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Premature Labor and Neonatal Sepsis caused by Campylobacter fetus, subsp. fetus -- Ontario

Evidence is growing that Campylobacter fetus, subsp. fetus, causes human abortion and premature labor. A case report follows.

A 900-gram male infant was delivered vaginally in a Toronto, Ontario, Canada, hospital, 5 hours after the spontaneous onset of labor at 26 weeks' gestation. Apgar scores were 1 and 5 at 1 and 5 minutes, respectively. The infant was intubated, given penicillin G (25,000 U), and transferred to the neonatal intensive care unit. On arrival, his temperature was 34.8 C (95 F) rectally; systolic blood pressure, 78; heart rate, 164 beats/minute; and respiratory rate, 48/minute. The infant was lethargic, with moderate respiratory distress. A chest radiograph showed a normal cardiac silhouette, with a bilateral reticular pattern and air bronchograms in both lung fields. The infant was felt to be premature, with neonatal respiratory distress syndrome and sepsis. Ampicillin (100 mg/kg/day) and gentamicin (5 mg/kg/day) were given. A Gram stain of a gastric aspirate revealed numerous curved gram-negative bacilli with an appearance typical of Campylobacter; erythromycin (40 mg/kg/day) was also started. C. fetus, subsp. fetus, was isolated from this aspirate, as well as from blood and stool. Cerebrospinal fluid (CSF) obtained after antibiotics were started was clear, had six red blood cells, 106 white blood cells (55% polymorphonuclear cells), and a glucose of 2.6 mmol/L. No organisms were seen on Gram stain.

The infant steadily improved over the next few days and was extubated after 6 days. He received ampicillin and gentamicin for 3 weeks; erythromycin was discontinued after 1 week.

The infant's mother was a 28-year-old office worker. Her first pregnancy 4 years earlier had been uneventful, and she had carried her infant to term. She had felt well during the current pregnancy until 2 weeks before her premature delivery, when she had fever and chills for 1 day and watery diarrhea for 3 days. No other family members had been ill, and there was no history of contact with family pets or other animals. She had not consumed unpasteurized milk or milk products.

C. fetus, subsp. fetus, was isolated from the mother's vagina and stool 2 days postpartum. The organism was identified by its unique morphology and motility when viewed by phase-contrast microscopy and its biochemical characteristics. Disc diffusion antibiotic susceptibility testing showed that all isolates from both mother and infant were susceptible to ampicillin (10 ug), erythromycin (15 ug), gentamicin (10 ug), and chloramphenicol (30 ug) but resistant to tetracycline (5 ug). CSF culture was negative. Reported in Canada Diseases Weekly Report 1984;10:102-3 by AE Simor, MD, MA Karmali, MD, T Jadavji, MD, Depts of Bacteriology and Pediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada.

Editorial Note

Editorial Note: Within the genus Campylobacter, only C. jejuni, C. coli, and C. fetus, subsp. fetus, are known to be associated with human disease. The former is a major cause of infectious diarrhea (1); the latter typically causes bacteremia and sepsis in the immunocompromised host (2). C. fetus, subsp. fetus, was first recognized nearly 70 years ago as a cause of abortion in animals (3) and was subsequently found responsible for both epidemic and sporadic abortion in cattle and sheep (4-6).

This report adds to the growing body of evidence that C. fetus, subsp. fetus, also causes human abortion or premature labor with septicemia in the neonate (7,8). The incidence of maternal C. fetus, subsp. fetus, infection, leading to feto-placental involvement is not known. However, a greater awareness, earlier diagnosis, and appropriate treatment of this infection in pregnant women may prevent fetal loss.

References

  1. Karmali MA, Fleming PC. Campylobacter enteritis. Can Med Assoc J 1979;120:1525-32.

  2. Bokkenheuser V. Vibrio fetus infection in man. I. Ten new cases and some epidemiologic observations. Am J Epidemiol 1970;91:400-9.

  3. Great Britain. Board of Agriculture and Fisheries. Report of the Departmental Committee appointed by the Board of Agriculture and Fisheries to inquire into epizootic abortion. Part III. Abortion in sheep. McFadyean J, Stockman S. Appendix. 1913:1-29.

  4. Plastridge WN, Williams LF, Petrie D. Vibrionic abortion in cattle. Am J Vet Res 1947;VIII:178-83.

  5. Jensen R, Miller VA, Hammarlund MA, Graham WR. Vibrionic abortion in sheep. I. Transmission and immunity. Am J Vet Res 1957;XVIII:326-9.

  6. Smith T. Etiological relation of spirilla (Vibrio fetus) to bovine abortion. J Exp Med 1919;30:313-23.

  7. Hood M, Todd JM. Vibrio fetus--a cause of human abortion. Am J Obstet Gynecol 1960;80:506-11.

  8. Eden AN. Perinatal mortality caused by Vibrio fetus. Review and analysis. J Pediatr 1966;68:297-304.



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