ACCEPTED: CLINICAL VIGNETTES/CASE REPORTS—SMALL INTESTINE
Acute Gastroenteritis Revealing Helicobacter Bacteremia: How Common Is This?
The Helicobacter genus includes 31 formally described species with Helicobacter pylori (H. pylori) being the most prominent. 4.4 billion individuals worldwide were estimated to be positive for H. pylori. It is the prime cause of chronic gastritis and a prevalent etiological agent for gastric cancer and peptic ulcer disease. This group of helical shaped, gram negative organisms are often associated with gastrointestinal manifestations but only few species are known to cause bacteremia.
A 44 year-old HIV positive male presented with diarrhea, vomiting, abdominal pain and fever. Complete blood count, metabolic panel, serum lactate, and lipase were within normal limits. A gastrointestinal pathogen panel was negative. Computed Tomography of the abdomen with contrast showed fluid filled dilated loops of bowel significant for enteritis. Gram stain was positive for gram negative curved rods, and the patient was discharged home to complete 14 days of azithromycin for presumed Campylobacter bacteremia. After discharge, blood cultures were reported as Helicobacter species. Two days later, patient returned with lower extremity swelling with leucocyte count 30,320 and lactate 2.9. Vancomycin and meropenem were initiated. Subsequent blood cultures again grew Helicobacter species. Esophagogastroduodenoscopy showed esophagitis and diffuse gastric erythema. Random biopsies were taken for cultures and were negative for H. pylori. Chest radiograph, transesophageal echocardiogram and white blood cell - Ceretec scan were all negative for any other source of infection. Patient was discharged on 14 days of meropenem with repeat blood cultures negative.
Helicobacter bacteremia resulting from gastrointestinal and hepatobiliary tract infection remains underestimated. Evidence suggests that translocation of organisms from the GI tract is an important early step in causing bacteremia. Therefore, awareness of methods for diagnosis and treatment of these infections is important, particularly in the evaluation of immunocompromised patients. Research regarding translocation is also worthy of further investigation.© The American College of Gastroenterology 2018. All Rights Reserved.