Successful outpatient management of Campylobacter fetus bacteremia in an immunocompetent patient with endovascular involvement.

We describe a case of Campylobacter fetus bacteremia with endovascular involvement in an immunocompetent female patient. The patient was treated with high dose ciprofloxacin as an outpatient and recovered well.

A 70-year-old woman presented with fever, rigors and a painful, red, swollen left thigh. She was on holiday and had presented to another hospital with similar symptoms six days previously. She had received 24 h of intravenous flucloxacillin and had been discharged on oral flucloxacillin. However, following discharge, at 55 h, blood cultures grew Campylobacter fetus and she was advised to seek medical review urgently. She had a history of bariatric surgery and iron deficiency and she lived on a farm where she raised a menagerie of animals, including sheep and cattle. Her dog recently had diarrhea after a meal of malodorous, raw chicken.

On representation to the hospital, she was febrile (39.4 °C) and appeared toxic. Her left thigh was tender and indurated and her right calf was diffusely erythematous; her examination was otherwise unremarkable. Ultrasonography of the left thigh revealed thrombosed superficial varicose veins with associated subcutaneous edema (Fig. 1). She began intravenous cefazolin and gentamicin and over the next 24 h she defervesced and her pain improved. Disc diffusion testing using the Kirby-Bauer method showed zones of inhibition of 41 mm for gentamicin and 34 mm for ciprofloxacin. After 48 h, she was switched to oral ciprofloxacin monotherapy, 750 mg twice daily, which was continued for 4 weeks. She was followed closely as an outpatient for six weeks. She made a full and uneventful recovery and was able to resume her vacation.

Fig. 1

(A)Tender and indurated left thigh. B. Ultrasound showing thrombosis of superficial vein (absent doppler flow, white arrow) and edema (increased echodensity, black arrow). C. 1000x magnification view showing slender, curved Gram-negative rods of C. fetus isolated from the patient's blood cultures.

C. fetus is an uncommon, but recognised cause of bacteremia, particularly in elderly and immunocompromised patients [1,2]. The reported case-fatality rate is as high as 15% [1]. The most common clinical manifestations are diarrhea and cellulitis, although endovascular infection is a serious - and relatively frequent - complication [1,2]. C. fetus has a vascular tropism, involving the vascular endothelium, particularly where pre-existing damage is present [3]. The potential for vascular rupture requires the clinician to consider surgical excision of the infected vessel [4], although in the case the patient settled rapidly, and it was felt unnecessary.

This patient was probably exposed to the organism on her farm. Her dog’s diarrheal illness after the raw chicken meal is another possibility [5], although poultry appear to be a less common source of the organism [6]. The prompt clinical response to aminoglycoside therapy is typical, although an early switch to less toxic agents is recommended. There is no validated method for sensitivity testing in C. fetus, however the extrapolation of breakpoints for other Campylobacter species permitted substitution of high-dose ciprofloxacin. Despite endovascular involvement, our patient was safely managed as an outpatient and was able to resume her holiday with minimal delay.

Author statement

AC cared for the patient and wrote the first draft of the manuscript.

SS cared for the patient and revised the manuscript.

MRA cared for the patient and revised the manuscript.

SJH cared for the patient and revised the manuscript.

JH was the patient’s primary physician, revised the manuscript and prepared the figure.

Declarations of interest

None.