Campylobacter fetus infecting a chronic subdural haematoma in a patient with Human Immunodeficiency Virus: A case report
Background: C. fetus is the most common agent responsible for systemic campylobacteriosis and occurs mostly in patients with a predisposing underlying condition, immunodeficiency, or the elderly. C. fetus infection has diagnostic and therapeutic challenges. The diagnosis of C. fetus is challenging d...
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| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-03-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971224005824 |
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| Summary: | Background: C. fetus is the most common agent responsible for systemic campylobacteriosis and occurs mostly in patients with a predisposing underlying condition, immunodeficiency, or the elderly. C. fetus infection has diagnostic and therapeutic challenges. The diagnosis of C. fetus is challenging due to the organism's fastidious nature and the reliance on a high clinical index of suspicion for good microbiological sampling. The therapy of invasive C. fetus infections is challenging due to the lack of clear therapeutic guidelines and recommendations as well as antibiotic resistance. Chronic subdural haematoma (CSDH) is a possible site for bacterial infection and the clinician should develop a high index of suspicion for an infected subdural haematoma (ISH) when certain symptoms and predispositions are present. Case Description: We describe a case of an ISH with C. fetus in a 53- year-old male patient with Human Immunodeficiency Virus (HIV) infection. The patient had preceding head trauma 2 months prior to this presentation. A Computed tomography (CT) scan revealed a large right frontoparietal collection in keeping with a subdural haematoma. A gram stain of the blood culture as well as cultured colonies (from the blood culture and the subdural fluid culture) revealed delicate curved Gram-negative bacilli with gull wing formations, suggestive of Campylobacter species (spp.). Matrix-assisted laser desorption/ ionization time-of-flight mass spectrometry (MALDI-TOF MS), VITEK® MS PRIME ((bioMérieux, Marcy-l’Étoile, France) quickly confirmed the organism's identity to be C. fetus. The empiric therapy (Ceftriaxone (2g IVI 12 hourly) and Metronidazole (500 mg IVI 8 hourly)) was changed to a Carbapenem (Meropenem (2g IVI 6 hourly)) to target C. fetus. The patient showed early improvement after Burr hole drainage of CSDH and antibiotics. The repeat CT scan (taken 4 days after Burr hole drainage) showed a small residual subdural collection with improved mass effect. Previous reports of ISH by C. fetus are also reviewed and summarized. Discussion: The symptoms of ISH are non-specific. Altered mental state, fever and focal neurological (motor) deficits are the three most common symptoms (in adults with ISH) reported in the literature. This case report intends to highlight the importance of maintaining a high clinical index of suspicion for ISH, with rare pathogens such as C. fetus, in at risk or immunocompromised patients presenting to the neurosurgical department with these symptoms. Preceding head trauma should also add to the index of suspicion. Conclusion: A high index of clinical suspicion for ISH and the consideration of rare pathogens in at risk patient populations should encourage good microbiological specimen collection and investigational requests as well as appropriate antimicrobial therapeutic selection. |
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| ISSN: | 1201-9712 |