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Indian Pediatr 2014;51: 505 |
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Campylobacter Jejuni Gastroenteritis
Complicated by Pancytopenia
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Birendra Rai and *Raja Ray
Department of Pediatrics, Midland Regional Hospital,
Mullingar, Ireland; and
* IPGMER, Kolkata, India.
Email: [email protected]
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We report a nine-month-old boy who was admitted with vomiting, diarrhea
and mild fever for 3 days, with one bout of passage of scanty
blood-mixed stool prior to admission. Stool culture grew
Campylobacter jejuni, and he was discharged after 40 hours of
intravenous and oral rehydration. Initial blood tests revealed
hemoglobin of 10.7 g/dL; white cell counts 8.5×10
3/µL;
and platelets 240×103/µL.
Urea and electrolytes were normal.
He returned to pediatric emergency after five days of
discharge with history of letharginess and progressive pallor. There was
no history of further bleeding from any site or any drug intake. He was
pale on examination. Repeat blood counts revealed hemoglobin of 7 g/dL,
total leucocyte count of 3.12×10 3/µL,
platelet count of 40×103/µL,
and reticulocyte Index of 3.5%. Peripheral blood smear showed normocytic
normochromic anemia with no evidence of blast cells. Lactate
dehydrogenase, autoimmune profile, liver function tests, and vitamin B12
and folate levels were normal. Ultrasound of the abdomen, and chest
X-ray were normal. Bone marrow was hypercellular with erythroid
hyperplasia and few megakaryocytes; cytogenetic profile was normal. He
received one unit of red cell transfusion and expectant management were
followed. Blood cell counts fully normalized after five weeks of
conservative management. He is doing well at one year follow-up.
C. jejuni presents with self-limited diarrhea,
vomiting, abdominal pain and mild fever, usually resolving in a week.
Gastrointestinal bleeding, pancreatitis, meningitis, demyelinating
encephalomyelitis, Guillain Barre Syndrome, endocarditis, osteomyelitis
and arthritis have been reported to occur following campylobacter
infections [1]. Various viral and some bacterial infections have been
reported in past to cause transient pancytopenia due to activation of T
cell mechanisms [2,3]. The invasive potential of campylobacter may lead
to major systemic complications, usually in immunocompromised patients
or in patients at extremes of ages [4,5]. Though our patient was not
immunocompromised but relative immune non-competitiveness is always a
possibility in a very young infant. We pursued conservative management
after a single red cell transfusion as bone marrow regeneration process
reinstated normal full blood counts in five weeks.
We conclude that C. jejuni infection can cause
systemic complications, including pancytopenia, in young infants, and
clinicians need to be aware of this possibility.
References
1. Allos BM. Campylobacter jejuni infections: update
on emerging issues and trends. Clin Infect Dis. 2001;32:
1201-6.
2. Wu J, Cheng YF, Zhang LP, Liu GL, Lu AD, Jia
YP, Wang B. Clinical features and etiological spectrum in children with
pancytopenia. Zhongguo Dang Dai Er Ke Za Zhi.2011;13: 718-21.
3. Makheja KD, Maheshwari BK, Arain S, Kumar S,
Kumari S, Vikash. The common causes leading to pancytopenia in patients
presenting to tertiary care hospital. Pak J Med Sci. 2013;29:1108-11.
4. Nielsen H, Hansen KK, Gradel KO, Kristensen B, Ejlertsen
T, Østergaard C, et al. Bacteraemia as a result of Campylobacter
species: a population-based study of epidemiology and clinical risk
factors. Clin Microbiol Infect. 2010;16:57-61.
5. Pacanowski J, Lalande V, Lacombe K, Boudraa C,
Lesprit P, Legrand P, et al. CAMPYL Study Group. Campylobacter bacteremia:
clinical features and factors associated with fatal outcome. Clin Infect
Dis. 2008;47:790-6.
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