Clinical Features, Immunological Characteristics, and Treatment Outcomes of Campylobacter spp. Infections in Patients With Common Variable Immunodeficiency

Adriel Roa-Bautista; Li-An K Brown; Susan Tadros; Siobhan O Burns; Gauri Godbole; David M Lowe

doi:10.1016/j.jaip.2023.06.050

Clinical Features, Immunological Characteristics, and Treatment Outcomes of Campylobacter spp. Infections in Patients With Common Variable Immunodeficiency

J Allergy Clin Immunol Pract. 2023 Nov;11(11):3493-3501.e4. doi: 10.1016/j.jaip.2023.06.050. Epub 2023 Jul 3.

Authors

Adriel Roa-Bautista¹, Li-An K Brown², Susan Tadros³, Siobhan O Burns⁴, Gauri Godbole⁵, David M Lowe⁶

Affiliations

¹ Department of Immunology, Marques de Valdecilla University Hospital, Santander, Spain; Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK.
² Institute of Immunity and Transplantation, University College London, London, UK.
³ Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK.
⁴ Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK; Institute of Immunity and Transplantation, University College London, London, UK.
⁵ Department of Infectious and Tropical Diseases, University College London Hospitals NHS Foundation Trust, London, UK; Gastrointestinal Bacteria Reference Unit, UK Health Security Agency, London, UK.
⁶ Department of Clinical Immunology, Royal Free London NHS Foundation Trust, London, UK; Institute of Immunity and Transplantation, University College London, London, UK. Electronic address: d.lowe@ucl.ac.uk.

PMID: 37406804
DOI: 10.1016/j.jaip.2023.06.050

Abstract

Background: Campylobacter infection usually causes a self-limited clinical illness lasting 5 to 7 days, resolving without antimicrobial treatment in immunocompetent subjects. However, an inadequate immune response can lead to a prolonged and severe disease requiring antibiotics and more aggressive therapeutic approaches.

Objective: To comprehensively describe Campylobacter spp. infections in patients with common variable immunodeficiency (CVID).

Methods: A retrospective cohort of 14 CVID patients with Campylobacter infection and 95 CVID controls attending the immunology clinic at a large tertiary hospital was assessed. Immunological, clinical, and microbiological parameters were measured with median follow-up over 20 years in both cohorts. Patients were treated according to a novel algorithm for Campylobacter in antibody-deficient patients.

Results: Campylobacter patients had a higher proportion of CD21lowCD38low and transitional B cells (median 38.0% vs 14.2% and 5.4% vs 3.2%) and lower long-term average CD19+ B cells (median 0.06 vs 0.18 × 109/L) and CD4+ T cells (0.41 vs 0.62 × 109/L) in comparison with the controls. Similarly, Campylobacter patients showed a decline in B cells (median 0.02 vs 0.14 × 109/L), CD4+ T cells (0.33 vs 0.59 × 109/L), CD8+ T cells (0.26 vs 0.62 × 109/L), and natural killer cells (0.08 vs 0.18 × 109/L) over time. Antimicrobial resistance, especially to macrolides and fluoroquinolones, was common. Bacterial clearance with associated clinical improvement was obtained after a median of 20 and 113 days for acute Campylobacter (resolution within 3 mo of onset) and chronic Campylobacter (>3 mo) infections, respectively. Seven received first-line treatment (azithromycin or chloramphenicol), 4 second-line (neomycin), and 3 third-line (combination of tigecycline, chloramphenicol, and ertapenem; 1 received gentamicin owing to resistance to carbapenems).

Conclusions: Our study highlights immunological and clinical characteristics of recurrent Campylobacter infections in patients with CVID. Our treatment algorithm was successful and should be evaluated in a larger cohort.

Keywords: Antibiotic treatment; CVID; Campylobacter; Common variable immunodeficiency.

MeSH terms

Anti-Infective Agents*
Campylobacter Infections* / complications
Campylobacter Infections* / drug therapy
Campylobacter Infections* / epidemiology
Campylobacter*
Chloramphenicol
Common Variable Immunodeficiency* / complications
Common Variable Immunodeficiency* / drug therapy
Humans
Retrospective Studies
Treatment Outcome

Substances

Anti-Infective Agents
Chloramphenicol