[PAGID] REcurrent Campylobacter jejuni in a XLA patient

[Kate Sullivan]

I think the speciation of these species is quite problematic.  I defer to the ID folks to explain why.  My guess is that this is either the type of Campylobacter that used to be called Flexispira or you have a focus that you haven't cleared.  It is relevant because in both cases you will need very prolonged multicoverage therapy.  TO look for a focus, PET scans can be quite helpful.  To get a more precise read on the actual bacteria, you might reach out to your national laboratories to see if they can culture it and do DNA analysis or you might try the US NIH labs.


Kate
On Sep 14, 2010, at 4:58 AM, Pere Soler Palacin wrote:


> Dear colleagues, we would be pleased if you could consider evaluating the following case we have just been referred:

>  

> 10-year-old boy with diagnosis of XLA, malnutrition and malabsorption (fecal alpha-1-antitrypsin was 1,68 mg/gr in 2009 and 2.1 mg/ gr in 2010) leading to failure to thrive and the need of increasing doses of IVIG to reach normal plasma levels. The patient has presented several respiratory tract infections and CT scan (2009) showed bronchiectasis in lower left lobe.

> The patient has presented recurrent bacteremia due to Campylobacter jejuni since 2009. Due to resistance pattern, the patient has received both gentamycin and imipenem subsequently. Despite of antibiotic treatment, stool cultures repeatedly yielded macrolide resistant Campylobacter jejuni.

> In his last episode of bacteremia (July 2010) the patient has been treated with cefotaxime and gentamycin for 2 weeks but was then switched to meropenem (for 10 days) with good clinical response. Blood cultures became negative but stool cultures remain positive. He is now receiving oral cephalosporin.

> Abdominal ultrasound study and bone scintigraphy were normal and echocardiogram showed mild pericardial effusion but no signs of IE.

> Oral kanamycin is not available in Spain, and the isolated strain showed was resistant to neomycin, therefore aminoglycosides do not seem to be an option for oral treatment. Would you consider oral doxycicline?

> In our opinion, this patient’s will be at risk of recurrent bacteremia until stool cultures become negative. Do you agree with it? What would be the next step in this patient?

> Thanks again,

>  

> Pere Soler-Palacín

> Pediatric Infectious Diseases and Immunodeficiencies Unit.

> Vall d'Hebron University Hospital.

> Barcelona, Spain.

> 

> ----- Mensaje original -----

> De: pagid-request at list.clinimmsoc.org

> Para: psoler at vhebron.net

> Enviados: Miércoles, 15 de Julio 2009 21:27:58

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Kathleen Sullivan MD PhD
Professor of Pediatrics
Chief, Division of Allergy Immunology
The Children's Hospital of Philadelphia
(p) 215-590-1697
(f) 267-426-0363




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