Table 1.
Clinical and bacteriological features, CSF characteristics, treatments, and outcomes of C. fetus meningitis cases reported in the literaturea
| Case no. (reference) | Sex/age (yr) | Underlying condition(s) | Clinical course | Bacteriology | CSF result(s) | Echocardiography | Treatment | Outcome |
|---|---|---|---|---|---|---|---|---|
| 1 (15) | M/47 | Chronic alcoholism | Fever, neck stiffness, diarrhea | C. fetus (Vibrio fetus) in CSF and BC | 2,128 WBC/μl; 80% N; P, 1.52 g/liter; G, 0.24 g/liter | No | PEN, TET | Cured |
| 2 (16) | M/55 | Chronic lymphocytic leukemia | Fever, neck stiffness, distal paresthesia, arthromyalgia | C. fetus subsp. fetus in CSF and BC | 240 N/μl | No | PEN, TET | Cured |
| 3 (17) | F/48 | Rheumatic fever | Fever, pericarditis, neck stiffness, hemiparesis | C. fetus (Vibrio fetus) in BC | 1,399 WBC/μl; 89% N | No | PEN, CHL | Cured |
| 4 (18) | M/50 | Diabetes mellitus | Fever, headache, diarrhea | C. fetus subsp. fetus in CSF | 3,436 WBC/μl; 58% N; P, 0.96 g/liter; G, 0.20 g/liter | No | PEN, AMP, CHL | Cured |
| 5 (19) | F/69 | Diabetes mellitus, idiopathic thrombocytopenic purpura | Fever, confusion | C. fetus subsp. fetus in CSF and BC | 1,230 WBC/μl; 92% N | No | PEN, CHL, SFZ | Died |
| 6 (20) | M/40 | None | Fever, neck stiffness, diarrhea | C. fetus subsp. fetus in CSF | 8,464 WBC/μl; 66% L; P, 1.2 g/liter; G, 0.50 g/liter | No | AMP, PEN, STR, ERY | Cured |
| 7 (21) | M/50 | None | Fever, headache, convulsions, hemiparesis, abdominal pain | C. fetus subsp. fetus in CSF and BC | 36 WBC/μl; 100% L; P, 0.73 g/liter; G, 0.70 g/liter | No | AMP, CHL | Cured |
| 8 (22) | M/68 | Metastatic adenocarcinoma of the rectum | Fever, diarrhea, malaise | C. fetus subsp. fetus in CSF | Meningitis | No | ERY | Died (other cause?) |
| 9 (22) | M/65 | Alcoholic cirrhosis | Fever, convulsion, malaise | C. fetus subsp. fetus in CSF | Meningitis | NR | CFZ, GEN, ERY, AMP | Relapse then cured |
| 10 (23) | M/38 | Chronic alcoholism | Fever, neck stiffness | C. fetus subsp. fetus in CSF | 2,040 WBC/μl; 84% N; P, 1 g/liter; G, 0.48 g/liter | No | AMX | Cured |
| 11 (24) | M/47 | Kidney transplant recipient | Fever, headache | C. fetus subsp. fetus in CSF and BC | 48 WBC/μl; 70% N; 30% L; P, 0.8 g/liter; G, 1.04 g/liter | No | CHL | Cured |
| 12 (25) | F/39 | Chronic alcoholism, epilepsy | Fever, neck stiffness, hemiparesis | C. fetus subsp. fetus in CSF | 1,800 N/μl; P, 1.31 g/liter; G, 0.05 g/liter | No | SAM | Cured |
| 13 (25) | M/36 | Chronic alcoholism | Fever, confusion | C. fetus subsp. fetus in BC | 154 N/μl; P, 0.95 g/liter; G, 0.22 g/liter | No | AMP | Cured |
| 14 (26) | M/55 | Alcoholic hepatitis, diabetes mellitus | Fever, neck stiffness | C. fetus in CSF | 400 WBC/μl; 75% L; 23% N; P, 0.83 g/liter; G, 1.06 g/liter (ratio, 0.3) | No | AMP, MOX | Cured |
| 15 (27) | M/83 | Chronic alcoholism | Fever, confusion | C. fetus subsp. fetus in CSF and BC | 577 WBC/μl; 96% N; P, 0.6 g/liter; G, 0.91 g/liter | No | AMC, RIF, NET, CIP, CRO | Died (other cause) |
| 16 (11) | M/47 | Chronic alcoholism | Fever, neck stiffness, cellulitis | C. fetus subsp. fetus in BC | 300 WBC/μl; majority of N; P, 0.85 g/liter; G, 0.57 g/liter (ratio, 0.4) | Yes, no IE | CTX, VAN | Cured |
| 17 (28) | M/71 | Diabetes mellitus | Fever, neck stiffness, confusion | C. fetus subsp. fetus in CSF and BC | 11,100 WBC/μl; 98% N; P, 5.08 g/liter; G, 0.95 g/liter (ratio, 0.2) | No | IPM for 4 wk | Cured |
| 18 (29) | M/51 | Head injury | Fever, convulsion | NR | Meningitis | NR | NR | Cured |
| 19 (30) | M/40 | Crohn's disease treated with infliximab | Fever, headache | C. fetus in CSF, BC, and SC | 344 WBC/μl; majority of N; P, 0.33 g/liter; G, 0.68 g/liter | No | ERY | Cured |
| 20 (5) | M/28 | Epilepsy, khat chewing | Fever, diarrhea, neck stiffness | C. fetus in BC | 170 WBC/μl; normal P and G | Yes, no IE | CRO, CIP, AZM | Cured |
| 21 (this report) | M/75 | Diabetes mellitus | Fever, diarrhea, confusion | C. fetus in CSF and BC | 1,430 WBC/μl; 65% N; P, 1.14 g/liter; G, 2.68 g/liter (ratio, 0.5) | TTE and TEE, aortic endocarditis | IPM for 4 wk + GEN for 1st 5 days | Cured |
a
Abbreviations: M, male; F, female; BC, blood culture; SC, stool culture; CSF, cerebrospinal fluid; WBC, white blood cells; N, neutrophils; L, lymphocytes; P, CSF protein level; G, CSF glucose level; ratio = G/glycemia; IE, infectious endocarditis; NR, not reported; AMX, amoxicillin; AMC, amoxicillin-clavulanic acid; AMP, ampicillin; SAM, ampicillin-sulbactam; AZM, azithromycin; CFZ, cefazolin; CTX, cefotaxime; CRO, ceftriaxone; CHL, chloramphenicol; CIP, ciprofloxacin; ERY, erythromycin; GEN, gentamicin; IPM, imipenem; MOX, moxalactam; NET, netilmicin; PEN, penicillin; RIF, rifampin; SFZ, sulfadiazine; STR, streptomycin; TET, tetracycline; VAN, vancomycin; TTE, transthoracic echocardiography; TEE, transesophageal echocardiography.