[CIS PIDD] [cis-pidd] CVID with chronic GI campylobacter

Thu Apr 6 02:35:40 EDT 2017

Dr. Hartog:

Dr. Seppanen brings up an excellent point.  Check out Ge et al., J Microbiol Meth 2013.  An issue is that the Americans (the CLSI) and Europeans (EUCAST) do not agree on what the antibiotic susceptibility breakpoints are  (the Europeans are stricter ... go figure!!).  Consequently, I suspect your patient may have received less effective antibiotic therapy than we would think he had.   Add to the issue that the only bactericidal therapy he might have seen would be amoxicillin.  The fluoroquinolones and macrolides are generally bacteriostatic.  I would always prefer a bactericidal drug -- especially in the setting of immunodeficiency.

Ertapenem +/- gentamicin (if the bug is sensitive) may be worthwhile.  

(My inner antibiotic stewardship officer just had a heart attack)

Good luck with the case.

   - Karl 

Karl O. A. Yu, M.D., Ph.D., F.A.A.P.
Section of Infectious Diseases  |  Department of Pediatrics  |  Comer Children's Hospital  |  University of Chicago
5841 S Maryland Ave,  MC 6054,  Chicago  IL  60637
Office phone: 773-702-9281  |  Pager: 773-702-6800 x1744  |  Fax: 773-702-1196

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From: cis-pidd at lyris.dundee.net [cis-pidd at lyris.dundee.net] on behalf of CIS-PIDD [cis-pidd at lists.clinimmsoc.org]
Sent: Thursday, April 06, 2017 1:12 AM
To: CIS-PIDD
Subject: VS: [cis-pidd] CVID with chronic GI campylobacter

Hi Nicholas,

we rather recently treated an adult IgG Deficiency patient with multiple autoimmunity, with had similar problems.

We finally managed to clear the stool (PCR)  and get symptoms to alleviate with carbapenem (cannot find now if we used an aminoglycocide as well).

N=1, but possibly of help?

Mikko

Mikko Seppänen
Head
Hospital District of Helsinki and Uusimaa, Children’s Hospital, Rare Disease Center
P.O.Box 280, 00029 HUS |Lastenlinnantie 2, Helsinki
Senior Consultant
Hospital District of Helsinki and Uusimaa, Inflammation Center, Adult Primary Immunodeficiency Outpatient Clinic
mikko.seppanen at hus.fi<mailto:mikko.seppanen at hus.fi>
+358 9 47180201| +358 50 4279606
faxi +358 9 47174703
www.hus.fi<http://www.hus.fi/>; www.harvinaissairaudet.fi<http://www.harvinaissairaudet.fi/>

____________________________________________
Lähettäjä: cis-pidd at lyris.dundee.net [mailto:cis-pidd at lyris.dundee.net] Puolesta CIS-PIDD
Lähetetty: 5. huhtikuuta 2017 23:05
Vastaanottaja: CIS-PIDD <cis-pidd at lyris.dundee.net>
Aihe: [cis-pidd] CVID with chronic GI campylobacter

I just took over care for a 66 y/o male with CVID, inclusion body myositis (previously thought to be polymositis but 2nd opinion leaning inclusion), pancytopenia (WBC 3-4,000, Hgb~10, platelets 40-70 and ALC 300-800 over last few years).  On diagnosis in 2012 his labs were IgG<40, IgA<5, and IgM<5, last IgG trough was 798.  No genetics have been done.

His biggest active issue is chronic diarrhea from chronic GI campylobacter.  He has had treatment with amoxicillin, levofloxacin, ciprofloxacin, azithromycin, and doxycycline.  Based on stool PCR testing, none of these have cleared the infection.  Multiple endoscopies hae shown active colitis, granulation tissue, crypt apoptosis, always thought to be secondary to campylobacter

As recent as last year his IgG had been closer to 1200 and he had no sinopulmonary infections (he has had 2 pneumonias this year with lower levels, we will be working on getting IgG trough back up), but did have continued diarrhea and campylobacter.

Most recent stool culture and multiplex PCR in February was positive for campylobacter.  He has had significant weight loss and loss of IgG from this diarrhea.  ID is planning to repeat culture with sensitivities next week.  But I wanted to reach out to see if anyone else has experience with chronic campylobacter in patients with CVID.  Any ideas for next step in treatment?

Thank you for your help
Nick
--

Nicholas Hartog, MD
Allergy and Clinical Immunology
Assistant Professor – Michigan State University College of Human Medicine
Nicholas.hartog at spectrumhealth.org<mailto:Nicholas.hartog at spectrumhealth.org>

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