Recurrent Campylobacter jejuni bacteremia in a patient with hypogammaglobulinemia

Abstract

Rationale:Although some cases of recurrent bacteremia due to Campylobacter jejuni have been reported in immunocompromised patients, antibiotic treatment strategies to eradicate C. jejuni and prevent recurrent infections in immunocompromised patients have not been established. Authors’ experience of such rare cases should be shared for improving patients’ outcomes.Patient concerns:An 18-year-old boy with hypogammaglobulinemia, who received intravenous immunoglobulin replacement therapy every 3 weeks, was admitted to hospital repeatedly due to recurrent diarrhea and cellulitis of the leg.Diagnoses:The patient was admitted 6 times, and among them, C. jejuni was isolated from blood cultures 4 times and stool cultures 2 times.Interventions:The patient experienced recurrent C. jejuni enteritis and bacteremia 5 times despite macrolide therapy. Doxycycline was administered for 3 months after the fifth admission.Outcomes:Ten months after the completion of doxycycline therapy for 3 months, C. jejuni enteritis relapsed; however, since then, recurrent infection has not occurred for 10 months.Lessons:Immunocompromised patients can experience recurrent C. jejuni infection despite prolonged antibiotic therapy. Further studies to establish appropriate antibiotic therapy for eradicating colonized C. jejuni and preventing recurrent infection are needed.

Recurrent Campylobacter Enteritis in Patients with Hypogammaglobulinemia: Review of the Literature

“…Our literature review of recurrent Campylobacter enteritis and immunodeficiency yielded 14 cases associated with hypogammaglobulinemia [22][23][24][25][26][27][28][29][30][31][32], all of which were considered to be primary, and most commonly included CVID and XLA [1]. While hypogammaglobulinemia is a well-recorded complication of rituximab treatment [33], there are no other published reports of recurrent or persistent campylobacteriosis in this context.…”

“…Therefore, 14 cases of hypogammaglobulinemia and recurrent Campylobacter gastroenteritis form the basis of this review (Table 1). Of these, six patients had common variable immunodeficiency (CVID) [22][23][24][25], four had X-linked hypogammaglobulinemia (XLA) [26][27][28][29], and two had immunodeficiency with thymoma (Good syndrome) [24,30]. In two cases, the nature of hypogammaglobulinemia was not reported [31,32] but was likely primary, as no secondary causes were reported, and because thrombocytopenia and autoimmune hemolytic anemia suggested CVID in one of these patients [32].…”

“…In 8 of the 14 patients, bacteremia was also recorded [25][26][27][28][29][30][31]. All patients received at least one course of antibiotics except for one case where therapy was not mentioned [31].…”

“…All patients received at least one course of antibiotics except for one case where therapy was not mentioned [31]. In seven patients, IVIG replacement therapy [24,26,[28][29][30]32] was recorded before recurrent Campylobacter enteritis was noted; in six cases, IVIG was not mentioned [22,23,27,28,31], and in one case it was started after hypogammaglobulinemia was diagnosed because of recurrent Campylobacter infections [25]. In seven patients, diarrhea was resolved [24][25][26]30,32], while in six patients, including our patient, symptoms improved [22,23,28,29].…”

Two-sided femoral Campylobacter jejuni osteomyelitis in a patient with acquired hypogammaglobulinemia: a case report

“…Treatment with IVIG is an option in case of hypogammaglobulinemia, but the added effect of IVIG has not been studied specifically in Campylobacter spp. infections and its use is therefore debatable [4,5]. There have been reports of patients treated with intravenous IgM who had better bacterial clearance than with predominantly IgG containing IVIG [6], but no randomized controlled studies have been performed.…”