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Campylobacter cholecystitis.
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MedLine Citation:
PMID:  19960123     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
There are 13 cases of campylobacter cholecystitis reported so far in the medical literature. Among them, only 4 patients had diarrhea. We report another case of acalculous cholecystitis in a setting of campylobacter enteritis. The case report is followed by a literature review regarding this rare condition.
Authors:
Deepak Udayakumar; Mohammed Sanaullah
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2009-12-01
Journal Detail:
Title:  International journal of medical sciences     Volume:  6     ISSN:  1449-1907     ISO Abbreviation:  Int J Med Sci     Publication Date:  2009  
Date Detail:
Created Date:  2009-12-04     Completed Date:  2010-02-25     Revised Date:  2013-05-29    
Medline Journal Info:
Nlm Unique ID:  101213954     Medline TA:  Int J Med Sci     Country:  Australia    
Other Details:
Languages:  eng     Pagination:  374-5     Citation Subset:  IM    
Affiliation:
Department of Internal Medicine, University of North Dakota, Fargo, ND 58102, USA. dudayakumar@medicine.nodak.edu
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MeSH Terms
Descriptor/Qualifier:
Acalculous Cholecystitis / diagnosis*,  drug therapy,  microbiology*
Adult
Anti-Bacterial Agents / pharmacology,  therapeutic use
Campylobacter / drug effects,  isolation & purification*
Campylobacter Infections / diagnosis*,  drug therapy,  microbiology*
Erythromycin / pharmacology,  therapeutic use
Female
Humans
Microbial Sensitivity Tests
Treatment Outcome
Chemical
Reg. No./Substance:
0/Anti-Bacterial Agents; 114-07-8/Erythromycin
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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Journal Information
Journal ID (nlm-ta): Int J Med Sci
Journal ID (publisher-id): ijms
ISSN: 1449-1907
Publisher: Ivyspring International Publisher, Sydney
Article Information
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© Ivyspring International Publisher. This is an open-access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited.
Received Day: 18 Month: 8 Year: 2009
Accepted Day: 23 Month: 11 Year: 2009
collection publication date: Year: 2009
Electronic publication date: Day: 1 Month: 12 Year: 2009
Volume: 6 Issue: 6
First Page: 374 Last Page: 375
ID: 2786993
PubMed Id: 19960123
Publisher Id: ijmsv06p0374

Campylobacter cholecystitis
Deepak Udayakumar1
Mohammed Sanaullah2
1. Resident Physician, Department of Internal Medicine, University of North Dakota, Fargo, ND 58102, USA
2. Attending Physician, Department of Internal Medicine, Meritcare Hospital, 801 Broadway N, Fargo ND 58102, USA
Correspondence: ✉ Correspondence to: Deepak Udayakumar M.D., Department of Internal Medicine, University of North Dakota, 1919 Elm Street North, Fargo, ND 58102. Tel/Mobile: 701 540 3669. Email: dudayakumar@medicine.nodak.edu
[conflict] Conflict of Interest: The authors have declared that no conflict of interest exists.

Case

A 35-year-old healthy lady presented with high grade fever, severe abdominal pain, nausea, vomiting and profuse watery diarrhea, sometimes green in color. There was no history of animal contact, recent travel or camping. On exam, the patient was hypotensive and was looking acutely ill. Initial labs showed leukocytosis of 11900 with 39% bands. She also had hypokalemia of 3.3 mmol/L, acute kidney injury with elevated creatinine of 1.6 mg/dl from a baseline of 0.6 secondary to dehydration. She was resuscitated with IV fluids, started on empirical Ciprofloxacin and Metronidazole. The patient continued to have abdominal pain. Murphy's sign was positive which prompted us to do a right upper quadrant ultrasound which showed thickened gall bladder wall of upto 1cm consistent with cholecystitis. Stool culture grew campylobacter sensitive to erythromycin. Ciprofloxacin and Metronidazole were changed to Erythromycin and she also underwent a laparoscopic cholecystectomy. The pathology report confirmed acalculous cholecystitis. No sludge was noted. Patient started feeling better after the surgery and was discharged home. During the post-hospitalization follow-up after 2 weeks the patient was asymptomatic except for occasional loose stools.


Discussion

Campylobacter is a small, slender, gram-negative curved rod, which is one of the most common causes of enteritis in humans. Campylobacter fetus may have some attraction towards the gallbladder as in a survey, 20% of slaughtered 700 cattle and sheep harbored this bug in their gallbladder.1

Campylobacter can cause cholecystitis without diarrhea unlike the case that we report here. Please see the table for clinical presentations of the reported cases of campylobacter cholecystitis. The diagnosis of campylobacter cholecystitis is usually missed because culture of campylobacter is not routinely requested after cholecystectomy. However, even if the bile is cultured, campylobacter appears to be a less common cause of cholecystitis. Darling et al cultured about 280 bile samples post cholecystectomy for campylobacter. But none of them grew campylobacter.2 Hence routine ordering of bile culture under microaerophilic condition is not recommended unless the Gram stain shows gram negative curved rods. 3 Resistance of Campylobacter fetus to cephalosporins and penicillins was reported as early as 1986.4 Majority of the reported cases including our patient had good outcome with cholecystectomy and antibiotics especially erythromycin (see Table 1). Only one of the reported cases died, however she had advanced hepatocellular carcinoma.3 There is one case report of relapse of campylobacter bacteremia in a AIDS patient in about 8 months after the first episode of campylobacter cholecystitis.1 In conclusion, campylobacter cholecystitis is rare but should be kept in the back of the mind while treating a patient with campylobacter enteritis.


References
1. Costel EE,Wheeler AP,Gregg CR,Campylobacter fetus ssp fetus cholecystitis and relapsing bacteremia in a patient with acquired immunodeficiency syndromeSouth Med JYear: 1984779279286377511
2. Darling WM,Peel RN,Skirrow MB,Mulira JL,Campylobacter CholecystitisLancetYear: 197916130287770
3. Takatsu M,Ichiyama S,Toshi N,et al. Campylobacter fetus subsp. fetus cholecystitis in a patient with advanced hepatocellular carcinomaScand J Infect DisYear: 1997291971989181660
4. Verbruggen P,Creve U,Hubens A,Verhaegu J,Campylobacter fetus as a cause of acute cholecystitisBr J SurgYear: 198673463947876

Article Categories:
  • Case Report

Keywords: Campylobacter cholecystitis, Extra-intestinal manifestations of campylobacter, cholecystitis, campylobacter.

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