Except for one study [
4], the incidence of
C.coli bacteremia remains unknown [
5] but seems to be very rare. This is likely due to the susceptibility of this pathogen to the antibacterial activity of the serum [
6]. This could explain why
C.coli bacteremia episodes are often reported in immunocompromised patients or in children [
5,
7-
12]. Only a few studies report bacteremia occurring in immunocompetent patients during acute enteritis [
4,
13]. Therefore, the incidence of
C.coli bacteremia may be underestimated due to infrequent blood sampling at the early stage of infection, and inappropriate culture conditions [
14].
Although bacteremia may be misdiagnosed, aortic aneurysm and spondylodiscitis are more highly visible infections. Nevertheless, no cases of these localizations have been reported for
C.coli. We found only one case of meningitis due to this pathogen, but observed no arthritis, endocarditis, pneumonia or prostatitis. We have no evidence for an associated endocarditis and colonoscopy revealed only a small non-inflammatory polyp. We also did not find any cause of immunosuppression in our patient except for age >65 years. Skirrow et al [
4] found the average incidence of
Campylobacter bacteremia to be 1.5/1,000 intestinal
Campylobacter infections in their total population, and 5.9/1000 in patients aged 65 or over.
A combination of cephalosporin and gentamicin was chosen in an attempt to obtain a synergistic bactericidal effect during the first ten days of treatment. Ciprofloxacin was prescribed as prolonged antibiotic therapy in an attempt to obtain permanent high concentrations at the infected site. Although a 3 months duration of treatment for abdominal aortic aneurysms infected with Campylobacter has been evocated in two cases [
15,
16], considering that an endovascular prosthesis had been inserted in an infected site and the risk of relapsing infection, we considered a life-long antibiotic suppressive therapy as reported for other bacteria [
17,
18]. A prolonged course of ciprofloxacin was then proposed to the patient due to its activity toward foreign body infection due to Gram-negative bacilli, as demonstrated in both experimental and clinical studies [
19-
22].
Concerning the spondylodiscitis, despite some reported studies [
23-
25], as drainage of the prevertebral and left psoas abscesses was done during the first surgical intervention; no specific intervention was then performed.
We believe that the spondylodiscitis was primarily due to C.coli bacteremia, but it is unclear as to whether the aneurysm rupture was secondary to bacteremia or to erosion of the arterial wall by the abscess.
A limitation of our case report is that species identification was made with the API Campy identification system and not by PCR. As previously reported the sensibility of the API Campy test, particularly for identification of
C.coli, is poor [
26-
28]. Despite imperfect specificity of this test, diagnosis of
C.coli was always confirmed by PCR in these studies. In accordance with these data, the possibility of misdiagnosing
Campylobacter species in the present case seems to be very low.
1 Caroline Dehecq,1 Christian Cattoen,2 Laurence Destrieux Garnier,3 Béatrice Sarraz Bournet,4 Yazdan Yazdanpanah,1 and Eric Senneville1
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