Campylobacter 감염증과 그 예방

Describe most recent data on manifestations and treatment of intestinal and extra-intestinal manifestations of Campylobacter among immunocompromised patients. Resistance to fluoroquinolones, macrolides, and tetracycline challenge traditional empiric therapies. Recurrent Campylobacter enteritis and bacteremia are associated with hypogammaglobinemia, HIV, transplant-associated immunotherapy, and hematologic malignancies. C. jejuni and C. coli are the most commonly associated Campylobacter species although C. fetus, C. upsaliensis, C. lari, C. curvus, and C. rectus should be considered as potential causative agents of rare extra-intestinal infections. Successful diagnosis and treatment of these cases may require the recognition of the limits of standard diagnostics and the recent emergence of highly resistant strains of Campylobacter, particularly C. coli.

Intestinal and Extra-Intestinal Manifestations of Campylobacter in the Immunocompromised Host

BACKGROUND There are few reports of patients with Campylobacter enteritis after renal transplantation, and only a few case reports of bacteremia have been published. Although antibiotic therapy for 3-5 days has been recommended for immunocompromised patients, the optimal treatment for Campylobacter enteritis after renal transplantation has not been established. This study aimed to clarify the clinical characteristics and treatment outcomes of Campylobacter enteritis after pediatric renal transplantation. METHODS This retrospective study included patients who underwent pediatric renal transplantation and were found to have Campylobacter species in stool cultures between January 2014 and May 2017. RESULTS This study included eight patients who underwent pediatric renal transplantation. The median age at the time of renal transplantation was 14 years, and the median period between transplantation and disease occurrence was 4.6 years. Clinical symptoms were abdominal pain for eight patients, diarrhea for eight patients, fever for seven patients, vomiting for three patients, and headache for three patients. Campylobacter jejuni was isolated from the stool cultures of all patients. The median administration period of antibiotics as initial therapy was 7 days (range, 4-11 days). However, clinical relapse was observed in four patients after completing antibiotic therapy. Patients who experienced clinical relapse required a second course of antibiotic therapy for a median duration of 7 days (range, 5-10 days). CONCLUSIONS Patients with Campylobacter enteritis after pediatric renal transplantation are at high risk for clinical relapse and may require a longer duration of antibiotic therapy than that generally described.

Clinical characteristics of Campylobacter enteritis after pediatric renal transplantation: a retrospective analysis from single center.

Joubert syndrome (JS) is an inherited ciliopathy characterized by a distinctive cerebellar and brain stem malformation which is known as the "molar tooth sign" on axial brain images, hypotonia, and developmental delay. Approximately 25-30% of patients with JS have kidney disease and many of them progress to end-stage kidney disease (ESKD). However, there are few reports on the outcomes of renal replacement therapy (RRT) in patients with JS and ESKD. In this study, we clarified the clinical features, treatment, and outcomes of patients with JS who underwent RRT. We retrospectively analyzed the medical records and clinical characteristics of 11 patients with JS who underwent RRT between June 1994 and July 2019. Data are shown as the median (range). Gene analysis was performed in 8 of the 11 cases, and CEP290 mutations were found in four patients, two had TMEM67 mutations, one had a RPGRIP1L mutation, and one patient showed no mutation with the panel exome analysis. Complications in other organs included hydrocephalus in two cases, retinal degeneration in eight cases, coloboma in one case, liver diseases in four cases, and polydactyly in one case. Peritoneal dialysis (PD) was introduced in seven cases, with a median treatment duration of 5.4 (3.4-10.7) years. Hemodialysis was performed using arteriovenous fistula in two cases, and kidney transplantation was performed 9 times in eight cases. Only one of the grafts failed during the observation period of 25.6 (8.2-134.2) months. The glomerular filtration rate at the final observation was 78.1 (41.4-107.7) mL/min/1.73 m2. The median age at the final observation was 13.4 (5.6-25.1) years, and all patients were alive except one who died of hepatic failure while on PD. Any type of RRT modality can be a treatment option for patients with JS and ESKD.

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Yoko Takagi

Papers

Clinical characteristics of Campylobacter enteritis after pediatric renal transplantation: a retrospective analysis from single center.

Any modality of renal replacement therapy can be a treatment option for Joubert syndrome.