Case report of Campylobacter jejuni-associated myopericarditis: rare case of cardiac involvement by a common gastroenteritis pathogen

Myocarditis and pericarditis in young patients following Campylobacter jejuni enterocolitis infection: a systematic review of case studies

BACKGROUND

Campylobacter is known to be the leading cause of foodborne illness. Campylobacter jejuni, specifically, most commonly causes self-limiting enterocolitis, but infection can lead to extraintestinal manifestations, including rare yet severe cardiac complications, such as myocarditis and/or pericarditis. This review aims to determine whether a relationship exists between the timing of a positive stool culture and the overall clinical course in patients with Campylobacter jejuni-associated myocarditis and/or pericarditis.

METHODS

A systematic search was conducted using PubMed, MEDLINE, CINAHL Ultimate, Academic Search Premier, and Nursing and Allied Health Premium databases. A gray literature search was also performed. Covidence.org was used to screen, select, and extract data by two independent reviewers. Following a full-text evaluation, the quality of each study was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Case Reports.

RESULTS

The search resulted in 434 records, of which 7 case reports met the inclusion criteria, each study including one patient. The average number of days from hospital presentation to obtaining a stool sample was 1.7. The average number of days from stool culture obtainment to clinical course improvement was 3.3, with four case studies reporting a range of 2-4 days.

CONCLUSION

This systematic review raises awareness regarding the manifestations of Campylobacter jejuni, specifically the severe cardiac symptoms that may present in young individuals. Given the significant sequelae that can develop, providers must elicit a thorough history consisting of questions related to recent travel, food consumption, and gastrointestinal symptoms, especially among young individuals presenting with cardiac complaints.

Genomic Characterization of Campylobacter jejuni Associated with Perimyocarditis: A Family Case Report

Campylobacter spp. is the leading cause of foodborne gastrointestinal infections in humans worldwide. This study reports the first case of four family members who had contact with the same source of Campylobacter jejuni contamination with different results. Only the little siblings were infected by the same C. jejuni strain, but with different symptoms. Whereas the daughter was slightly affected with mild enteritis, the son suffered a longer campylobacteriosis followed with a perimyocarditis. This is the first case of the youngest patient affected by C. jejuni-related perimyocarditis published to date. The genomes of both strains were characterized by whole-genome sequencing and compared with the C. jejuni NCTC 11168 genome to gain insights into the molecular features that may be associated with perimyocarditis. Various comparison tools were used for the comparative genomics analysis, including the identification of virulence and antimicrobial resistance genes, phase variable (PV) genes, and single nucleotide polymorphisms (SNPs) identification. Comparisons of the strains identified 16 SNPs between them, which constituted small but significant changes mainly affecting the ON/OFF state of PV genes after passing through both hosts. These results suggest that PV occurs during human colonization, which modulates bacteria virulence through human host adaptation, which ultimately is related to complications after a campylobacteriosis episode depending on the host status. The findings highlight the importance of the relation between host and pathogen in severe complications of Campylobacter infections.

Phylogenetic Association and Genetic Factors in Cold Stress Tolerance in Campylobacter jejuni

Campylobacter jejuni is a major foodborne pathogen transmitted to humans primarily via contaminated poultry meat. Since poultry meat is generally processed, distributed, and stored in the cold chain, the survival of C. jejuni at refrigeration temperatures crucially affects human exposure to C. jejuni. Here, we investigated genetic factors associated with cold stress tolerance in C. jejuni. Seventy-nine C. jejuni strains isolated from retail raw chicken exhibited different survival levels at 4°C for 21 days. Multilocus sequence typing (MLST) clonal complex 21 (CC-21) and CC-443 were dominant among cold stress-tolerant strains, whereas CC-45 was common among cold stress-sensitive strains. Genome-wide average nucleotide identity (ANI) analysis identified a phylogenetic cluster associated with cold stress tolerance. Moreover, a pangenome analysis revealed 58 genes distinctively present in the cold stress-tolerant phylogenetic cluster. Among these 58 genes, cfrA, encoding the ferric enterobactin receptor involved in ion transport and metabolism, was selected for further analysis. Remarkably, the viability of a ΔcfrA mutant at 4°C was significantly decreased, while the levels of total reactive oxygen species and intracellular iron exceeded those of the wild type. Additionally, a knockout mutation of cfrA also significantly decreased the viability of three cold stress-tolerant isolates at 4°C, confirming the role of cfrA in cold stress tolerance. The results of this study demonstrate that unique phylogenetic clusters of C. jejuni associated with cold stress tolerance exist and that cfrA is a genetic factor contributing to cold stress tolerance in C. jejuni. IMPORTANCE The tolerance of foodborne pathogens to environmental stresses significantly affects food safety. Several studies have demonstrated that C. jejuni survives extended exposures to low temperatures, but the mechanisms of cold stress tolerance are not fully understood. Here, we demonstrate that C. jejuni strains in certain phylogenetic groups exhibit increased tolerance to cold stress. Notably, cfrA is present in the phylogenetic cluster associated with cold stress tolerance and plays a role in the survival of C. jejuni at low temperatures by alleviating oxidative stress. This is the first study to discover phylogenetic associations involving cold stress tolerance and to identify genetic elements conferring cold stress tolerance to C. jejuni.