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Campylobacter jejuni isolated from a chest wall abscess
Case Report
or S-shaped gram-negative bacteria were seen in the Gram stain. Subsequent biochemical identification tests were incubated at 37 °C for 48 hr in a gas mixture of 507o O,, 10070 CO2, and 850/0 N2. Susceptibility o f the strain was determined by the Kirby-Bauer agar-diffusion method, but the agar used was Oxoid CM 271 and was supplemented with 7°70lysed sheep blood. The test was incubated under the microaerophilic conditions mentioned. Catalase was formed, and the oxidase reaction was positive. Nitrates were reduced to nitrites. No carbohydrates were fermented. Indole and urease tests were negative. These characteristics identified the organism as a species of the genus Campylobacter. The positive catalase excluded identification o f the isolate as the catalase-negative Campylobacter sputorum. The organism grew at 43 °C but not at 25 °C, eliminating the possibility o f identifying the isolate as Campylobaeterfetus (Table 1). Susceptibility to nalidixic acid (30 lag disk) precluded the nalidixic-acid-resistant Campylobacter spp. Because the bacteria were able to form glycine by hydrolysis o f hippurate, the strain was identified as Campylobacter jejuni. Strains not able to produce H~S in iron medium (such as this one) have been described as biotype 1 (3). The identification was confirmed by Dr. M. B. Skirrow (C. jejuni, biotype 1)'. The serogroup was determined as Penner serogroup 1 (Manchester serogroup 6) by Dr. John Abbott. Strains belonging to this
Campylobacter jejuni Isolated f r o m a Chest Wall Abscess Harry L. Muytjens, M.D.
Department of Medical Microbiology and Jaap Hoogenhout,/(/I.D.
Department of Radiotherapy St. Radboud Academic Hospital N(imegen The Netherlands
A 72-year-old patient was seen in the radiotherapy follow-up clinic complaining of fever (39 °C) and chest pain on deep inspiration that had continued for several days. She had no diarrhea, nor had anyone else in her family. Six months previously, she had undergone a left radical mastectomy for an infiltrative duct carcinoma, followed by postoperative irradiation o f the parasternal lymph nodes. Physical examination revealed red, tender skin on the chest wall around the mastectomy scar and a fluctuant swelling. Erythrocyte sedimentation rate was 109 m m / h r , and the white blood count was 9,000/mm ~ with 80% neutrophils, 14070 lymphocytes, and 6o70 monocytes. A needle aspiration was performed and 50 ml of a serosanguineous fluid was obtained and sent to the laboratory for bacteriologic examination. Direct examination of a Gram-stained film showed many erythrocytes and neutrophils, but no microorganisms were seen. A blood agar plate inoculated with the specimen revealed moderate growth o f an organism after 3 days incubation at 37 °C in a candle jar. Spiral
serogroup are common. The isolate was susceptible to erythromycin, tetracycline, and gentamicin, but resistant to ampicillin and cephalothin. Although amoxicillin (0.375 g orally four times daily) was given for 10 days, it seems unlikely that it influenced the outcome to a great extent since the strain was resistant to amoxicillin in vitro. The patient's temperature became normal 3 days later, although 40 ml of serosanguineous fluid was aspirated again. Four days after the second aspiration, the erythema disappeared. For the third time, 20 ml o f serosanguineous fluid was removed. The infection fully subsided after 19 days. The isolation o f C. jejuni outside the gastrointestinal tract is uncommon: blood cultures can be positive; cholecystitis (2), meningitis (4), and urinary tract (1) infection due to C. jejuni have been described. Since no publication describing the isolation of C. jejuni from a chest wall abscess is known to us, we think that clinical microbiologists should be aware o f this possibility.
References 1. Davies, J. S., and J. B. Penfold.
1979. Campylobacter urinary infection. Lancet i:1091-I092. 2. Mertens, A., and M. De Smet. 1979. Campylobacter eholecystitis. Lancet i:1092-1093. 3. Skirrow, M. B., and J. Benjamin.
1980. Differentiation of enteropathogenic campylobacter. J. Clin. Pathol. 33:1122. 4. Thomas, K., K. N. Chan, and C.
D. Ribeiro. 1980. Campylobacter jejuni/coli meningitis in a neonate. Br. Med. J. 280:1301-1302.
Table 1
Characteristics of Catalase-Positive Campylobacter spp. "Nalidixic-acid-resistant
Growth at 25'~C Growth at 43 '~2 Susceptibility to nalidixic acid Hippurate hydrolysis
166
C. fetus
C. jejuni
C. c o i l
Campylobacter. ""
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ClinicalMicrobiologyNewsletter
or S-shaped gram-negative bacteria were seen in the Gram stain. Subsequent biochemical identification tests were incubated at 37 °C for 48 hr in a gas mixture of 507o O,, 10070 CO2, and 850/0 N2. Susceptibility o f the strain was determined by the Kirby-Bauer agar-diffusion method, but the agar used was Oxoid CM 271 and was supplemented with 7°70lysed sheep blood. The test was incubated under the microaerophilic conditions mentioned. Catalase was formed, and the oxidase reaction was positive. Nitrates were reduced to nitrites. No carbohydrates were fermented. Indole and urease tests were negative. These characteristics identified the organism as a species of the genus Campylobacter. The positive catalase excluded identification o f the isolate as the catalase-negative Campylobacter sputorum. The organism grew at 43 °C but not at 25 °C, eliminating the possibility o f identifying the isolate as Campylobaeterfetus (Table 1). Susceptibility to nalidixic acid (30 lag disk) precluded the nalidixic-acid-resistant Campylobacter spp. Because the bacteria were able to form glycine by hydrolysis o f hippurate, the strain was identified as Campylobacter jejuni. Strains not able to produce H~S in iron medium (such as this one) have been described as biotype 1 (3). The identification was confirmed by Dr. M. B. Skirrow (C. jejuni, biotype 1)'. The serogroup was determined as Penner serogroup 1 (Manchester serogroup 6) by Dr. John Abbott. Strains belonging to this
Campylobacter jejuni Isolated f r o m a Chest Wall Abscess Harry L. Muytjens, M.D.
Department of Medical Microbiology and Jaap Hoogenhout,/(/I.D.
Department of Radiotherapy St. Radboud Academic Hospital N(imegen The Netherlands
A 72-year-old patient was seen in the radiotherapy follow-up clinic complaining of fever (39 °C) and chest pain on deep inspiration that had continued for several days. She had no diarrhea, nor had anyone else in her family. Six months previously, she had undergone a left radical mastectomy for an infiltrative duct carcinoma, followed by postoperative irradiation o f the parasternal lymph nodes. Physical examination revealed red, tender skin on the chest wall around the mastectomy scar and a fluctuant swelling. Erythrocyte sedimentation rate was 109 m m / h r , and the white blood count was 9,000/mm ~ with 80% neutrophils, 14070 lymphocytes, and 6o70 monocytes. A needle aspiration was performed and 50 ml of a serosanguineous fluid was obtained and sent to the laboratory for bacteriologic examination. Direct examination of a Gram-stained film showed many erythrocytes and neutrophils, but no microorganisms were seen. A blood agar plate inoculated with the specimen revealed moderate growth o f an organism after 3 days incubation at 37 °C in a candle jar. Spiral
serogroup are common. The isolate was susceptible to erythromycin, tetracycline, and gentamicin, but resistant to ampicillin and cephalothin. Although amoxicillin (0.375 g orally four times daily) was given for 10 days, it seems unlikely that it influenced the outcome to a great extent since the strain was resistant to amoxicillin in vitro. The patient's temperature became normal 3 days later, although 40 ml of serosanguineous fluid was aspirated again. Four days after the second aspiration, the erythema disappeared. For the third time, 20 ml o f serosanguineous fluid was removed. The infection fully subsided after 19 days. The isolation o f C. jejuni outside the gastrointestinal tract is uncommon: blood cultures can be positive; cholecystitis (2), meningitis (4), and urinary tract (1) infection due to C. jejuni have been described. Since no publication describing the isolation of C. jejuni from a chest wall abscess is known to us, we think that clinical microbiologists should be aware o f this possibility.
References 1. Davies, J. S., and J. B. Penfold.
1979. Campylobacter urinary infection. Lancet i:1091-I092. 2. Mertens, A., and M. De Smet. 1979. Campylobacter eholecystitis. Lancet i:1092-1093. 3. Skirrow, M. B., and J. Benjamin.
1980. Differentiation of enteropathogenic campylobacter. J. Clin. Pathol. 33:1122. 4. Thomas, K., K. N. Chan, and C.
D. Ribeiro. 1980. Campylobacter jejuni/coli meningitis in a neonate. Br. Med. J. 280:1301-1302.
Table 1
Characteristics of Catalase-Positive Campylobacter spp. "Nalidixic-acid-resistant
Growth at 25'~C Growth at 43 '~2 Susceptibility to nalidixic acid Hippurate hydrolysis
166
C. fetus
C. jejuni
C. c o i l
Campylobacter. ""
+ -
+ + +
+ + -
+ -
ClinicalMicrobiologyNewsletter