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Helicobacter cinaedi infection

Category: Illness or disabilities

Type

Involuntary

Introduction and description

 Helicobacter cinaedi is a bacterium that has come to be recognized as an important organism. It grows slowly and is difficult to isolate in culture.  It is the most common enterohepatic Helicobacter species that causes bacteremia in humans.

Helicobacter cinaedi is a Gram-negative spiral rod.  Perhaps of key importance is that it normally inhabits the gastrointestinal tract of mammals.  This means that where there is infection elsewhere in the body it is possibly caused by dysbiosis – destruction of the gastrointestinal tract by pesticides, herbicides, fungicides, pharmaceuticals, food additives, coeliac disease, antibiotics in food or as medicine and so on.  The gut is compromised, the pathogen enters the blood stream and disease ensues.

Symptoms

The main symptoms are fever often accompanied by back pain, abdominal pain and gastroenteritis, including diarrhoea, but unlike many other infectious diseases, the clinical course is not always acute. For these reasons, it is difficult to accurately diagnose.

It is beginning to be recognised, however, as a cause of a number of major diseases, infections and severe or chronic illnesses, such as:

  •  Meningitis PMID:  25022901
  • Arteriosclerosis PMID:  25022901 -  H. cinaedi infection significantly enhances atherosclerosis. Aortic root lesions show increased accumulation of neutrophils and F4/80+ foam cells, due, at least partly, to bacteria-mediated increased expression of proinflammatory genes. Infection can be asymptomatic
  •  Proctitis - an inflammation of the anus and the lining of the rectum, affecting only the last 6 inches of the rectum PMID:  25022901
  • Erysipelas - an acute skin rash, usually on any of the legs and toes, face, arms, and fingers.  It is an infection of the upper dermis and superficial lymphatics PMID:  25022901
  • Cellulitis -  a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. Signs and symptoms include an area of redness which increases in size over a few days PMID:  25022901
  • Bacteremia - the presence of bacteria in the blood. It is distinct from sepsis, which is the host response to the bacteria. PMID:  25022901
  • Osteomyelitis can be caused by H. cinaedi resulting in low back pain and fever. The pathogen may be  detected in the blood and lumbar disc [PMID: 26109448]

Quite a large number of so called auto-immune diseases are caused by this bacteria, although some researchers still have not cottoned on to the fact that the disease and bacteria are linked, for example

  • Systemic lupus erythematosus (SLE) can be caused by Helicobacter cinaedi bacteremia.  PMID: 28321078
  • Arthritis, PMID:  25022901

Although the incidence of H. cinaedi is [apparently] not that high, there are indications that the list above is but the tip of a massive iceberg when it comes to the actual number of diseases that may be caused by this pathogen:

A total of 51,272 sets of blood cultures were obtained during the study period, of which 5,769 sets of blood cultures were positive for some organism and 126 sets were H. cinaedi positive. The time required for blood cultures to become positive for H. cinaedi was ≤5 days in 69 sets (55%) and >5 days in 57 sets (45%). Most patients had an underlying disease, including

  • chronic kidney disease (21 cases),
  • solid tumor (19 cases),
  • hematological malignancy (13 cases),
  • diabetes mellitus (8 cases),
  • chronic liver disease (6 cases)

Only 1 patient had no apparent underlying disease. The clinical symptoms included

  • cellulitis in 24 cases,
  • colitis in 7 cases, and
  • fever only in 27 cases, including
  • 7 cases of febrile neutropenia.

The 30-day mortality rate of H. cinaedi bacteremia was 6.3%......, most cases of H. cinaedi bacteremia occurred in immunocompromised patients. We might have overlooked nearly half of the H. cinaedi bacteremia cases if the duration of monitored blood culture samples had been within 5 days. Therefore, when clinicians suspect H. cinaedi bacteremia, the observation period for blood cultures should be extended.  PMID:  24574294



Causes

Helicobacter cinaedi is a bacterium in the family Helicobacteraceae, Campylobacterales order. It was formerly known as Campylobacter cinaedi until molecular analysis published in 1991 led to a major revision of the genus Campylobacter.

Helicobacter cinaedi was first isolated from rectal cultures from homosexual men in 1984. In the 1980s to mid 1990s, the microorganism was mainly isolated from samples from homosexual men or immunocompromised patients; however, during the last two decades, H. cinaedi has been isolated from immunocompromised and from immunocompetent individuals worldwide.
In Japan, the isolation of this microorganism was first reported in 2003. Since then, many cases have been reported in hospitals across the country. Despite many reports, the etiological properties and pathogenicity of H. cinaedi remain elusive; however, we are increasingly able to recognize some of the features and the clinical relevance of infection. In particular, a long incubation period is essential for detection in an automatic blood culture system and many of the recent isolates are resistant to both macrolides and quinolones  PMID:  25022901

What does the harm?  It appears that H. cinaedi  uses  cytolethal distending toxin RNA .

Wikipedia

Cytolethal distending toxins (abbreviated CDTs) are a class of heterotrimeric toxins produced by certain gram-negative bacteria that display DNase activity. These toxins trigger G2/M cell cycle arrest in specific mammalian cell lines, leading to the enlarged or distended cells for which these toxins are named. Affected cells die by apoptosis.

Each toxin consists of three distinct subunits named alphabetically in the order that their coding genes appear in the cdt operon. Cytolethal distending toxins are classified as AB toxins, with an active ("A") subunit that directly damages DNA and a binding ("B") subunit that helps the toxin attach to the target cells. CdtB is the active subunit and a homolog to mammalian DNase I, whereas CdtA and CdtC make up the binding subunit.

Bacteria that produce CDTs often persistently colonize their host.

References and further reading

  • Kiehlbauch JA, Tauxe RV, Baker CN, Wachsmuth IK (1994). "Helicobacter cinaedi-associated bacteremia and cellulitis in immunocompromised patients". Annals of Internal Medicine. 121 (2): 90–93. doi:10.7326/0003-4819-121-2-199407150-00002.
  • J Infect Chemother. 2014 Sep;20(9):517-26. doi: 10.1016/j.jiac.2014.06.007. Epub 2014 Jul 9.  Clinical and bacteriological characteristics of Helicobacter cinaedi infection.  Kawamura Y1, Tomida J2, Morita Y2, Fujii S3, Okamoto T4, Akaike T3.
  • Intern Med. 2017 Mar 15; 56(6): 725–728.  doi:  10.2169/internalmedicine.56.7287  PMCID: PMC5410488  PMID: 28321078  Helicobacter cinaedi Bacteremia Mimicking a Flare of Systemic Lupus Erythematosus  Ruriko Nishida,1 Nobuyuki Shimono,1,2 Noriko Miyake,1 Yong Chong,1 Shinji Shimoda,1 Hiroshi Tsukamoto,1 and Koichi Akashi1
  • J Clin Microbiol. 2015 Sep; 53(9): 3054–3056.   Published online 2015 Aug 18. Prepublished online 2015 Jun 24. doi:  10.1128/JCM.00787-15 PMCID: PMC4540914 PMID: 26109448   Vertebral Osteomyelitis Caused by Helicobacter cinaedi  Aisa Yoshizaki,a Hiroshi Takegawa,b Asako Doi,a,c Yasushi Mizuno,a and Hiroaki Nishioka
  • Promotion of atherosclerosis by Helicobacter cinaedi infection that involves macrophage-driven proinflammatory responses  Shahzada Khan, , H. N. Ashiqur Rahman, , Tatsuya Okamoto, , Tetsuro Matsunaga, , Yukio Fujiwara, , Tomohiro Sawa, , Jun Yoshitake, , Katsuhiko Ono, , Khandaker Ahtesham Ahmed, , Md Mizanur Rahaman, , Kohta Oyama, , Motohiro Takeya, , Tomoaki Ida, Yoshiaki Kawamura, Shigemoto Fujii & Takaaki Akaike   Scientific Reports volume 4, Article number: 4680 (2014)
  • The Helicobacter cinaedi antigen CAIP participates in atherosclerotic inflammation by promoting the differentiation of macrophages in foam cells - Mario Milco D’Elios , Francesca Vallese […] Gaia Codolo Scientific Reports (2017)
  • J Clin Microbiol. 2014 May;52(5):1519-22. doi: 10.1128/JCM.00265-14. Epub 2014 Feb 26.  Clinical characteristics of bacteremia caused by Helicobacter cinaedi and time required for blood cultures to become positive.  Araoka H1, Baba M, Kimura M, Abe M, Inagawa H, Yoneyama A.

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