[PAGID] REcurrent Campylobacter jejuni in a XLA patient

[Richard Wasserman]

I share Kate's concern about a focus of infection. In similar circumstances
cholecystectomy has solved the problem.
Richard Wasserman
Dallas

On Tue, Sep 14, 2010 at 5:17 AM, Kate Sullivan
<sullivak at mail.med.upenn.edu>wrote:


> 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

> Asunto: Welcome to the "PAGID" mailing list

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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

>

>

>

>

>



-- 
Richard L. Wasserman, MD, PhD
DallasAllergyImmunology
7777 Forest Lane, Suite B-332
Dallas, Texas 75230
Office (972) 566-7788
Fax (972) 566-8837
Cell (214) 697-7211
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