1050
Correspondence
Acute Pancreatitis Associated with Campy/obaeter jejuni Bacteremia
Correspondence: Dr. Carmen Ezpeleta, Servicio de Microbiologia, Hospital de Basurto. Avda. Montevideo 18.48013. Bilbao. Spain.
Clinical Infectious Diseases 1992;15:1050 © 1992 by The Universityof Chicago. All rights reserved.
1058-4838/92/1506-0022$02.00
became afebrile by the 12th day. A barium enema was performed; diverticula and a filling defect in the sigmoid colon were found. The polypoid lesion was removed via the sigmoidoscope, and the reported finding on histologic examination was villous adenoma with no evidence of malignant degeneration. The serum amylase values, plasma osmolality, and glucose levels returned to normal within the first 10 days of treatment. The stool and urine cultures were negative. She was discharged and continued therapy with insulin at home. We cannot establish a true causal relation between pancreatitis and C.jejuni bacteremia. However, the absence ofother possible causes of pancreatitis and the concomitance of bacteremia suggest a probable causal relation. Acute pancreatitis is one of the extraintestinal infections that are described in reviews of C jejuni infections. Bitkanen et al. [7] reviewed symptoms and epidemiological characteristics of 188 hospitalized patients with C jejuni enteritis. They diagnosed pancreatitis in II of 50 patients whose levels of serum amylase or lipase were determined. They concluded that pancreatitis may occur more often in association with C jejuni infection than was previously believed. We agree with Murphy et al. [8] that pancreatitis is an exceptional manifestation of C jejuni infection. To our knowledge, this is the sixth case report of pancreatitis associated with Campy/abaete, infection in the Englishlanguage literature and the first case involving concomitant bacteremia.
C. Ezpeleta, P. Rojo de Ursua, F. Obregon, F. Goni, and R. Cisterna Sections ofMicrobiology. Gastroenterology. and Endocrinology. Hospital of Basurto. Bilbao. Spain
References I. Penner JL. The genus Campylobacter: a decade of progress. C1in Microbioi Rev 1988;1:157-72. 2. Gallagher P. Ghadwick P, Jones OM. Turner L. Acute pancreatitis associated with campylobacter infection. Br J Surg 1981;68:383. 3. Ponka A. Kosunen TV. Pancreas affection in association with enteritis due to Campylobacter fetus ssp. jejuni. Acta Med Scand 1981; 209:239-40. 4. Bar BM. Van Dam FE. A patient with pancreatitis caused by Campylobacter. Ned Tijdschr Geneeskd 1985; 129:2123-5. 5. de Bois MH. Schoemaker MC, van der WerfSD, Puylaert JB. Pancreatitis associated with Campylobacterjejuni infection: diagnosis by ultrasonography. BMJ 1989;298: 1004. 6. Castilla L. Castro M. Guerrero P. Acute pancreatitis associated with Campylobacter enteritis. Dig Dis Sci 1989;34:96/-2. 7. Bitkanen T. Ponka A, Petterson T. Kosunen TV. Campylobacter enteritis in 188 hospitalized patients. Arch Intern Med 1983; 143:215-9. 8. Murphy S. Beeching NJ. Rogerson SJ, Harries AD. Pancreatitis associated with Salmonella enteritidis. Lancet 1991;338:571.
Downloaded from http://cid.oxfordjournals.org/ at New York University on September 17, 2015
SIR-The genus Campy/abaete, includes 14 recognized species. The species most commonly associated with human disease are Campy/abaete, fetus and Campy/abaete, jejuni. C fetus often produces systemic illness, whereas acute enteritis is the most common presentation of C jejuni infection [I]. Several extraintestinal manifestations of these infections have been reported. There have been infrequent reports of C jejuni infection concurrent with overt clinical pancreatitis [2-6]. We report a case of acute pancreatitis associated with C jejuni bacteremia. An 88-year-old woman was admitted to the hospital with a 2-day history of malaise, sweating, anorexia, polydipsia, nausea without vomiting, and a nonproductive cough. She had a history of hypertensive cardiopathy but not of diabetes or any other known pathology. On admission she was stuporous, her temperature was 38.5°C, and her blood pressure was 140/90 mm Hg. The skin and mucous membranes showed signs of dehydration. On chest examination the cardiac sounds were arrythmic at a rate of 140, and there were diffuse rales in both lungs. Abdominal exploration revealed no abnormalities. Initial laboratory investigations revealed the following values: white blood cells, 17,800 X 109/L (neutrophils, 92%); hemoglobin, 13.9 gldL; platelets, 113 X 109/L; serum glucose, 6.54 giL; serum amylase, 2,990 U/L (normal, 0-220 U/L); Na, 156.4 mEq/L; K, 3.6 mEq/L; and urea, 1.15 giL. The urine glucose determination was positive and that of ketones was negative. Other laboratory data, including aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and "Y-glutamyltransferase values, were normal. A roentgenogram revealed that the thorax was normal. Abdominal ultrasonography showed a normal gall bladder, pancreas, and liver as well as normal bile ducts and kidneys. Blood, urine, and stool samples were submitted for culture. On admission, therapy with insulin, intravenous fluids, nasogastric suction, and a broad-spectrum antibiotic (cefotaxime) was started. On the 3rd day after admission, two blood cultures yielded a curved gram-negative rod that was identified as C jejuni subspecies jejuni by oxidase, catalase, hippuricase, and nitrate reduction tests. It grew at 42°C but not at 25°C and was resistant to cephalothin. Therapy with erythromycin and tobramycin was then started. Her general condition improved and she
CID 1992; 15 (December)
Correspondence
Acute Pancreatitis Associated with Campy/obaeter jejuni Bacteremia
Correspondence: Dr. Carmen Ezpeleta, Servicio de Microbiologia, Hospital de Basurto. Avda. Montevideo 18.48013. Bilbao. Spain.
Clinical Infectious Diseases 1992;15:1050 © 1992 by The Universityof Chicago. All rights reserved.
1058-4838/92/1506-0022$02.00
became afebrile by the 12th day. A barium enema was performed; diverticula and a filling defect in the sigmoid colon were found. The polypoid lesion was removed via the sigmoidoscope, and the reported finding on histologic examination was villous adenoma with no evidence of malignant degeneration. The serum amylase values, plasma osmolality, and glucose levels returned to normal within the first 10 days of treatment. The stool and urine cultures were negative. She was discharged and continued therapy with insulin at home. We cannot establish a true causal relation between pancreatitis and C.jejuni bacteremia. However, the absence ofother possible causes of pancreatitis and the concomitance of bacteremia suggest a probable causal relation. Acute pancreatitis is one of the extraintestinal infections that are described in reviews of C jejuni infections. Bitkanen et al. [7] reviewed symptoms and epidemiological characteristics of 188 hospitalized patients with C jejuni enteritis. They diagnosed pancreatitis in II of 50 patients whose levels of serum amylase or lipase were determined. They concluded that pancreatitis may occur more often in association with C jejuni infection than was previously believed. We agree with Murphy et al. [8] that pancreatitis is an exceptional manifestation of C jejuni infection. To our knowledge, this is the sixth case report of pancreatitis associated with Campy/abaete, infection in the Englishlanguage literature and the first case involving concomitant bacteremia.
C. Ezpeleta, P. Rojo de Ursua, F. Obregon, F. Goni, and R. Cisterna Sections ofMicrobiology. Gastroenterology. and Endocrinology. Hospital of Basurto. Bilbao. Spain
References I. Penner JL. The genus Campylobacter: a decade of progress. C1in Microbioi Rev 1988;1:157-72. 2. Gallagher P. Ghadwick P, Jones OM. Turner L. Acute pancreatitis associated with campylobacter infection. Br J Surg 1981;68:383. 3. Ponka A. Kosunen TV. Pancreas affection in association with enteritis due to Campylobacter fetus ssp. jejuni. Acta Med Scand 1981; 209:239-40. 4. Bar BM. Van Dam FE. A patient with pancreatitis caused by Campylobacter. Ned Tijdschr Geneeskd 1985; 129:2123-5. 5. de Bois MH. Schoemaker MC, van der WerfSD, Puylaert JB. Pancreatitis associated with Campylobacterjejuni infection: diagnosis by ultrasonography. BMJ 1989;298: 1004. 6. Castilla L. Castro M. Guerrero P. Acute pancreatitis associated with Campylobacter enteritis. Dig Dis Sci 1989;34:96/-2. 7. Bitkanen T. Ponka A, Petterson T. Kosunen TV. Campylobacter enteritis in 188 hospitalized patients. Arch Intern Med 1983; 143:215-9. 8. Murphy S. Beeching NJ. Rogerson SJ, Harries AD. Pancreatitis associated with Salmonella enteritidis. Lancet 1991;338:571.
Downloaded from http://cid.oxfordjournals.org/ at New York University on September 17, 2015
SIR-The genus Campy/abaete, includes 14 recognized species. The species most commonly associated with human disease are Campy/abaete, fetus and Campy/abaete, jejuni. C fetus often produces systemic illness, whereas acute enteritis is the most common presentation of C jejuni infection [I]. Several extraintestinal manifestations of these infections have been reported. There have been infrequent reports of C jejuni infection concurrent with overt clinical pancreatitis [2-6]. We report a case of acute pancreatitis associated with C jejuni bacteremia. An 88-year-old woman was admitted to the hospital with a 2-day history of malaise, sweating, anorexia, polydipsia, nausea without vomiting, and a nonproductive cough. She had a history of hypertensive cardiopathy but not of diabetes or any other known pathology. On admission she was stuporous, her temperature was 38.5°C, and her blood pressure was 140/90 mm Hg. The skin and mucous membranes showed signs of dehydration. On chest examination the cardiac sounds were arrythmic at a rate of 140, and there were diffuse rales in both lungs. Abdominal exploration revealed no abnormalities. Initial laboratory investigations revealed the following values: white blood cells, 17,800 X 109/L (neutrophils, 92%); hemoglobin, 13.9 gldL; platelets, 113 X 109/L; serum glucose, 6.54 giL; serum amylase, 2,990 U/L (normal, 0-220 U/L); Na, 156.4 mEq/L; K, 3.6 mEq/L; and urea, 1.15 giL. The urine glucose determination was positive and that of ketones was negative. Other laboratory data, including aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, and "Y-glutamyltransferase values, were normal. A roentgenogram revealed that the thorax was normal. Abdominal ultrasonography showed a normal gall bladder, pancreas, and liver as well as normal bile ducts and kidneys. Blood, urine, and stool samples were submitted for culture. On admission, therapy with insulin, intravenous fluids, nasogastric suction, and a broad-spectrum antibiotic (cefotaxime) was started. On the 3rd day after admission, two blood cultures yielded a curved gram-negative rod that was identified as C jejuni subspecies jejuni by oxidase, catalase, hippuricase, and nitrate reduction tests. It grew at 42°C but not at 25°C and was resistant to cephalothin. Therapy with erythromycin and tobramycin was then started. Her general condition improved and she
CID 1992; 15 (December)
