Neonatal campylobacter enteritis with secondary lactose intolerance.

Abstract

A five-day-old female infant was admitted to the hospital neonatal unit from the maternity ward with a history of frequent watery stools from shortly after birth. The pregnancy and delivery were uneventful and the birth weight was 3450 g. The baby had been fed on a modified cows milk formula (Osterfeed). Clinical examination was unremarkable, however copious watery stools were produced soon after each feed. Culture of faeces revealed a gram negative organism on Skirrow’s medium which was identified as Campylobacter jejuni biotype I . Culture of the mother’s stool was negative and no other baby in the maternity unit developed symptoms. The pH of the faecal fluid was 6.0 and contained lactose 30 mmol/l, galactose 2.7 mmol/l and glucose 11 mmolil. Lactose, galactose and glucose were detected on urinary sugar chromatography. On day 7 the baby weighed 2 960 g, a weight loss equal to 14% of birth weight. Oral erythromycin and a low lactose feed (Galactomin 17) were commenced. Her diarrhoea resolved completely on this regime and on day 13 she weighed 3630 g. At one month she had a recurrence of symptoms with negative investigations but responded to changing of the feed to a lactose free soya milk preparation (Wysoy) and at 4 months she weighed 6550 g. At this stage, lactose tolerance test produced no diarrhoea and jejunal biopsy demonstrated lactase activity and normal histology. Campylobacter jejuni has recently been recognised as an important cause of enteritis in the community and is now one of the most frequent enteric pathogens reported. Neonatal infection is uncommon, but there have been several case reports in recent years (1 , 2). We present a case of lactose intolerance in a newborn secondary to Campylobacter jejuni gastroenteritis. Lactose intolerance following Campylobacter infection has not previously been reported. The initial presentation could be confused with primary lactase deficiency thus illustrating the importance of using culture techniques suitable for the isolation of Campylobacter species from the faeces of neonates. The probable development of cows milk protein allergy is well recognised in the post enteritis syndrome (3). Galatomin is a low lactose casein containing milk preparation. It would have been more appropriate to use a lactose-free hydrolysed protein milk formula to reduce the risk of development of cow’s milk protein allergy. Reintroduction of a normal cow’s milk protein preparation after development of cow’s milk protein allergy is usually possible after the first year.