A 50 year old male initially presented with cold symptoms. He was seen and evaluated at urgent care, with suspicion for bronchitis, but with no improvement with albuterol. Physical exam raised a suspicion for bacterial sinusitis. The patient was treated with amoxicillin/clavulanic acid with little improvement, and he was admitted to the hospital a week later for fever and diarrhea. Blood cultures were obtained. He was initially treated with cefepime prior to the speciation of the culture, and then switched to erythromycin for a 7 day course.
Blood cultures were positive for gram negative curved/spiral rods. Gram stain and colony morphology were consistent with Campylobacter which was confirmed as C. jejuni by MALDI-TOF.
Image 1. Gram stain showing gram negative curved/spiral rods.
C. jejuni are gram negative curved or spiral rods. Campy CVA agar is used for stool cultures because it is selective for Campylobacter and contains cefoperazone, vancomycin, and amphotericin B (CVA) which inhibit normal fecal flora. The media is incubated at 42°C under microaerophilic conditions, supporting the growth of Campylobacter jejuni and C. coli. C. jejuni is thermophilic, with growth on blood agar at 37°C and 42°C. Growth does not occur at 25°C. The colonies on blood agar are non-hemolytic, gray and smooth. Our isolate grew, albeit not happily, on blood and chocolate at 37°C with 5-10% CO2.
Infection is often transmitted by contaminated foods such as undercooked chicken. C. jejuni are most commonly associated with human infections however, C. coli have also been implicated. Guillain-Barre syndrome has been associated with patients following an infection with C. jejuni. It is not known how our patient was exposed. Macrolides are effective treatment modalities for C. jejuni, as well as fluoroquinolones, however, resistance to fluoroquinolones is increasing.
-Mustafa Mohammad, MD is a 3rd year anatomic and clinical pathology resident at the University of Vermont Medical Center.
-Christi Wojewoda, MD, is the Director of Clinical Microbiology at the University of Vermont Medical Center and an Assistant Professor at the University of Vermont.