, 2013;Prag et al, 2007;Leemann et al, 2006;Gerrard et al, 2001). H. bilis has been associated with human chronic cholecystitis and biliary cancer (Matsukura et al, 2002;Fox et al, 1998) and with inflammatory bowel disease in mice (Maggio-Price et al, 2006).…”