Introduction
Campylobacter is a common cause of acute gastroenteritis with the most common species being jejuni and coli. Campylobacter rarely manifests as a systemic infection, and when present it is in patients with underlying conditions, immune deficiency such as human immunodeficiency virus (HIV), or previous gastrointestinal surgery. We present a case report of a patient who presented to our hospital with fever and gastrointestinal symptoms and found to have campylobacter bacteremia with likely colostomy source.
Case Presentation
A 72-year-old male presented to the emergency department with altered mental status, fever, vomiting, and resolving diarrhea. Vital signs were normal, and his exam was only significant for lethargy. Past medical history was significant for rectal cancer status post colectomy with colostomy back in 2008. The patient was admitted and started on Zosyn 3.375 grams and IV fluids. Blood cultures, clostridium difficile antigen testing, urine culture, and both influenza and COVID-19 nasal swabs were collected. CT imaging of the abdomen and brain along with a chest X-ray were performed, both being within normal limits. Blood cultures resulted back as gram negative rods, ultimately speciating to be Campylobacter coli. After speciation, pharmacy was consulted, and antibiotics were changed to azithromycin 500 mg daily. After speciation, upon questioning, the patient stated he had recently been bleeding from his colostomy bag. It was determined from presenting symptoms and lack of significant imaging results, that translocation of the campylobacter coli likely occurred from his colostomy bag issues. Gastroenterology was consulted to assess colostomy bag due to bleeding, and they found no obvert reason for bleeding and determined colostomy bag could be assessed in outpatient follow-up. No other sources of infection were found. After a four-day hospitalization, the patient was ready for discharge with vital signs stable, no apparent distress, abdomen non-tender, and awake, alert, and oriented x 4. The patient was discharged to complete 7 additional days of azithromycin and was scheduled for follow-up with his primary care provider and gastroenterologist for evaluation of colostomy. Patient permission for case information to be published was obtained.
Discussion
To our knowledge, this is the first reported case where a colostomy bag bleed resulted in an bacteremia caused by campylobacter coli. A study in Denmark observed an incidence of campylobacter bacteremia to be 2.9 people per 1 million. From this study, they gathered that the most common clinical characteristics found in patients to be fever, abdominal pain, and diarrhea.1 Campylobacter bacteremia has been estimated to occur in <1% of patients with C. jejuni or coli enteritis and almost always is transient and asymptomatic, but can be severe in immunosuppressed hosts.2 Macrolides are the antibiotic treatment of choice currently with fluoroquinolones seeing increasing resistance rates in the United States.3,4 Our patient had non-specific infectious symptoms with a prior medical history of immunosuppression and previous gastrointestinal surgeries making him more at risk for developing a campylobacter bacteremia. With the blood culture speciation, treatment was able to be modified in order to assure clearance of the infection was achieved. This case highlights the predisposing factors patients may have to make them more susceptible to a bloodstream infection caused by campylobacter species.
Conclusion
With the incidence rate of campylobacter bacteremia being exceedingly low, initial clinical presentation of patients may be unclear to physicians right away. The patient symptoms presented in this case helped point physicians in the direction of obtaining an infectious disease work up, ultimately resulting in a positive blood culture campylobacter coli. While this case report does not have much implication for changes in clinical practice since blood cultures are usually obtained, it does highlight potential bacterial infections that can arise from colostomy complications.
Funding
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Competing Interests Statement
The authors declare that they have no conflict of interest.
Consent
The patient gave permission for information regarding their case to be published.