Recurrent Bacteremia Caused by a “ Flexispira ”-Like Organism in a Patient with X-Linked (Bruton’s) Agammaglobulinemia

Abstract

ABSTRACT Helicobacter spp., except for Helicobacter cinaedi , have only rarely been reported in cases of septicemia. A patient with X-linked (Bruton’s) agammaglobulinemia was found to have persistent sepsis with a Helicobacter -like organism despite multiple courses of antibiotics. His periods of sepsis were associated with leg swelling thought to be consistent with cellulitis. The organism was fastidious and required a microaerophilic environment containing H 2 for growth. Optimal growth was observed at 35 to 37°C on sheep blood, CDC anaerobe, and Bordet-Gengou agars. Serial subcultures every 4 to 5 days were required to maintain viability. The organism was strongly urease positive and showed highest relatedness to Helicobacter -like organisms with the vernacular name “ Flexispira rappini ” by 16S rRNA gene sequence analysis. Genomic DNA hybridization studies, however, found 24 to 37% relatedness to “ F. rappini ” and even less to other Helicobacter spp. Although the organism phenotypically resembles “ Flexispira ” and Helicobacter , it is thought to represent a new taxon. The patient’s infection was eventually cleared with a prolonged (5-month) course of intravenous imipenem and gentamicin.