A 77-year-old woman was admitted at the end of July 2005 with fever for 4 days up to 39oC with chills but without focal symptoms.
As antecedent, emphasis was placed on the precaution of a nephrotic syndrome diagnosed one year earlier by a type II membranous glomerulopathy treated with prednisone at an initial dose of 50 mg daily and 10 mg since then.
He had also been treated nine months earlier for acute pyelonephritis and then another similar event in June 2005, which did not require hospitalization.
Since that date, the patient received uninterrupted antimicrobial prophylaxis with ciprofloxacin (at doses not specified).
Three months before admission, she had a self-limiting condition of watery diarrhea that did not require medical consultation or medication.
There was no history of pet ownership.
On admission examination, the patient was diagnosed with tachycardia (48 kg BMI 20.2 kg/m2), tachycardia, fever, and no consciousness or focal signs.
Laboratory results showed significant anemia (hemate paste 27.6%, hemoglobin 9.2 gr/dL) and absence of leukocytosis or leukopenia.
Chest X-ray was normal and urine sediment showed leukocyturia (10-12 per microscopic field), without pyocytes, microhematuria or cylinders.
Proteinuria values were low (75 mg/dL and in an estimated form < 1.5 g/day, and renal failure was detected due to lack of albumin sensitivity (creatinine clearance 20 mL/min).
There was no lymphocyte count in stable conditions prior to admission or immunoglobulin count.
The directed anamnesis did not investigate the consumption of somatic foods.
Empirical treatment with intravenous ceftriaxone was started with a progressive improvement of the patient.
Blood cultures taken at admission revealed the presence of curved gram-negative bacilli (growth within 13 hours of noncompliance).
The study was complemented with a paste-bicarbonate dye (Hucker dye).
Simultaneously received the result of the urocultiva that showed Escherichia coli > 105c/mL, multiresistant to ampicillin, amikacin, cephalosporins, quinolones and cotrim
The strain produced the b-lactamase extended spectrum.
The results of these microbiological tests led to an adjustment of the antimicrobial treatment three days after admission, replacing ceftriaxone by sulfonamide/cefoperazone.
Some days later, confirmation of Campylobacter fetus subs. fetus in blood was received from the Instituto de Salud Pública (ISP), a reference laboratory.
In the ISP, a specific staining for flagella visualization confirmed its presence3.
The strain showed oxidase, catalase and nitratase-positive tests, grew in 1% glycine broth (which allowed differentiation from C. fetus subsp. venerealis), developed a negative acetate test for hypoxyura.
In contrast to what has been described for C. jejuni, it was susceptible to cephalothin and resistant to nalidixic acid.
Given the favorable response observed with sulphonamide/cefoperazone, this treatment continued for 14 days and was replaced with amoxicillin/clavulanic acid for another 3 weeks.
We did not take control hemocultives and did not have an in vitro susceptibility study of Campylobacter in our case.
During hospitalization, infective endocarditis was ruled out with transthoracic echocardiography.
The evolution of the patient, after associated abdominal treatment, was favorable until a month of follow-up; however, she had to be readmitted two months later for a clinical picture of decay and pain documented in the hemi-abdomen
The condition had no specific etiologic diagnosis, was not associated with positive blood cultures to Campylobacter sp, there was no positive staining in stools for this agent, nor was it associated with positive detection of Clostridium difficile cytotoxin.
The patient responded favorably to metronidazole sulfonylurea/cefoperazone and was empirically used to suspect infectious colitis initially including pseudomycoses due to C. difficile.
Follow-up echocardiography showed no complications and was performed 3 months later.
In her last follow-up in March 2006, the patient was in good condition, with stable renal failure.
