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Thrombophlebitis and cellulitis due to Campylobacter fetus ssp. fetus. Report of four cases and a review of the literature.

Four cases of acute thrombophlebitis and cellulitis due to C. fetus ssp. fetus are reported, with a review of 18 previously reported cases. Vascular infection with thrombophlebitis due to C. fetus ssp. fetus occurred predominantly in adult male patients with underlying debilitating, immunocompromising illnesses resulting in a mortality rate of 32%. Although approximately one-third of the patients had exposure to known reservoirs of C. fetus ssp. fetus, none of the patients presented with diarrhea, and only one of the cases had C. fetus ssp. fetus recovered from stool culture. Diagnosis of C. fetus ssp. fetus thrombophlebitis or cellulitis is based on clinical suspicion and recovery of the agent from blood culture; the latter requires an average incubation period of 8 days. Empiric therapy with erythromycin, and an aminoglycoside or chloramphenicol is recommended in suspect patients pending results of blood cultures.

Adult↗

Responses to vibroacoustic stimulation in a fetus with an encephalocele compared to responses of normal fetuses.

BACKGROUND: Observation of fetal movement and fetal heart rate (FHR) responses to repeated vibroacoustic stimulation (VAS) might be useful as a measure to assess fetal well-being and to assess the integrity of the fetal central nervous system (CNS). We observed the movement and FHR responses to repeated VAS of a term fetus with a serious brain anomaly as compared to responses of normal term fetuses. SUBJECTS, METHODS, RESULTS: In 37 normal term fetuses and in a term fetus with an encephalocele we studied movement and FHR response to repeated VAS. All normal fetuses responded within 1 s after stimulation with general body movement and FHR acceleration. At 36 gestational weeks, no movement or FHR responses were seen in the fetus with an encephalocele. Repetition of the test in this fetus after one week still showed no response to repeated VAS. CONCLUSION: Normal fetuses showed movement and FHR responses to external stimulation. The fetus with an encephalocele did not respond to repeated VAS with a movement or FHR acceleration. Case studies in fetuses with structural anomalies of the CNS are needed to gain insight into the spectrum of possible responses to VAS.

Acoustic Stimulation↗

Uterine and umbilical blood flows and net nutrient uptake by fetuses and uteroplacental tissues of cows gravid with either single or twin fetuses.

To evaluate the influence of cow breed and number of fetuses on uterine and umbilical blood flows and nutrient fluxes or uterine tissues from gravid cows, surgery was performed on Charolais or Hereford cows with single or twin fetuses at 177 +/- .2 d (mean +/- SEM) after mating. Indwelling catheters were placed in a fetal femoral artery and vein, in an umbilical vein of each fetus, and in a uterine artery and vein of each gravid horn. Deuterium oxide (D2O) was infused into a fetal femoral vein at 183 +/- .3 and 190 +/- .5 d after mating to estimate uterine and umbilical blood flows (liters/minute). Blood oxygen and plasma glucose and lactate concentrations were determined and uterine arterio-venous (A-V) and umbilical venous-fetal arterial (v-a) differences and net uterine and fetal uptakes were calculated. Net utilization by the uteroplacenta was calculated as the difference between uterine and fetal net uptakes. Uterine blood flows were lower (P less than .01) in Hereford (4.80 +/- .28) than in Charolais (7.07 +/- .33) and lower (P less than .01) per fetus in cows with twin fetuses (5.22 +/- .34) than in cows with a single (6.65 +/- .28) fetus. Umbilical blood flows were greater for single than for twin fetuses. Fetal oxygen and glucose net uptakes averaged 57 and 12%, respectively, of net uteroplacental utilization. Lactate was released from uteroplacental tissues to fetal (42%) and maternal circulations (58%). Fetal oxygen uptakes tended to be less for twin fetuses (P = .08) than for a single fetus.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗

A study of oligosaccharide variants of alpha-fetoproteins produced by normal fetuses and fetuses with trisomy 21.

BACKGROUND: The mechanisms of the increase in the percentage of alpha-fetoproteins (AFPs) that strongly binds to Lens culinaris agglutinin (AFP-L3) in pregnancies with a trisomy 21 fetus have not been analyzed. To investigate the oligosaccharide variants of AFP produced by normal fetuses and fetuses with trisomy 21, the lectin reactivity of AFP was analyzed. METHODS: Fetal liver tissue, amniotic fluid, and maternal serum were obtained from five normal pregnancies and five pregnancies with a trisomy 21 fetus. The percentages of AFP reactive to lectins were determined by lectin-affinity electrophoresis coupled with antibody-affinity blotting. RESULTS: The percentages of AFP-L3 in the fetal liver and the maternal serum were 23.9 and 27.0%, respectively, in normal pregnancies, and 28.7 and 38.5%, respectively, in pregnancies with a trisomy 21 fetus. There was no statistically significant difference between the percentage in the fetal liver and the percentage in the maternal serum in normal pregnancies; however, a significant difference (P < 0.01) was found in pregnancies with a trisomy 21 fetus. In regard to the percentage of AFP-L3 in the fetal liver, there was no significant difference; however, a significant difference (P < 0.05) was found in the maternal serum between normal pregnancies and pregnancies with a trisomy 21 fetus. CONCLUSIONS: The transference of the AFP-L3 fraction might be relatively high in the placentas of women carrying a trisomy 21 fetus, and this could be the one of the reasons for the increase in the percentage of AFP-L3 in the maternal serum in pregnancies with a trisomy 21 fetus.

Adolescent↗

Three-dimensional quantitative echocardiographic assessment of ventricular volume in healthy human fetuses and in fetuses with congenital heart disease.

The purpose of this study was to evaluate the feasibility of three-dimensional freehand echocardiographic assessment of ventricular volumetry in healthy fetuses and in fetuses with congenital heart disease. The study was approved by the hospital institutional review board. After echocardiographic examination by conventional ultrasonographic equipment interfaced with a magnetic tracking system, three-dimensional cardiac data were collected prospectively in 57 fetuses. Ventricular volumes were determined from three-dimensional data sets, and 22 fetuses with congenital heart disease were compared with 29 healthy fetuses. A multiple regression analysis of covariance was performed to assess between-group differences. Gated three-dimensional volume data sets enabled assessment of ventricular volumes in 51 of the 57 fetuses. Both fetuses with and without congenital heart disease had exponential increases in cardiac volumes during gestation. In fetuses with congenital heart disease and a marked inequality of ventricular size but no heart failure, the combined end-diastolic and stroke volumes of both ventricles were found to be significantly reduced compared with controls with no disease and fetuses with other types of congenital heart disease. Three-dimensional imaging can provide estimates of ventricular volume changes in fetal hearts with abnormal ventricular morphology that cannot easily be performed by two-dimensional echocardiography, and it may provide insight into evolving congenital heart disease.

Echocardiography, Three-Dimensional↗

Campylobacter infection associated with raw milk. An outbreak of gastroenteritis due to Campylobacter jejuni and thermotolerant Campylobacter fetus subsp fetus.

Raw milk is identified with increasing numbers of outbreaks of gastroenteritis and is an important vehicle for transmission of Campylobacter infection. Unlike Campylobacter jejuni, Campylobacter fetus subsp fetus has not been associated with common-source outbreaks of gastroenteritis. This report describes an outbreak of gastroenteritis involving C jejuni and a thermotolerant strain of C fetus subsp fetus associated with raw milk. Fifteen (39%) of 38 persons who attended a banquet in Wisconsin in June 1982 developed acute gastroenteritis. Stool specimens were obtained from nine ill guests; four yielded C jejuni and three yielded C fetus subsp fetus. The C fetus subsp fetus isolates were identified fortuitously, in part because of unusual thermotolerance (growth at 42 degrees C), permitting isolation at temperature appropriate for C jejuni. Survey results implicated raw milk as the source of the outbreak. Findings provide evidence of a potentially emergent milkborne pathogen contributing to the risk of raw milk consumption and suggest that current diagnostic laboratory techniques may fail to identify significant foodborne agents.

Adolescent↗

Cloning and nucleotide sequence of the gyrA gene from Campylobacter fetus subsp. fetus ATCC 27374 and characterization of ciprofloxacin-resistant laboratory and clinical isolates.

The gyrA gene of Campylobacter fetus subsp. fetus, which encodes the A subunit of DNA gyrase, was cloned, and its nucleotide sequence was determined. An open reading frame of 2,586 nucleotides which encodes a polypeptide of 862 amino acids with an Mr of 96,782 was identified. C. fetus subsp. fetus GyrA is most closely related to Campylobacter jejuni GyrA, with 73% homology at the nucleotide level and 78% identity between polypeptides. The next most closely related GyrA was that from Helicobacter pylori, with both DNA homology and amino acid identity of 63%. The gyrA and gyrB (DNA gyrase B subunit) genes were located on the genomic map of C. fetus subsp. fetus ATCC 27374 and shown to be separate. A clinical isolate of C. fetus subsp. fetus and a laboratory-derived mutant of ATCC 27374, both resistant to ciprofloxacin, had identical mutations within the quinolone resistance determining region. In both mutants a G-->T transversion, corresponding to a substitution of Asp-91 to Tyr in GyrA, was linked to ciprofloxacin resistance, giving MICs of 8 to 16 micrograms/ml.

Amino Acid Sequence↗

Biochemical and genetic characteristics of atypical Campylobacter fetus subsp. fetus strains isolated from humans in the United States.

During a 2-year period, 14 biochemically atypical Campylobacter fetus subsp. fetus-like strains were received by the Campylobacter Reference Laboratory at the Centers for Disease Control. Sources of the isolates were blood, nine strains; stools, two strains; amniotic fluid, one strain; and abscesses, two strains. Atypical phenotypic characteristics exhibited by one or more strains were growth at 42 degrees C, 10 strains; no H2S by lead acetate paper, 3 strains; resistance to a 30-micrograms cephalothin disk, 2 strains; and nonmotility, 1 strain. By DNA-DNA hybridization, all 14 isolates and the type strain of C. fetus subsp. fetus (ATCC 27374) were 94 to 100% related in reassociation reactions at 50 degrees C, with 0.0 to 0.5% divergence, and were 86 to 100% related in reassociation reactions at 65 degrees C. Thus, all of these atypical strains were C. fetus subsp. fetus. MICs of 11 antimicrobial agents for these 14 strains were variable. All strains were susceptible to chloramphenicol, erythromycin, gentamicin, and tetracycline, and most were susceptible to ampicillin, clindamycin, and penicillin. Eleven strains were resistant to cephalothin (MIC greater than or equal to 16 micrograms/ml), nine were resistant to rifampin (MIC greater than or equal to 8 micrograms/ml), and all were resistant to nalidixic acid (MIC greater than 32 micrograms/ml) and vancomycin (MIC greater than 32 micrograms/ml). One can expect to see biochemical variability in C. fetus subsp. fetus strains and to encounter such strains from a variety of human sources, the most important of which appears to be blood.

Campylobacter Infections↗

Hormone ontogeny in the ovine fetus. XXVI. A sex difference in the effect of castration on the hypothalamic-pituitary gonadotropin unit in the ovine fetus.

The detection of pulsatile ovine LH (oLH) secretion in the sheep fetus by 81 days gestation (term 147 days), the suppression of fetal gonadotropin secretion by chronic administration of an LH-releasing factor agonist or antagonist, and the capacity of N-methyl; D-aspartate (a neuroexcitatory amino acid analog) to evoke a fetal oLH pulse strongly support a functional LH-releasing factor pulse-generator in the ovine fetus. In light of the sex difference in fetal gonadal function and gonadotropin secretion before day 114, we postulated that fetal castration would have a discordant effect on the pattern of gonadotropin secretion in males and females. Fetal sheep were either castrated (male = 11; female = 9) or sham operated (male = 9; female = 6) at 110-115 days gestation. Chronic indwelling arterial and venous catheters were implanted, and animals were studied for up to 30 days. During each study period fetal arterial blood samples were drawn every 15 min for 5 h and the plasma assayed for oFSH and oLH by specific RIAs. Multiple studies were performed on each fetus. In all fetuses (both intact and castrated) a decrease in oLH pulse frequency occurred after day 130. In female fetuses before day 130, castration had no effect on mean oLH pulse frequency (sham, 0.72 +/- 0.19 pulses/5 h; castrate, 0.50 +/- 0.13 pulses/5 h; P greater than 0.05). After day 130, pulsatile oLH secretion decreased in both intact and castrated female fetuses to undetectable levels during the sampling period. In contrast, castration significantly (P less than 0.001) increased mean oLH pulsatility in males before and after day 130 (less than 130 days, sham, 1.06 +/- 0.24 pulse/5 h; castrate, 2.70 +/- 0.22 pulse/5 h; greater than 130 days, sham, 0.18 +/- 0.12 pulses/5 h; castrate, 1.65 +/- 0.26 pulses/5 h). Mean oLH pulse amplitude was increased by castration only in the male fetuses (sham, 3.89 +/- 0.87 ng/ml; castrate, 6.02 +/- 0.39 ng/ml; P less than 0.05). oFSH pulses were infrequent in both sexes and not influenced by castration. The mean plasma concentration of oFSH was greater in intact female fetuses than in intact males (female, 5.65 +/- 1.15 ng/ml vs. male, 2.07 +/- 0.45 ng/ml; P less than 0.01). Castration increased the mean value for plasma oFSH in males (4.40 +/- 0.43 ng/ml; P less than 0.001) but had no effect in females (3.83 +/- 0.64 ng/ml; P greater than 0.05).(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗

Prostate gland growth during development is stimulated in both male and female rat fetuses by intrauterine proximity to female fetuses.

In rodents, steroid hormones are transported between adjacent fetuses, and male or female fetuses that develop in utero between female fetuses (2F males or 2F females) have higher serum levels of estradiol and lower serum levels of testosterone relative to siblings of the same sex that develop between two male fetuses (2M males or 2M females). The present study was prompted by the prior unexpected finding that as adults, 2F male mice have an enlarged prostate, and increased numbers of prostatic androgen receptors relative to 2M males. We examined prostate development in both male and female rat fetuses from different intrauterine positions using computer-assisted, 3-dimensional reconstruction of the urogenital complex. In males, this included the prostate, seminal vesicles and utricle (a remnant of the Müllerian ducts), while in females it included development of prostatic glandular buds. The mean cross-sectional area of developing prostatic epithelial buds, utricle and seminal vesicles was significantly increased in 2F male relative to 2M male fetuses. In female fetuses, prostatic bud development was significantly more likely to occur in 2F (67%) than in 2M (29%) animals. These findings suggest that the transport of a small supplement of estrogen from adjacent female fetuses enhances androgen-dependent accessory organ development. We also found that mRNAs encoding receptors for both estrogen and androgen were located in the mesenchyme of the developing male prostate. The localization of estrogen and androgen receptor mRNA in this region further suggests that the mesenchymal induction of prostatic epithelial growth involves both hormones. The cranial dorsolateral prostatic buds exhibited the greatest enlargement in 2F males. This region of the developing prostate in rats is comparable (that is the embryonic homologue) to the region exhibiting benign prostatic hyperplasia (BPH) during aging in men. We propose that the potential for pathological regrowth of the prostate during aging is imprinted by estradiol during fetal development.

Animals↗

Caliber of the coronary sinus in fetuses with cardiac defects with and without left persistent superior vena cava and in growth-restricted fetuses with heart-sparing effect.

OBJECTIVE: To assess reference ranges for fetal coronary sinus (CS) diameter and to compare them with values from fetuses showing heart defects with and without left superior vena cava (LSVC) as well as with severe intrauterine growth retardation and heart-sparing effect on color Doppler. METHODS: The coronary sinus was visualized on two-dimensional ultrasound in a plane slightly caudal to the apical four-chamber view. For the normal range of the size of the CS in relation to gestational age, data was collected from 108/114 (95%) normal fetuses with good visualization between 20 weeks' gestation and term. Abnormal conditions comprised two groups: group 1 consisted of 52 fetuses with heart anomalies, including three subgroups: 11 fetuses with isolated LSVC emptying into the coronary sinus, 12 fetuses with LSVC associated with structural heart defects and 29 fetuses with structural heart defects but without LSVC. Group 2 consisted of 11 fetuses with severe intrauterine growth retardation and dilated coronary arteries as seen by color Doppler ultrasound. RESULTS: Under normal conditions, there was a significant increase in the CS diameter with advancing gestational age (1.2-2.7 mm). Significant dilatation was found only in the two groups with LSVC (range 2.7-6.5 mm), independent of whether the finding was isolated or associated with cardiac defects. CONCLUSION: CS visualization and measurements are easily feasible in the human fetus in the apical four-chamber view. Significant dilatation of the CS is a sign of LSVC. The examiner should be aware of this condition as such dilatation is commonly falsely diagnosed as atrial or atrioventricular septal defect.

Case-Control Studies↗

Plasma growth hormone concentration in the chronically catheterized ovine fetus during spontaneous term delivery and premature delivery induced by continuous intravascular infusion of low doses of adrenocorticotropin or cortisol to the fetus.

Fetal plasma growth hormone concentrations were measured in 15 pregnant ewes over the last 5 days before delivery. In five chronically catheterized pregnant ewes that underwent spontaneous vaginal delivery 146 +/- 2 days (mean +/- SD) of gestation, fetal plasma growth hormone concentrations fell from 124.6 +/- 44.1 ng X ml-1 5 days before delivery to 35.2 +/- 31.3 ng X ml-1 at delivery. In three fetuses in which premature delivery was induced by the infusion of cortisol to the fetus at 128 days of gestation, fetal plasma growth hormone levels fell from 195 +/- 19.1 ng X ml-1 to 70.7 +/- 25.5 ng X ml-1 over the last 5 days of intrauterine life. In seven fetuses in which premature delivery was induced with infusion of synthetic adrenocorticotropin to the fetus beginning at 120 or 130 days of gestation, the fetal plasma growth hormone level did not fall (175.6 +/- 75.7 to 158.9 +/- 60.1 ng X ml-1). Fetal plasma cortisol concentrations at delivery were significantly higher in the cortisol-infused fetuses (214 +/- 38.4 ng X ml-1) than in both control (94.4 +/- 33.7 ng X ml-1) and adrenocorticotropic hormone-infused fetuses (94.5 +/- 31.9 ng X ml-1). The fall in the fetal plasma growth hormone level in cortisol-induced fetuses may be due to the higher fetal plasma cortisol concentrations achieved in the cortisol-infused compared with the adrenocorticotropic hormone-infused fetuses in which no comparable decrease in growth hormone was observed. These findings suggest that there are significant differences in the fetal response to various experimental regimens used for the induction of premature labor in the sheep.

Adrenocorticotropic Hormone↗

Hemodynamics of the renal artery and descending aorta in fetuses with renal disease using color Doppler ultrasound--longitudinal comparison to normal fetuses.

OBJECTIVE: To examine the hemodynamic values of the renal artery (RA) and descending aorta (DA) in normal fetuses, and to compare these values to those of fetuses with renal disease, thus evaluating the usefulness of hemodynamic analysis for the diagnosis of fetal renal disease. MATERIALS AND METHODS: We examined 46 normal fetuses and 15 fetuses with renal disease (six cases of polycystic kidney (PCK) and nine cases of hydronephrosis). We measured the maximum systolic velocity (Vmax ) of the RA and DA using color Doppler. Measurements were made five times, from the 20th to the 40th week, in both the control and the renal disease group. RESULTS: In the fetuses with PCK (Potter's syndrome) that died postpartum from non-functional kidneys, the Vmax of the RA and DA in the 35th week were 13 cm/s and 25.4 cm/s, respectively. In the fetus with PCK (Trisomy 9) that died due to non-functional kidneys in the 34th week, the values were 13.3 cm/s and 29.6 cm/s, respectively. These values were well below those of the normal group: more than 1.5 SD below the mean. In two fetuses from the nine with hydronephrosis that had a unilateral non-functional kidney, the RA did not clearly show identifiable blood flow. CONCLUSIONS: The V max of the RA and DA in fetuses with renal disease correlates with fetal kidney function, particularly the RA Vmax.Vmax of 1.5 SD below the mean should be the lower normal limit.

Aorta, Thoracic↗

Hysterotomy and selective delivery of an intrauterine dead fetus to prevent intrauterine death or brain damage of the surviving fetus in monochorionic twin pregnancy.

When pregnancy is continued after death of one fetus in monochorionic twin pregnancy, the surviving fetus sometimes exhibits intrauterine death or brain damage. Hysterotomy and selective delivery of an intrauterine dead fetus was performed in order to prevent intrauterine death or brain damage of the surviving fetus at 24 weeks' gestation in a monochorionic twin pregnancy. The healthy baby except for immaturity was born at 30 weeks' gestation, and exhibited no brain damage postnatally. When one fetus has died in utero before maturity of surviving fetus, hurried selective delivery of dead fetus should be one of the useful treatments to prevent intrauterine death or brain damage of the surviving fetus in monochorionic twin pregnancy.

Adult↗

Circulating hematopoietic progenitor cells in a fetus with alpha thalassemia: comparison with the cells circulating in normal and non-thalassemic anemia fetuses and implications for in utero transplantations.

Our aim was to evaluate the number of progenitor cells circulating in an alpha-thalassemic fetus during its infusion in utero with paternal CD34(+) and adult red cells and to compare those values with those circulating in normal and non-thalassemic anemic fetuses of matched gestational age. The treatment of the alpha-thalassemic fetus has been described elsewhere. Fetal blood was obtained from normal and anemic fetuses by fetal blood sampling for diagnostic or therapeutic purposes according to a protocol approved by the human subject committee. The number of progenitor cells in fetal blood was estimated on the basis of the number of colonies they gave rise to in semisolid cultures. The alpha-thalassemic fetus, as did the other fetuses analyzed, contained high numbers (10(6)-10(7) depending on the age) of progenitor cells, values which were higher than the number (10(4)-10(5)) of paternal progenitor cells being transplanted. Progenitor cells with adult characteristics (adult kinetics of differentiation) were detected rapidly (10 min) after the CD34(+) cell infusion, but were not detectable 2-3 weeks after the transplant. These results indicate that adult progenitor cells do not have a numerical advantage when transplanted into alpha-thalassemic fetuses.

Antigens, CD34↗

[A case report of Campylobacter fetus subspecies fetus oophoritis].

A 45-year-old female with oophoritis (pelvic inflammatory disease) caused by Campylobacter fetus (C. fetus) is reported. She was admitted to the hospital because of high fever and an acute abdomen. On admission, severe inflammation was observed by the laboratory findings, and abdominal X-ray and CT scan revealed ileus with marked swelling of the right ovary. Laparotomy was performed with adonexooophrectomy due to the tubo-ovarian abscesses. C. fetus was isolated from the right ovary, salpinx and ascites. Erythromycin was administered after a sensitive test of C. fetus as the bacteria was isolated at operation. She was discharged on the 17th day after her admission. Indirect immunofluorescent test with hyperimmune rabbit sera to isolated C. fetus revealed a fine to coarse granular immunoreaction in the cytoplasm of the macrophages infiltrated in the tissue. This result was interpreted as the existence and growth of bacteria in the right ovarian tissue. Oophoritis due to C. fetus subspecies fetus is very rare. To our knowledge, this case is the second case reported in Japan.

Campylobacter Infections↗

[A case of meningoencephalitis and spondylodiscitis caused by Campylobacter fetus subsp. fetus infection].

Campylobacter fetus subsp. fetus (C. fetus) is a gram-negative, curved, rod-shaped microaerophile, occasionally may cause meningitis or meningoencephalitis in humans. This report documents the case of 49-year-old man with lumbar spondylodiscitis and meningoencephalitis caused by C. fetus infection. On admission, the patient was delirious and severe inflammatory reactions were seen in his serum. Cerebrospinal fluid (CFS) revealed normal glucose concentration and moderate mononuclear leukocytosis. Campylobacter species, which was very difficult to be identified, was cultured from the blood and CSF. During his clinical course, the patient complained of severe back pain, and lumbar MRI showed low intensity in a T1-weighed image of the L4 and L5 vertebral bodies and high intensity in a T2-weighed image of the L4-5 disc. The patient was diagnosed with spondylodiscitis caused by C. fetus infection. Meningoencephalitis may have occurred as a secondary infection. Antibiotics were administered, and the patient's condition improved. To our knowledge, only a few cases of spondylodiscitis caused by C. fetus have been reported. A CSF glucose concentration in the normal range and mononuclear leukocytosis are atypical findings in patients with pyogenic meningitis. Therefore, neurologists must be fully aware of the possible symptoms and signs of C. fetus infection.

Campylobacter Infections↗