Campylobacter fetus Meningitis in a Patient with Crohnʼs Disease

To the Editor: Campylobacter fetus is an uncommon cause of meningitis in adults. However, Gazaigne et al1 have reported that bloodstream infection with C. fetus should be suspected in elderly patients, immunodeficient patients, and patients with cardiovascular damage. Moreover, the administration of steroids and infliximab is considered to be a risk factor that promotes bacterial infections. Here, we report a case of Crohn's disease (CD) that was complicated with C. fetus meningitis. To our knowledge, this is the first report of meningitis caused by C. fetus in a patient with CD. A 40-year-old man was diagnosed with CD in 1988 and underwent right hemicolectomy and ileectomy in the same year due to perforation of the ileum. In the subsequent 2 decades he was treated with prednisolone (15 mg) and mesalazine (2250 mg). In 2008 he was admitted to another hospital because of massive bloody stool in the absence of any other abdominal symptoms. To treat the bloody stool the patient was medicated with infliximab. His bloody stool disappeared gradually but then reappeared 4 weeks later. Since the patient was in hypovolemic shock and required a blood transfusion, he was referred to our hospital. Initial blood tests performed upon admission revealed white blood cell counts of 14,800/mm3, red blood cell counts of 1.89 × 106/mm3, hemoglobin levels of 4.8 g/dL, and C-reactive protein levels of 1.0 mg/dL. After conservative therapy the patient's condition improved promptly. However, on admission, the patient also had a high fever and a severe headache without neck stiffness. Although antibiotic therapy consisting of 6 g/day piperacillin was started, these symptoms did not improve. A lumbar puncture showed that the cerebrospinal fluid (CSF) had a cell count of 344/3 mm3 with mononuclear and polynuclear pleocytosis, total protein of 33 mg/dL, and glucose of 68 mg/dL. C. fetus was isolated from the CSF, blood, and stool after culture. Consequently, 1 g/day erythromycin was administered. The patient's symptoms then improved promptly. Three separate species of Campylobacter have been identified, namely, C. jejuni, C. coli, and C. fetus.2 While C. jejuni and C. coli are common enteropathogenic organisms, C. fetus is a much less frequently occurring human pathogen.3,C. fetus is a Gram-negative, motile bacterial species that has a characteristic “S-shaped” rod morphology. It is frequently present in the intestinal flora of cattle and sheep and is a cause of spontaneous abortions in cattle and sheep as well as an opportunistic pathogen in humans.4 In humans, particularly immunocompromised patients, pregnant women, and neonates, it has been associated with extraintestinal infections including endocarditis, thrombophlebitis, pneumonia, pleuritis, and arthritis.5,6 Here we report for the first time a case of CD that was complicated with C. fetus meningitis. Moreover, it was extremely rare that C. fetus could be isolated from not only the CSF but also the blood and the stool. It is believed that the ingestion of contaminated raw beef is the route by which humans are infected with C. fetus. However, since our patient had not eaten raw beef before the appearance of bloody stools, the route by which the patient was infected with C. fetus is unclear. It is likely that the long-term treatment of this patient with steroids predisposed him to develop C. fetus-induced meningitis. Moreover, the patient had received 5 mg/kg infliximab by a single intravenous infusion to treat his bloody stools. Infliximab is an antitumor necrosis factor-α (TNF-α) antibody. TNF-α plays a central role in the immune system and it is possible that patients treated with infliximab may be prone to develop various infections such as pulmonary tuberculosis and intraperitoneal abscess. Thus, it may be that the infliximab treatment may have contributed to the onset of meningitis in our patient, although through a single infusion. In summary, while C. fetus infrequently infects humans, immunocompromised patients such as steroid-treated patients with CD may be more vulnerable to infections with this bacterium.