CME INDIA Case Presentation by Dr. S. Senthilkumaran, M.D, Dip. A&E, FCCM, FIAEM, Head, Department of Emergency & Critical Care Medicine, Manian Medical Centre, Erode.
CME INDIA Case Study
History
- 65 years old male
- Fever associated with chills & rigor
- H/o severe myalgia, cough & chest pain
- Treated by his family physician
- Worsening of his symptoms, he presented to ED
- No h/o abdominal pain, loose stools or burning micturition
- Recent travel to Japan
- After returning from Tokyo, he developed generalized weakness & fever
- Allergies – Not known
- Family history – Non-contributory
- Past history – K/c DM/ SHT
- Medication – OHA & ARBI’s
On Examination
- Conscious, oriented
- Dyspneic, Tachypneic
- Febrile 102 F, Mildly dehydrated
- Chest- B/L Crepts+
- P/A- Soft
- PR: 102/ min
- Bp: 70 / 40 mmHg
- RR: 34/min.
- Spo2: 92% with 15 lits of o2 /NRBM
- TC – 18,000
- 75% neutrophils
- ESR- 30 mm/ 1H
- MP/ MF – Negative
- FAT- Negative
- Urine RE: 3-5 pus cells
Chest X-ray
- CXR- patchy infiltrates at right lower lobe with moderate pleural effusion (outside)
- USG- moderate Right pleural effusion
- Pan culture sent
Clinical Diagnosis:
- Acute febrile illness for evaluation
- Right lower lobe pneumonia
What was done:
- NIV- Bipap
- Rt IJV cannulated
- Noradrenalin & Dobutamine started
- Diagnostic tapping of pleural fluid done – sent for analysis
- Shifted to ICU
Course in ICU
- On NIV – tolerating
- Hemodynamically stable
- Started on Meropenem & Clarithromycin
- Adequate urine out put
- Symptomatically better.
Report
- Our hospital microbiologist suspected some endogenous microbes.
- Sample was sent to veterinary college hospital
- Culture grown as “Campylobacter fetus subsp. Fetus”
History Revisited
- He had eaten traditional Japanese food, esp. Mixed fried rice
- Four of other friends who travelled were also admitted with similar complaints with varying severity.
- All five improved well.
CME INDIA Learning Points
- Rarity
- Many potentially lethal diseases are easily diagnosed and treated
- The first step to making a diagnosis is to think about it
Table
Biologic and Clinical Characteristics of Campylobacter jejuni and Campylobacter fetus subsp. Fetus
| Feature | Campylobacter jejuni | Campylobacter fetus subsp. Fetus |
| Major reservoir | Avian species, food animal | Cattle and sheep |
| Affected hosts | Normal hosts, all ages: often in clusters of cases | Opportunistic agent in debilitated hosts, clustering rare, healthy hosts may be affected |
| Usual source of infection | Feces | Blood stream |
| Diarrheal Illness | Common | Uncommon |
| Clinical manifestation | Acute gastroenteritis, colitis | Systemic illness with bacteremia, meningitis, vascular infections, abscesses and gastroenteritis |
| Outcome of infection | Usually self-limited | May be fatal in debilitated hosts |
| Antibiotic Susceptibility | Erythromycin | Gentamicin |
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