Non-Helicobacter pylori species (NHPS) are newly emerging bacteria that naturally inhabit birds and mammals apart from humans and rarely cause diseases in humans. In recent years, a rise in the number of cases associated with NHPS infections in humans has been observed. Among them, infections with Helicobacter (H.) canis are sporadic and challenging to recognise clinically. To date, ten cases of H. canis infections in mainly immunocompromised humans have been reported in the literature. Transmission pathway is most likely zoonotic via the faecal-oral route during close contacts with dogs and cats or may result from a contaminated sheep milk intake. No clear guidelines for successful antibiotic regimen are known. Important additional risk factor for infection might be biologic agents and Janus kinase inhibitors (JAKi) used in the treatment of rheumatoid arthritis (RA) and other conditions. Herein we present the first case of H. canis bacteraemia in a RA patient treated with novel JAKi tofacitinib. A 65-year-old female patient with RA and rituximab-induced hypogammaglobulinemia treated with tofacitinib, methotrexate, and methylprednisolone came to a planned visit in our outpatient rheumatology clinic. She presented with a history of back pain that significantly worsened 2 days before visit. She had numbness and tingling sensation in both legs and muscle weakness. Neurological examination was within a normal range. The patient was afebrile, had no chills, and was haemodynamically stable. She was in close contact with her pet dogs. Laboratory examination showed increased markers of inflammation. She was found to have H. canis bacteraemia with underlying multilevel degenerative lumbar spinal stenosis. Identification of H. canis was performed by MALDI-TOF MS and 16 S rRNA gene sequence analysis of isolate from subcultured positive aerobic blood culture bottles. Antimicrobial susceptibility testing showed low minimum inhibitory concentrations to amoxicillin-clavulanate, cefotaxime, ceftriaxone, meropenem, and gentamicin. She was treated with combined antibiotic regimen (ceftriaxone, doxycycline) for 14 days, which resulted in total remission of the infection. Clinicians should recognise H. canis infection risk in patients with recent pet exposure and predisposing factors such as immunodeficiency disorders or diseases that demand immunosuppressive drug therapy. A minimum of two weeks of antibiotic therapy is suggested.

中文翻译：

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托法替尼治疗类风湿性关节炎患者犬幽门螺杆菌菌血症：病例报告和文献复习

非幽门螺杆菌 (NHPS) 是新出现的细菌，它们自然栖息在人类以外的鸟类和哺乳动物中，很少引起人类疾病。近年来，已观察到与人类 NHPS 感染相关的病例数有所增加。其中，犬螺杆菌 (H.) 感染是散发性的，临床上难以识别。迄今为止，文献中已经报道了 10 例主要在免疫功能低下的人中感染犬幽门螺杆菌的病例。传播途径很可能是在与狗和猫密切接触期间通过粪口途径传播的人畜共患病，或者可能由摄入受污染的羊奶引起。尚无成功的抗生素治疗方案的明确指南。感染的重要额外风险因素可能是用于治疗类风湿性关节炎 (RA) 和其他疾病的生物制剂和 Janus 激酶抑制剂 (JAKi)。在此，我们介绍了第一例在接受新型 JAKi 托法替尼治疗的 RA 患者中出现犬幽门螺杆菌菌血症的病例。一名 65 岁女性患者，患有 RA 和利妥昔单抗引起的低丙种球蛋白血症，接受托法替尼、甲氨蝶呤和甲基强的松龙治疗后，来到我们的风湿病门诊计划就诊。她有背痛病史，在就诊前 2 天明显恶化。她有双腿麻木和刺痛感，肌肉无力。神经系统检查在正常范围内。患者无发热，无寒战，血流动力学稳定。她与她的宠物狗有密切接触。实验室检查显示炎症标志物增加。她被发现患有犬幽门螺杆菌菌血症，并伴有潜在的多节段退行性腰椎管狭窄。通过 MALDI-TOF MS 和 16 S rRNA 基因序列分析对传代培养阳性需氧血培养瓶中的分离株进行犬幽门螺杆菌的鉴定。抗微生物药敏试验显示对阿莫西林-克拉维酸、头孢噻肟、头孢曲松、美罗培南和庆大霉素的最低抑菌浓度较低。她接受了联合抗生素方案（头孢曲松、多西环素）治疗 14 天，使感染完全缓解。临床医生应认识到近期宠物接触和易感因素（如免疫缺陷疾病或需要免疫抑制药物治疗的疾病）的犬幽门螺杆菌感染风险。