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Key Features

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Essentials of Diagnosis
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  • Fever, vomiting, abdominal pain, diarrhea

  • Definitive diagnosis by stool culture

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General Considerations
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  • Campylobacter jejuni frequently causes acute enteritis in humans

  • In North America and Europe, enteritis due to C jejuni is more common than that due to Salmonella or Shigella

  • Contaminated food and water, improperly cooked poultry, and person-to-person spread by the fecal-oral route are common routes of transmission

  • Newborns may acquire the organism from their mothers at delivery

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Clinical Findings

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Symptoms and Signs
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  • C jejuni enteritis

    • Can be mild or severe

    • Asymptomatic stool carriage is common in tropical countries

    • Incubation period is usually 1–7 days

    • Disease usually begins with

      • Sudden onset of high fever

      • Malaise

      • Headache

      • Abdominal cramps

      • Nausea and vomiting

    • Diarrhea follows and may be watery or bile-stained, mucoid, and bloody

  • Campylobacter fetus

    • Causes bacteremia and meningitis in immunocompromised patients

    • May cause maternal fever, abortion, stillbirth, and severe neonatal infection

  • Helicobacter pylori (previously called Campylobacter pylori) causes gastritis and peptic ulcer disease in both adults and children

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Differential Diagnosis
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  • Viral gastroenteritis

  • Salmonellosis

  • Shigellosis

  • Amebiasis

  • Other infectious diarrheas

  • Ulcerative colitis

  • Crohn disease

  • Intussusception

  • Appendicitis

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Diagnosis

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  • Peripheral WBC count generally is elevated, with many band forms

  • Microscopic examination of stool reveals erythrocytes and pus cells

  • Isolation of C jejuni from stool requires

    • Selective agar

    • Incubation at 42°C rather than 35°C

    • Incubation in an atmosphere of about 5% oxygen and 5% CO2

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Treatment

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  • Treatment of fluid and electrolyte disturbances is important

  • Erythromycin (30–50 mg/kg/d orally in four divided doses for 5 days), azithromycin (10 mg/kg/d orally once daily) for 3 days, or ciprofloxacin terminates fecal excretion

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Outcome

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Complications
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  • Dehydration is most common

  • Other uncommon complications include

    • Erythema nodosum

    • Convulsions

    • Reactive arthritis

    • Bacteremia

    • Urinary tract infection

    • Cholecystitis

  • Guillain-Barré syndrome may follow C jejuni infection by 1–3 weeks

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Prevention
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  • No vaccine is available

  • Hand washing and adherence to basic food sanitation practices help prevent disease

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Prognosis
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  • Outlook is excellent if dehydration is corrected and misdiagnosis does not lead to inappropriate diagnostic or surgical procedures

  • C jejuni enteritis

    • Illness is self-limiting, lasting 2–7 days, but relapses may occur

    • Without antimicrobial treatment, the organism remains in the stool for 1–6 weeks

    • Immune compromised patients may suffer prolonged or relapsing disease or complications due to bacteremia

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References

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Centers for Disease Control and Prevention (CDC): Campylobacter infections. Available at: http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter.
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Ricotta  EE  et al: Epidemiology and antimicrobial resistance of international travel associated Campylobacter infections in the United States, 2005–2011. Am J Public Health 2014;104(7): e108–e114
[PubMed: 24832415]
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Scallan  E: ...

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