Campylobacter jejuni infections in a prison population coinfected with the human immunodeficiency virus

BACKGROUND: Campylobacter jejuni is a common etiological agent of diarrhea in the general population. In recent years it has also been involved as etiological agent of intestinal and extraintestinal infections in patients infected with the human immunodeficiency virus (HIV). The clinical and microbiological features in a series of HIV+ patients infected with C. jejuni in a correctional facility are here reported. METHODS: Retrospective analysis of clinical records of patients who had C. jejuni recovered from clinical samples diagnosed at the Hospital General Penitenciario (HGP), Madrid, for 2 years (10-1-1991 to 9-30-1993). C. jejuni strains were identified at the Clinical Microbiology Department at the HGP following standard methods. Antibiotic sensitivity testing was performed by the agar dilution and microdilution methods. RESULTS: Twenty-eight patients were diagnosed as being infected with C. jejuni. The mean age was 32.4 years (95% CI: 30.1-34.7). Twenty-seven patients (96%) were males. Twenty-five patients (90%) were intravenous drug users (IVDU). Sixty-one percent of cases clustered in the september and october months. The main clinical symptoms were diarrhea with no pathological products and fever. Mean lymphocyte CD4+ count was 103/mm3 (95% CI: 45-162). Blood cultures were obtained from 13 patients, and bacteremia was detected in three of them (23%), with no associated mortality. Forty-eight percent of C. jejuni strains were resistant to fluorquinolones, and all of them were susceptible to erythromycin. The latter antibiotic was used as therapy in 82% of patients and clinical and microbiological cure was achieved in all 17 patients who were evaluated at follow-up. CONCLUSIONS: Campylobacter jejuni is an important enteropathogen in correctional facility population infected with HIV, which in this study involved severely immunosuppressed patients. The main clinical presentation was acute enterocolitis and bacteremia (detected in 23%), a higher percentage than that reported in the literature. An increased quinolone-resistance rate was detected (48%). Erythromycin, and possibly the new macrolides, are currently the antibiotics of choice.