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


  • 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

Diagnostics - Fever in returning traveler

  • TC – 18,000
  • 75% neutrophils
  • ESR- 30 mm/ 1H
  • MP/ MF – Negative
  • FAT- Negative
  • Urine RE:  3-5 pus cells

Chest X-ray

X-ray - Fever in returning traveler

  • 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.


  • Our hospital microbiologist suspected some endogenous microbes.
  • Sample was sent to veterinary college hospital
  • Culture grown as “Campylobacter fetus subsp. Fetus”

Gram strain - Fever in returning traveler
Selective agar and horse blood agar - Fever in returning traveler

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


Biologic and Clinical Characteristics of Campylobacter jejuni and Campylobacter fetus subsp. Fetus

FeatureCampylobacter jejuniCampylobacter fetus subsp. Fetus
Major reservoirAvian species, food animalCattle and sheep
Affected hostsNormal hosts, all ages: often in clusters of casesOpportunistic agent in debilitated hosts, clustering rare, healthy hosts may be affected
Usual source of infectionFecesBlood stream
Diarrheal IllnessCommonUncommon
Clinical manifestationAcute gastroenteritis, colitisSystemic illness with bacteremia, meningitis, vascular infections, abscesses and gastroenteritis
Outcome of infectionUsually self-limitedMay be fatal in debilitated hosts
Antibiotic SusceptibilityErythromycinGentamicin

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