Meningitis in Adults Due to Campylobacter fetus

tles (in a microaerobic environment at 257C and 357C) yielded Campylobacteriosis is a zoonosis that occurs worldwide. Alpure growth of C. fetus subspecies fetus identified by use of APIthough the most common clinical manifestation is cryptogenic Campy (bioMérieux, Cedex, France; API code no. 2400714) and bacteremia, sites of localized infections have been described [1, PCR assay (Centers for Disease Control and Prevention [CDC], 2]. Meningitis in adults due to Campylobacter fetus subspecies Atlanta). The MICs of the following antibiotics for the isolate fetus is a rare entity and, to our knowledge, only seven cases were: penicillin, 94 mg/mL; cefotaxime,ú32 mg/mL; ceftazidime, have been reported in the French-, Spanish-, and English-language 128 mg/mL; nalidixic acid, ú256 mg/mL; erythromycin, 0.75 literature since 1983 [3–7]. We describe an additional case of mg/mL; ofloxacin, 1 mg/mL; gentamicin, 1 mg/mL; amoxicillin/ meningitis due to C. fetus subspecies fetus in a patient with chronic clavulanate, 1 mg/mL; and imipenem, 0.064 mg/mL. Therapy with alcoholism. ofloxacin (400 mg t.i.d. for 4 weeks) and gentamicin (240 mg q.d. A previously healthy, 47-year-old man with chronic alcoholism for 3 weeks) was instituted. On day 21 of therapy, the following (250 g alcohol per day) presented to the emergency department for levels of antibiotics were measured in blood/CSF 2 hours after evaluation of fever and pretibial cellulitis of 1 week’s duration. Blood administration: ofloxacin, 3.9/2.3 mg/mL; gentamicin, 5.68/0.36 was drawn for two cultures. The patient was discharged on amoxicilmg/mL. Endocarditis was ruled out. The patient’s condition gradulin/clavulanate for 10 days, and his condition partially improved. ally improved; there were no neurological sequelae, and results of Two weeks later (on 21 April 1997) the patient developed a highall laboratory evaluations were normal. Nine months after treatgrade fever (temperature, 397C to 39.57C), malaise, nausea, vomiting, ment the patient continues to be healthy and asymptomatic. photophobia, and a severe frontal headache. Findings on physical A MEDLINE search (from 1983 to July 1997) for reports of examination were notable for a temperature of 387C, normal mentameningitis in adults due to C. fetus subspecies fetus identified only tion, neck stiffness, and mild hepatomegaly. The patient indicated seven cases (table 1) [3–7]. All patients had underlying predisposing that he had two dogs and one cat, but he denied exposure to raw or conditions, chronic alcoholism and alcoholic cirrhosis being the two undercooked meat or to unpasteurized milk. most common (six cases). Six patients had positive CSF cultures The patient’s WBC count was 9,700/mm with a normal differand five of eight patients had associated bacteremia. A history of ential. Serologies for antibodies to HIV and hepatitis C virus were ingestion of raw food or exposure to domestic or farm animals negative; however, there was evidence of previous infection with may help determine the diagnosis. One Moroccan patient had a hepatitis B, given that serologies for antibodies to hepatitis B cat, although Campylobacter species were not recovered from the surface antigen (HBsAg) and hepatitis B core antigen (HBcAg) animal’s feces [4]. Another patient had traveled to Mexico to receive were positive. A contrast-enhanced CT of the head was normal. nutritional therapy, and this travel history might have contributed to Specimens for two additional blood cultures were obtained. The the clinical illness [5]. The patient we described had two dogs and patient underwent a lumbar puncture, and evaluation of CSF reone cat, and they were not examined for carriage of fecal microorganvealed the following values: glucose, 3.2 mmol/L (7.2 mmol/L in isms, but they were the most likely origin of infection. This informablood); protein, 0.85 g/L; WBCs, 300/mL (80% neutrophils); and tion was not available for the remaining five cases. no RBCs. Evaluation of the CSF was negative for microorganisms. Community-acquired bacterial meningitis due to gram-negative Empirical antibiotic therapy with a combination of cefotaxime, for bacilli is rare. C. fetus subspecies fetus is an uncommon human 14 days, and vancomycin, for 3 days, was instituted. Cultures of pathogen, particularly in association with meningitis. Some investiblood (four specimens, the first and last of which were drawn 13 gators have pointed out the paucity of C. fetus isolates recovered days apart) yielded C. fetus subspecies fetus. A culture of CSF from humans; only 22 of 394 Campylobacter species isolates were remained negative. The patient’s condition gradually improved, identified in blood cultures during an 11-year period [2]. None of and he remained afebrile and was discharged. the isolates were identified in CSF. Classically, C. fetus has been