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
Karmali MA, Fleming PC. Campylobacter enteritis. Can Med
Assoc J
1979;120:1525-32.
Bokkenheuser V. Vibrio fetus infection in man. I. Ten new
cases
and some epidemiologic observations. Am J Epidemiol
1970;91:400-9.
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.
Plastridge WN, Williams LF, Petrie D. Vibrionic abortion in
cattle. Am J Vet Res 1947;VIII:178-83.
Jensen R, Miller VA, Hammarlund MA, Graham WR. Vibrionic
abortion
in sheep. I. Transmission and immunity. Am J Vet Res
1957;XVIII:326-9.
Smith T. Etiological relation of spirilla (Vibrio fetus) to
bovine abortion. J Exp Med 1919;30:313-23.
Hood M, Todd JM. Vibrio fetus--a cause of human abortion. Am
J
Obstet Gynecol 1960;80:506-11.
Eden AN. Perinatal mortality caused by Vibrio fetus. Review
and
analysis. J Pediatr 1966;68:297-304.
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