Campylobacter fetus meningitis in an asplenic diabetic patient manifesting a chronic clinical course; case report and review of Japanese cases

We report a case of Campylobacter fetus (C. fetus) meningitis that manifested a chronic clinical course in an asplenic diabetic patient. The patient had eaten raw beef liver, and after 1 week, he suffered from headache and fever, with repeated remissions and deterioration. Four weeks after onset, neck stiffness was observed, and he was diagnosed with meningitis due to Campylobacter fetus. The cerebrospinal fluid (CSF) sample showed leukocytosis (3760/μl; neutrophils 91 %, lymphocytes 9 %). The infection responded to meropenem and ampicillin. A review of the literature between 1976 and 2013 revealed that C. fetus meningitis in adults is still a rare entity, and about one-third of case reports written in English are from Japan. We specifically reviewed the case reports of C. fetus meningitis in adults written in Japanese between 1979 and 2013 to examine the clinical features and influence of underlying disease, especially diabetes mellitus. Unexpectedly, most patients with C. fetus meningitis manifested a chronic clinical course, and CSF samples showed lymphocyte-predominant leukocytosis in at least 25 out of 43 cases. Antibiotic treatment, especially with carbapenem, was effective, and the overall prognosis of C. fetus meningitis was good, but 3 out of 43 patients had after effects. Two of the patients had diabetes mellitus as an underlying disease.