title: Recurrent bacteremia with Helicobacter cinaedi: case report and review of the literature.
abstract: BACKGROUND
  Helicobacter cinaedi is a rare pathogen in humans, occurring mostly in immuno-compromised patients, with a high potential for recurrence. We describe a case of a patient with lymphoma hospitalized for chemotherapy.
  
  
  METHODS
  At admission, the patient presented with an indolent and non-prurigenic macular rash around her implantable venous access device. Gram staining of blood cultures revealed the presence of spiral-shaped gram-negative rods that could not be grown upon subculture. Helicobacter cinaedi was identified by PCR. No other symptoms or pathology were observed in a whole body CT scan. The implantable venous access device was removed and empiric therapy by ceftriaxone and gentamicin for 2 weeks was initiated, followed by peroral clarithromycin 2 x 500 mg/day and later by levofloxacin 2 x 500 mg/day for 7 weeks. Oncologic remission was achieved 3 months later. However, the patient was re-hospitalized 2 months later for fever, shivering, reappearance of the macular non-prurigenic rash, diarrhea, cough and asthenia. Blood cultures grew H. cinaedi. Multiple investigations could not identify the source. Empiric antibiotic therapy of ceftriaxone and doxycycline was started for 2 weeks with resolution of symptoms, followed by an oral combination of amoxicillin, metronidazole and doxycycline for 2 months; doxycycline was continued for another month. Bacteremia has not recurred for a period of 19 months.
  
  
  CONCLUSIONS
  Although H. cinaedi is considered to be a low virulent bacteria, its potential to cause recurrent bacteremia should not be underestimated. H. cinaedi could have an endovascular source of infection and should be treated for an adequate duration with combined antibiotherapy.
authors.affiliation: Division of Infectious Diseases, Department of Medicine, University Hospital of Geneva, Switzerland. ilker.uckay@hcuge.ch
authors.forename: Ilker
authors.initials: I
authors.lastname: Uçkay
authors.forename: Jorge
authors.initials: J
authors.lastname: Garbino
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Dietrich
authors.forename: Béatrice
authors.initials: B
authors.lastname: Ninet
authors.forename: Peter
authors.initials: P
authors.lastname: Rohner
authors.forename: Véronique
authors.initials: V
authors.lastname: Jacomo
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016470:Bacteremia / Q000175:diagnosis* / Q000188:drug therapy; D004359:Drug Therapy, Combination; D005260:Female; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy; D006801:Humans; D008875:Middle Aged; D012008:Recurrence
chemical_list: D000900:Anti-Bacterial Agents