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Helicobacter Pylori Bacteremia: an Unusual Finding

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Helicobacter Pylori Bacteremia: an Unusual Finding Infectious Disease Reports 2016; volume 8:6612 Helicobacter pylori bacteremia: Case Report Correspondence: Concetta De Luca, Analysis an unusual finding Laboratory, IRCCS Humanitas Research Hospital, The patient was a 68-year-old woman with Via Manzoni 56, 20089 Rozzano (MI), Italy. 1 2 Concetta De Luca, Annalisa Mancin, ulcerated antral gastric cancer. She was admit- E-mail: [email protected] 1 1 Maria Calabrò, Cristina Daleno, ted to the surgical unit of Humanitas Antonella Ferrario,1 Raffaella Renzulli,1 Gavazzeni Hospital in preparation of surgery Key words: Helicobacter pylori; Bacteremia; Stomach surgery. Cristina Scuderi,1 Erminia Casari1 in September 2015. She had no significant 1Microbiology Section, Analysis medical history except for cholecystectomy, Contributions: the authors contributed equally. Laboratory, IRCCS Humanitas Research right saphenectomy and surgical intervention Hospital, Rozzano; 2Department of for bilateral otosclerosis. Medical examination Conflict of interest: the authors contributed General Surgery, Humanitas Gavazzeni at presentation indicates pale skin and moder- equally. ate epigastric tenderness. The abdominal com- Research Hospital, Bergamo, Italy puted tomography (CT) revealed a well-known Received for publication: 20 May 2016. pathological thickening of the gastric antrum Revision received: 11 August 2016. and adenopathy. The laboratory tests showed Accepted for publication: 29 August 2016. carcinoembryonic antigen (CEA) levels of 61.3 This work is licensed under a Creative Commons Abstract ng/mL. On day 2, the patient underwent a Attribution-NonCommercial 4.0 International laparoscopy and subtotal gastrectomy with License (CC BY-NC 4.0). We report a case of Helicobacter pylori tran- lymphadenectomy, intravenous cefazolin was sient bacteremia in a woman with ulcerated administrated at the time of induction of anes- ©Copyright C. De Luca et al., 2016 antral gastric cancer. The patient was hospital- thesia and for four days postoperatively. After Licensee PAGEPress, Italy ized for laparoscopy and subtotal gastrectomy. surgery, on day 8, she developed fever (39°C) Infectious Disease Reports 2016; 8:6612 After surgery she developed fever (39°C) and and elevated C-reactive Protein (CRP=6.00 doi:10.4081/idr.2016.6612 was empirically treated with levofloxacin. mg/dL). Three sets of blood cultures (six bot- Blood cultures, collected and sent immediately tles) were immediately collected and sent to only to Laboratory, were positive for a spiral Gram- our laboratory, and empiric intravenous antibi- negative bacterium. This isolate was identified otic therapy was started (Levofloxacin 500 mg Discussion as H. pylori and the specific susceptibility test ×2). After one day of incubation, only one was performed. One day after the fever was anaerobic bottle (Bactec anaerobic/F, BectonuseThe culture and rapid identification of H. decreased but antibiotic treatment with lev- Dickinson, Sparks, MD, USA) became positive. pylori in blood cultures are still difficult.3-5 In our ofloxacin was continued and it was maintained Gram staining showed the presence of a spiral case the organism grew in only one anaerobic until discharge. In summary, H. pylori tran- Gram-negative bacterium. We immediately bottle after 24 h while in the previously reported sient bacteremia may occur as a rare complica- alerted the clinician and, based on the case aerobic blood culture was positive after 4-6 tion after stomach surgery. Further studies are patient’s clinical history, we supposed that the days of incubation.4,5 This might be correlate to necessary to elucidate the potential role of organism was H. pylori. Subculture of this the microaerophilic nature of H. pylori. Helicobacter pylori presence in blood. organism was unsuccessful in sheep blood Furthermore it is difficult to obtain the H. pylori agar (Becton Dickinson), chocolate agar colonies on agar. In the previous cases the (Becton Dickinson), Campylobacter agar organism grew under microaerophilic condi- (Becton Dickinson) and Mac Conkey agar tions with Becton Dickinson Campy Pak Plus Introduction (Becton Dickinson) under aerobic and microaerophiliccommercial incubation conditions. and on a brucella agar plate with 5% sheep blood, hemin and vitamin K.3,4 Regarding the Helicobacter pylori is a microaerophilic Subsequently the blood culture was inoculated fastidious human pathogen. It plays a key role onto Schaedler agar (Becton Dickinson) in identification of the bacterium it is interesting in the pathogenesis of peptic ulcer disease, anaerobic environment and after 48 h a single to note that the amplification of 16S rRNA has and is associated with gastric carcinoma and type of colonies with characteristic morpholo- been utilizing as an alternative choice to bio- 4 gastric mucosa-associated lymphoidNon tissue gy was obtained. The isolate was identified as chemical identification test. lymphoma. There are some clinical reports H. pylori by MALDI-TOF (Bruker Daltonics, Several factors are known to determine regarding bacteremia caused by Helicobacter Germany). Susceptibility testing was per- translocation of microbe across gastrointesti- spp.1,2 H. pylori bacteremia has been formed with Etest® (bioMérieux, Marcy nal barrier. H. pylori can affect the ecology of described for the first time by Ndawula et al.3 l’Etoile, France) and elaborated with EUCAST gastrointestinal microflora leading to bacteri- in a 83-year-old woman with malignant lym- criteria. For the susceptibility test , H. pylori al overgrowth and physical disruption of phoma and without symptoms or signs sug- was inoculated in Mueller Hinton agar supple- intestinal mucosal barrier. These effects may gestive of peptic ulcer. Another case report of mented with defibrinated horse blood and - contribute to invasion of the bloodstream by H. pylori bacteremia has been reported by NAD (Becton Dickinson) and incubated for the bacterium.6 Unfortunately, in this case, H. Han et al. in a 65-year-old woman with a his- 48h in microaerophilic condition. The isolate pylori presence in stomach before or after tory of gastric bleeding, breast cancer, anti- was found to be sensitive to amoxicillin/amox- surgery was not investigated. Previous study neoplastic chemotherapy, and prednisone icillin-clavulanate, clarithromycin, lev- reported that gastrectomy is accompanied by use.4 Recently, Dutasta et al. reported a case ofloxacin, metronidazole and tetracycline. the greatest risk (50%) for bacterial translo- of community-acquired colitis associated with Based on the susceptibility test results and cation among a great variety of intra-abdomi- bacteremia caused by H. trogontum in an because the patient’s conditions improved nal operations.7 Therefore we can speculate immunocompetent patient.5 We report a case immediately, antibiotic treatment with lev- that our case of bacteremia may occur as a of bacteremia caused by H. pylori after stom- ofloxacin was continued and was maintained result of bacterial translocation during stom- ach surgery for subtotal gastrectomy. until discharge. ach surgery. [page 74] [Infectious Disease Reports 2016; 8:6612] Case Report Our patient developed fever (39°C) on day 8, gastric infection,4 ulceration of the epithelium 3. Ndawula EM, Owen RJ, el al. Helicobacter this might probably be related to the use of of the upper gastro-intestinal tract,3 from ani- pylori bacteremia. Eur J Clin Microbiol intravenous cefazolin at the time of induction mals to humans and after stomach surgery.5 It Infect Dis 1994;13:621 of anesthesia and for four days postoperatively. is helpful that clinical laboratories are aware 4. Han XY, Tarrand JT, Dickey BF, Esteva FJ. Than the improper choice of maintain intra- of the cultivation methods and identification Helicobacter pylori bacteremia with sepsis venous cefazolin postoperatively, in this partic- methods for this highly fastidious organism. syndrome. J Clin Microbiol 2010;48:4661-3. ular case, contained H. pylori bacteremia. In Further studies are necessary to elucidate the 5. Dutasta F, Samaha E, Carayol N, et al. effect cefazolin was not tested but susceptibil- potential role of H. pylori presence in blood. Acute colitis caused by Helicobacter tro- ity can be inferred from amoxicillin-clavulanic gontum in immunocompetent patient. acid (0.032 µg/mL). Despite the transient Emerg Infect Dis 2016;22:335-6. nature of bacteremia, the presence of H. pylori 6. Huang Y, Fan XG, Tang ZS, et al. Detection in the stomach of our patient would still References of Helicobacter pylori DNA in peripheral require specific treatment for eradication. blood from patients with peptic ulcer or 1. Lasry S, Simon J, Marais A, et al. gastric. APMIS 2006;114:851-6. Helicobacter cinaedi septic arthritis and 7. Koratzanis G, Giamarellos-Bourboulis EJ, bacteremia in an immunocompetent Papalambros E, Giamarellou H. Bacterial Conclusions patient. Clin Infect Dis 2000;31:201-2. traslocation following intrabdominal sur- 2. Tee W, Jenney A, McPhee A, et al. gery. Any influence of anitimicrobial pro- H. pylori bacteremia may occur as a rare Helicobacter rappini isolates from 2 homo- phylaxis. Int J Antimicrob Agents 2002; complication in patients with undiagnosed sexual men. Clin Infect Dis 2001;33:e8-11. 20:457-60. only use commercial Non [Infectious Disease Reports 2016; 8:6612] [page 75].
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