title: Campylobacter jejuni Fatal Sepsis in a Patient with Non-Hodgkin's Lymphoma: Case Report and Literature Review of a Difficult Diagnosis.
abstract: Campylobacter jejuni (C. jejuni) bacteremia is difficult to diagnose in individuals with hematological disorders undergoing chemotherapy. The cause can be attributed to the rarity of this infection, to the variable clinical presentation, and to the partial overlapping symptoms underlying the disease. Here, we report a case of a fatal sepsis caused by C. jejuni in a 76-year-old Caucasian man with non-Hodgkin's lymphoma. After chemotherapeutic treatment, the patient experienced fever associated with severe neutropenia and thrombocytopenia without hemodynamic instability, abdominal pain, and diarrhea. The slow growth of C. jejuni in the blood culture systems and the difficulty in identifying it with conventional biochemical phenotyping methods contributed to the delay of administering a targeted antimicrobial treatment, leading to a fatal outcome. Early recognition and timely intervention are critical for the successful management of C. jejuni infection. Symptoms may be difficult to recognize in immunocompromised patients undergoing chemotherapy. Thus, it is important to increase physician awareness regarding the clinical manifestations of C. jejuni to improve therapeutic efficacy. Moreover, the use of more aggressive empirical antimicrobial treatments with aminoglycosides and/or carbapenems should be considered in immunosuppressed patients, in comparison to those currently indicated in the guidelines for cancer-related infections supporting the use of cephalosporins as monotherapy.
authors.affiliation: Department of Clinical Pathology and Microbiology, San Gallicano Institute, IRCCS, Rome 00144, Italy. gallo@ifo.it.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Gallo
authors.affiliation: Department of Clinical Pathology and Microbiology, San Gallicano Institute, IRCCS, Rome 00144, Italy. e.didomenico@ifo.it.
authors.forename: Enea Gino
authors.initials: EG
authors.lastname: Di Domenico
authors.affiliation: Department of Infectious Disease, San Gallicano Institute, IRCCS, Rome 00144, Italy. toma@ifo.it.
authors.forename: Luigi
authors.initials: L
authors.lastname: Toma
authors.affiliation: Department of Hematology, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy. marchesi.francesco@tiscali.it.
authors.forename: Francesco
authors.initials: F
authors.lastname: Marchesi
authors.affiliation: Intensive Care Medicine, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy. pelagalli@ifo.it.
authors.forename: Lorella
authors.initials: L
authors.lastname: Pelagalli
authors.affiliation: Department of Clinical Pathology and Microbiology, San Gallicano Institute, IRCCS, Rome 00144, Italy. n.manghisi@gmail.com.
authors.forename: Nicola
authors.initials: N
authors.lastname: Manghisi
authors.affiliation: Department of Biology and Biotechnology "Charles Darwin", University of Rome Sapienza, Rome 00185, Italy. fiorentina.ascenzioni@uniroma1.it.
authors.forename: Fiorentina
authors.initials: F
authors.lastname: Ascenzioni
authors.affiliation: Department of Clinical Pathology and Microbiology, San Gallicano Institute, IRCCS, Rome 00144, Italy. prignano@ifo.it.
authors.forename: Grazia
authors.initials: G
authors.lastname: Prignano
authors.affiliation: Department of Hematology, Regina Elena National Cancer Institute IRCCS, Rome 00144, Italy. mengarelli@ifo.it.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mengarelli
authors.affiliation: Department of Clinical Pathology and Microbiology, San Gallicano Institute, IRCCS, Rome 00144, Italy. ensoli@ifo.it.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Ensoli
mesh_terms: D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D002169:Campylobacter Infections / Q000175:diagnosis*; D016123:Campylobacter jejuni / Q000302:isolation & purification*; D042241:Early Diagnosis; D017809:Fatal Outcome; D006801:Humans; D016867:Immunocompromised Host; D008228:Lymphoma, Non-Hodgkin / Q000276:immunology / Q000382:microbiology*; D008297:Male; D018805:Sepsis / Q000209:etiology*; D061665:Time-to-Treatment
chemical_list: D000890:Anti-Infective Agents
keywords: Campylobacter jejuni; chemotherapy; non-Hodgkin’s lymphoma; skin lesion