Recurrent bacteremia caused by a "Flexispira"-like organism in a patient with X-linked (Bruton's) agammaglobulinemia

Helicobacter spp., except for Helicobaeter cinaedi, have only rarely been r eported in cases of septicemia. A patient with X-linked (Bruton's) agammagl obulinemia was found to have persistent sepsis with a Helicobacter-like org anism despite multiple courses of antibiotics, His periods of sepsis were a ssociated with leg swelling thought to be consistent with cellulitis. The o rganism was fastidious and required a microaerophilic environment containin g H-2 for growth. Optimal growth was observed at 35 to 37 degrees C on shee p blood, CDC anaerobe, and Bordet-Gengou agars. Serial subcultures every it to 5 days were required to maintain viability. The organism was strongly u rease positive and showed highest relatedness to Helicobacter-like organism s with the vernacular name "Flexispira rappini" by 16S rRNA gene sequence a nalysis. Genomic DNA hybridization studies, however, found 24 to 37% relate dness to "F. rappini'' and even less to other Helicobacter spp. Although th e organism phenotypically resembles "Flexispira" and Helicobacter, it is th ought to represent a new taxon, The patient's infection was eventually clea red with a prolonged (5-month) course of intravenous imipenem and gentamici n.