Campylobacter Fetus Meningitis in Adults

The zoonotic pathogen Campylobacter fetus is a rare cause of bacterial meningitis. Little is known about the clinical characteristics, predisposing factors and outcome of C fetus meningitis in adults. We report cases of C fetus meningitis in a nationwide cohort study of adult bacterial meningitis patients in the Netherlands and performed a review of the literature. Two patients with C fetus meningitis were identified from January 2006 through May 2015. The calculated annual incidence was 0.02 per million adults. Combined with the literature, we identified 22 patients with a median age of 48 years. An immunocompromised state was present in 16 patients (73%), mostly due to alcoholism (41%) and diabetes mellitus (27%). The source of infection was identified in 13 out of 19 patients (68%), consisting of regular contact with domestic animals in 5 and working on a farm in 4. Recurrent fever and illness was reported in 4 patients (18%), requiring prolonged antibiotic treatment. Two patients died (9%) and 3 survivors (15%) had neurological sequelae. C fetus is a rare cause of bacterial meningitis and is associated with an immunocompromised state. Based on the apparent slow clinical response seen in this limited number of cases, the authors of this study recommend a prolonged course of antimicrobial therapy when C fetus is identified as a causative agent of bacterial meningitis. Cases appeared to do best with carbapenem therapy. (Medicine 95(8):e2858) Abbreviations: C fetus = Campylobacter fetus, CSF = hijs C. Brouwer, M derik van de Beek, MD, PhD INTRODUCTION B acterial meningitis is a severe infectious disease requiring prompt antibiotic treatment. Most cases are caused by Neisseria meningitidis and Streptococcus pneumoniae, which are both part of the commensal nasopharyngeal flora in humans. Bacterial meningitis is rarely caused by bacteria having their natural reservoir in animals. One of these so-called zoonotic pathogens is Campylobacter fetus (formerly Vibrio fetus, Spirillum serpens), which is part of the commensal flora in the gastro-intestinal tracts of sheep and cattle. C fetus meningitis occurs worldwide, but little is known about its clinical characteristics, predisposing factors and outcome. We report 2 meningitis patients in the Netherlands. Additionally, we performed a review of the literature on C fetus meningitis.