Campylobacter fetus subsp. fetus

Transcription

1 Campylobacter fetus subsp. fetus 1) 1) 2) 1) 2) Campylobacter fetus subsp. fetus 6 cefotaxime piperacillin meropenem C. fetus subsp. fetus Key words: Campylobacter fetus subsp. fetus, chronic meningitis Campylobacter fetus 1), 2) 3)7) 8), 9) C. fetus subsp. fetus ,896/3/mm piperacillin (PIPC), cefotiam (CTM) 5 1 ( ) 3772 TEL: (Fig. 1) ,500/ml CRP /3/mm (Table 1) cefotaxime (CTX) 4 g/day 2 PIPC 2 Vol. 16 No

2 174 Fig. 1. Clinical course. CTX, cefotaxime; PIPC, piperacillin; MEPM, meropenem; ABPC, ampicillin; PAPM/BP, panipenem/ betamipron Table 1. Laboratory examination Biochemical test Cerebrospinal fluid Na 140 meq/l Cell count 343 /3/mm 3 K 4.3 meq/l Mononuclear 5.2 Cl 101 meq/l Polynuclear 94.8 Ca 9.7 mg/dl Glu 49 mg/dl Cre 0.7 mg/dl TP 67 mg/dl Glu 82 mg/dl Cl meq/l TP 7.3 g/dl Alb 4.4 g/dl ALP 290 IU/l Complete blood count GOT 21 IU/l WBC /ml GPT 24 IU/l RBC /ml LDH 130 IU/l HGB 14.3 g/dl CK 41 IU/l HCT 43.4 CRP 0.1 mg/dl PLT /ml g/day 1 3 meropenem (MEPM) 2 g/day GAM (Fig. 2) mm S (Fig. 3) Campylobacter spp. (Table 2) C. fetus subsp. fetus 2 Vol. 16 No

3 Campylobacter fetus 175 Fig. 2. Gram-negative spiral rods were isolated from GAM semisolid medium. Fig. 3. Colonies of C. fetus subsp. fetus on 5 sheep blood agar (cultured for 3 days). Table 2. Biochemical characteristic of isolated strain Oxidase Growth at: Catalase 25 Hippurate hydrolysis 37 Urease 42 Nitrate reduction H 2 S, lead acetate strip method Inhibited by: Growth in presence of: Nalidixic acid (30 mg/disk) 1 Glycine Cephalothin (30 mg/disk) 3.5 NaCl 16S rdna C. fetus PCR C. fetus subsp. fetus Etest minimum inhibitory concentration (MIC) 5 MuellerHinton ( ) (Table 3) Campylobacter spp. 10) Campylobacter jejuni, Campylobacter coli Campylobacter lari C. fetus C. fetus 1), 2) 3)7) 8), 9) 11) 10) 12) C. fetus 10) Vol. 16 No

4 176 Table 3. Susceptibility of C. fetus subsp. fetus against antibiotics Antibiotics Disk di#usion method Diameter (mm) Etest MIC (mg/ml) Ampicillin Piperacillin Cefotaxime Imipenem Meropenem Erythromycin CTX(32); range: mg/ml CTX(256) ; range: mg/ml C. fetus 6 GAM 2 Campylobacter spp. GAM 42 C. fetus 16S rdna PCR 42 C. fetus 13), 14) C. fetus Clinical and Laboratory Standards Institute (CLSI) Etest CLSI Enterobacteriaceae S, I, R ABPC, CTX, IPM EM PIPC, MEPM PIPC 1 CTX Etest MIC CTX Etest 32 mg/ml CTX (32) MIC 32 mg/ml MIC Etest 256 mg/ml CTX(256) 8.0 mg/ml MIC CTX(32) MIC 3 Tremblay 15) C. fetus Etest 3 CTX Etest 2 Etest MIC Campylobacter spp. C. fetus 10) CTX 4 Vol. 16 No

5 Campylobacter fetus 177 PIPC MEPM ABPC PIPC MIC CTX Etest CTX (256) CTX MEPM 16) pharmacokinetics parameter Time above MIC TAM CTX 4 g 2 MIC 8.0 mg/ml TAM 20.1, MEPM 2 g 4 MIC mg/ml TAM TAM 17) CTX TAM 40 CTX 1 4g 24 CTX 4 g 4 MIC 8.0 mg/ml TAM 35.3 TAM 40 C. fetus CTX C. fetus subsp. fetus S rdna PCR 1) Campylobacter fetus 1 73: ) Campylobacter fetus 1 78: ) Campylobacter fetus 1 58: ) Campylobacter fetus subsp. fetus 2 60: ) Campylobacter fetus 1 47: ) Campylobacter fetus 1 90: ) Campylobacter fetus 1 44: ) Campylobacter fetus 1 31: ) Campylobacter fetus 1 90: ) I: ) Campylobacter fetus 1 40: ) Campylobacter fetus subspecies fetus 2 32: ) G. M. Anstead, J. H. Jorgensen, F. E. Craig, M. J. Blaser, et al Thermophilic multidrugresistant Campylobacter fetus infection with hypersplenism and histiocytic phagocytosis in a patient with acquired immunodeficiency syndrome. Clin. Infect. Dis. 32: ) Campylobacter fetus subsp. fetus 1 12: ) Tremblay, C., C. Gaudreau Antimicrobial susceptibility testing of 59 strains of Campylobacter fetus subsp. fetus. Antimicrob. Agents Chemother. 42: ) Pharmacokinetics/pharmacodynamics parameter MIC time above the MIC Jpn. J. Antibiot. 56: Vol. 16 No

6 178 17) Craig, W. A., Pharmacokinetic/pharmodynamic parameters: Rationale for antibacterial dosin of mice and men. Clin. Infect. Dis. 26: 110. A Case of the Chronic Meningitis Due to Campylobacter fetus subsp. fetus Hirofumi Toda, 1) Kaori Satoh, 1) Itaru Furuta 2) 1) Department of Clinical Laboratory, Kinki University Hospital 2) Department of Laboratory Medicine, Faculty of Medicine, Kinki University We experienced the chronic meningitis caused by Campylobacter fetus subsp. fetus. The cerebrospinal fluid showed monocytic pleocytosis, and C. fetus subsp. fetus was detected by the culture. The isolated strain didn t show indistinct spiral, and was identified as C. fetus subsp. fetus by 16S rdna sequencing. Treatment by cefotaxime and piperacillin was ine#ective, but that by meropenem was e#ective. Our meningitis case caused by C. fetus subsp. fetus presented high level monocytic pleocytosis in cerebrospinal fluid. So it is necessary to detect and promptly identify the causative agent for discriminating between septic and aseptic meningitis. 6 Vol. 16 No