Division of Internal Medicine, Department of Rheumatology, University Medical Centre Maribor, Ljubljanska ulica 5, 2000, Maribor, Slovenia.
National Laboratory for Health, Environment and Food, Maribor, Slovenia.
Ann Clin Microbiol Antimicrob. 2021 Apr 8;20(1):22. doi: 10.1186/s12941-021-00426-x.
Non-Helicobacter pylori species (NHPS) are newly emerging bacteria that naturally inhabit birds and mammals apart from humans and rarely cause diseases in humans. In recent years, a rise in the number of cases associated with NHPS infections in humans has been observed. Among them, infections with Helicobacter (H.) canis are sporadic and challenging to recognise clinically. To date, ten cases of H. canis infections in mainly immunocompromised humans have been reported in the literature. Transmission pathway is most likely zoonotic via the faecal-oral route during close contacts with dogs and cats or may result from a contaminated sheep milk intake. No clear guidelines for successful antibiotic regimen are known. Important additional risk factor for infection might be biologic agents and Janus kinase inhibitors (JAKi) used in the treatment of rheumatoid arthritis (RA) and other conditions. Herein we present the first case of H. canis bacteraemia in a RA patient treated with novel JAKi tofacitinib.
A 65-year-old female patient with RA and rituximab-induced hypogammaglobulinemia treated with tofacitinib, methotrexate, and methylprednisolone came to a planned visit in our outpatient rheumatology clinic. She presented with a history of back pain that significantly worsened 2 days before visit. She had numbness and tingling sensation in both legs and muscle weakness. Neurological examination was within a normal range. The patient was afebrile, had no chills, and was haemodynamically stable. She was in close contact with her pet dogs. Laboratory examination showed increased markers of inflammation. She was found to have H. canis bacteraemia with underlying multilevel degenerative lumbar spinal stenosis. Identification of H. canis was performed by MALDI-TOF MS and 16 S rRNA gene sequence analysis of isolate from subcultured positive aerobic blood culture bottles. Antimicrobial susceptibility testing showed low minimum inhibitory concentrations to amoxicillin-clavulanate, cefotaxime, ceftriaxone, meropenem, and gentamicin. She was treated with combined antibiotic regimen (ceftriaxone, doxycycline) for 14 days, which resulted in total remission of the infection.
Clinicians should recognise H. canis infection risk in patients with recent pet exposure and predisposing factors such as immunodeficiency disorders or diseases that demand immunosuppressive drug therapy. A minimum of two weeks of antibiotic therapy is suggested.
非幽门螺杆菌物种（NHPS）是一种新出现的细菌，除人类外，它们自然栖息在鸟类和哺乳动物中，很少在人类中引起疾病。近年来，观察到与 NHPS 感染相关的人类病例数量有所增加。其中，感染幽门（H.）canis 是散发性的，临床上难以识别。迄今为止，文献中已报道了十例主要发生在免疫功能低下人群中的 H. canis 感染病例。传播途径最有可能是通过与狗和猫的密切接触，通过粪-口途径发生的人畜共患病，也可能是由于摄入受污染的羊奶所致。目前尚不清楚成功的抗生素治疗方案的明确指导方针。感染的重要额外危险因素可能是生物制剂和用于治疗类风湿关节炎（RA）和其他疾病的 Janus 激酶抑制剂（JAKi）。在此，我们报告了首例用新型 JAKi 托法替尼治疗的 RA 患者的 H. canis 菌血症。
一名 65 岁女性 RA 患者，因利妥昔单抗诱导的低丙种球蛋白血症接受托法替尼、甲氨蝶呤和甲基强的松龙治疗，来我院门诊就诊。她因背痛加重就诊，背痛在就诊前 2 天明显加重。她双腿有麻木和刺痛感，肌肉无力。神经系统检查在正常范围内。患者无发热、寒战，血流动力学稳定。她与宠物狗密切接触。实验室检查显示炎症标志物升高。她被发现患有 H. canis 菌血症，并有潜在的多水平退行性腰椎狭窄症。通过 MALDI-TOF MS 和从有氧血培养瓶中分离的 16S rRNA 基因序列分析鉴定 H. canis。药敏试验显示对阿莫西林-克拉维酸、头孢噻肟、头孢曲松、美罗培南和庆大霉素的最低抑菌浓度较低。她接受了联合抗生素治疗（头孢曲松、多西环素）14 天，感染完全缓解。
临床医生应认识到近期接触宠物和免疫功能低下或需要免疫抑制药物治疗的疾病等易患因素的患者中 H. canis 感染的风险。建议抗生素治疗至少 2 周。
