[PAGID] REcurrent Campylobacter jejuni in a XLA patient

[Junker, Anne]

If you do find chronic GI infection, you might consider oral Ig therapy which has been used in several anecdotal reports of normo-immune and immune compromised children with persistent rotovirus, polio, cryptosporidia or clostridium difficile GI infections. We have successfully used IVIg product at a dose of 150mg/kg, giving one dose on alternate days for 2 weeks, in treatment of several of our immunocompromised patients, including post-BMT with, respectively, rotovirus, polio, and salmonella B.  We reconsituted lyophilized preparations of Ig for intravenous use as a 5% solution and administered by NG tube.  We based this dose and scheduling on a single report on the kinetics of orally administered IVIg, which showed that rotovirus antigen would clear, and remain Ig-complexed, in stools of rotovirus-infected patients for up to 3 days after the single dose of 150mg/kg.  If you have the lab support, you could consider testing the opsonic capability of your available Ig preparation - one report I came across showed that maternal serum was more effective than commercial Ig product as a campylobacter opsonin for PMN-killing in an infected XLA patient (Clin Inf Dis 1996; 12:526  Autenrieth et al).

anne

Anne K. Junker, MD
Associate Professor, Division of Infectious & Immunological Diseases, Department of Pediatrics
Director, Clinical and Population Health Studies, Child & Family Research Institute
BC Children's and University of British Columbia
Director, Mother Infant Child Youth Research Network -Reseau de Recherche en Sante des Enfants et des Meres au Canada

Room K4-223
4480 Oak Street
Vancouver, BC, CANADA  V6H 3V4
Ph: 604-875-3591  Fx: 604-875-2414
ajunker at cw.bc.ca<mailto:ajunker at cw.bc.ca>

________________________________
From: pagid-bounces at list.clinimmsoc.org [mailto:pagid-bounces at list.clinimmsoc.org] On Behalf Of Richard Wasserman
Sent: Tuesday, September 14, 2010 6:40 AM
To: pagid at list.clinimmsoc.org
Subject: Re: [PAGID] REcurrent Campylobacter jejuni in a XLA patient

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<mailto: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.

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De: pagid-request at list.clinimmsoc.org<mailto:pagid-request at list.clinimmsoc.org>
Para: psoler at vhebron.net<mailto:psoler at vhebron.net>
Enviados: Miércoles, 15 de Julio 2009 21:27:58
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