1092 similar to the National Collection of Type Cultures strain 11168 except that it was sensitive to metronidazole; this type is commonly found in patients with acute enteritis. After 5 days’ treatment with erythromycin and a further lapse of a few days another midstream urine on June 30 was sterile. Serum taken 12 days after the patient’s first complaint showed an agglutination titre against a formolised suspension for his own organism of 1 in 160 (weak at 1 in 320). This had fallen to 1 in 10 (weak at 1 in 20) in serum taken 10 weeks after the start of his illness. Campylobacter urinary infections may be being missed: these organisms are not normally sought in urine and unless special search is made they will not be found. We thank Dr M. B. Skirrow, Worcester sistance and advice in this case. The Surgery, Station Approach, Frinton on Sea, Essex
Pathology Laboratory, St. Mary’s Hospital, Colchester, Essex
Royal Infirmary,
for his
JOHN S. DAVIES JOHN B. PENFOLD
SIR,-The association of meningism with enteric infections caused by Salmonella or Shigella is well recognised, but I can find no reports of an association between meningism and Campylobacterjejuni enteritis. I describe here two cases. A 29-year-old postal officer gave an 8 h history of fever, severe occipital headache, photophobia, nausea, and vague lower abdominal pain but with no other bowel symptoms. His wife had had diarrhoea on the previous day. The patient was febrile (38.4°C) with neck stiffness on full flexion, but Kernig’s sign was negative. The rest of the clinical examination was normal. His white cell count was 18.2x 109/1 (81% neutrophils, 17% lymphocytes, 2% monocytes). The cerebrospinal fluid (c.s.F.) was clear, colourless, and under normal pressure, with normal protein 0-3g/1 and glucose 3.8 mmol/1. The c.s.F. contained no white or red cells and stained deposit showed no organisms. Bacterial culture of the c.s.F. was negative but viral studies were not done. Blood cultures set up on admission were also negative. Urine analysis, serum electrolytes, and blood-urea were normal. 2 days after admission he had watery diarrhcea containing blood and mucus, and fxcal culture yielded C. jejuni but no other enteric bacterial, parasitic, or viral pathogens were identified. He made an uneventful recovery with symptomatic treatment. A 7-year-old-boy gave a 12 h history of retro-orbital headache, photophobia, dizziness, nausea, and colicky abdominal pain but with no other bowel symptoms. His 5-year-old brother had had a similar illness on the previous day. The patient was febrile (38.5°C) with slight neck stiffness but Kernig’s sign was negative. The rest of the clinical examination was normal. The white-cell count was 13.7 X 109/1 (89% neutrophils, 9% lymphocytes, 2% monocytes). The c.s.F. was clear, colourless, and under normal pressure with normal protein 0.15 g/1 and glucose 4.0 mmol/1. The c.s.F. contained no white or red cells, stained deposit showed no organisms, and bacterial and viral cultures were negative. Blood cultures and throat swab cultures taken on admission were negative. Urine analysis, serum electrolytes, and blood-urea were normal. 3 days after admission of the patient he passed soft bloodstained fseces from which C. jejuni was isolated. No other enteric bacterial, viral, or parasitic pathogens were identified. He made an uneventful recovery with symptomatic treatment. C. jejuni Krugman, S., Ward, R., Katz, S. Louis, 1977. p. 303.
L. Infectious Diseases of
tal, Liverpool, for permission to report these two cases. Regional Public Health Laboratory, Fazakerley Hospital, Liverpool L9 7AL
Children; St.
E. P. WRIGHT
CAMPYLOBACTER CHOLECYSTITIS
as-
MENINGISM ASSOCIATED WITH CAMPYLOBACTER JEJUNI ENTERITIS
1.
isolated from his brother who also had diarrhoea and also from the family puppy which was apparently healthy. Circumstantial evidence in these two cases suggests a possible association between C. jejuni and meningism. C. jejuni is being increasingly recognised as a cause of acute enteritis as indicated in your editoriaF, and C. jejuni should be considered, in addition to other enteric agents, in patients with meningism. I thank Dr H. E. Parry, infectious diseases unit, Fazakerley Hospi-
was
SIR,- There are few reports of infections caused by campylobacters outside the gastrointestinal tract. We describe here a case of campylobacter cholecystitis. A 52-year-old woman, with no medical history, was admitted to hospital on July 27, 1978, with fever of 10 days’ duration and worsening abdominal pain. On July 15 she had eaten with her family at a restaurant and during the night after this meal indigestion had started with slight fever, continuing the next day with nausea, vomiting, and diarrhoea. Her husband and son had also had diarrhoea, but they recovered spontaneously after 2 days. Our patient, however, remained weak with anorexia. The diarrhcea and abdominal pain increased. Symptomatic therapy was of no help and a relapsing fever developed with peaks of39°C. On admission to hospital, she was in good general condition, but reported 3 kg weight loss. Abdominal palpation revealed a mass in the right hypochondrium. A plain X-ray of the abdomen revealed a large calcified stone in the right hypochondrium. Intravenous pyelography was normal. Intravenous cholangiography revealed a gallbladder abnormality with patent bileducts. Her leucocyte-count was 11 800/ul with 69% neutrophils. Biochemical data were normal except for a rise of , 1 9 lutamyl transpeptidase 54 U/l (normal 4-18) and a total bilirubin of 1.25 mg/dl (normal ≤1.00). Urine examination was normal. An operation for acute empyematous cholecystitis was done on July 28. The gallbladder was hydropic (15 cm on 6 cm) and contained two giant gallstones and a seropurulent fluid. Anatomo-pathological examination confirmed an acute ulcerative recurrence of a chronic cholecystitis. Chloramphenicol 1 g twice daily was administered at the onset of operation and stopped 5 days later. The patient recovered uneventfully. Blood, bile, and stool were cultured. From the bile we isolated, after 5 days culture on thioglycollate broth in pure culture, Campylobacter jejuni. Routine culture of the bile for aerobes and anaerobes was negative. Blood taken on admission remained sterile on culture. Stools cultured by filtration technique3 7 days after surgery (and 2 days after chloramphenicol had been withdrawn) were also positive for C. jejuni. Repeat stool culture, 1 month later, was negative. Formolised suspensions of bacteria were used for detecting agglutinins in patient’s sera. Two sera, one obtained 2 weeks after the beginning of the disease and the other 1 month later, contained specific agglutinins to a titre of 1/1280 against the homologous antigen. The serotype was determined bv hwmagglutination using boiled antigen. When placed in contact with four different hyperimmune rabbit sera to two strains of C. jejuni (Z2 and Ed.) and two C. fetus strains (serotype 0, and O2) the antigens prepared with the strain isolated from the stools and that isolated from bile were agglutinated by antiserum Z2 (titres 1:1024 for both) and not by antisera Ed., 0,
or02’ To
our
knowledge this
is the second
published case’ of cam-
2. Lancet, 1978, ii, 135. 3. Butzler, J P., and others J. Pediat. 1973, 82, 318 4 Schwartz, R , and others.Am.J. Gastroent. 1966,
45, 366