Campylobacter Infection

Key Features

Essentials of Diagnosis

• Fever, vomiting, abdominal pain, diarrhea

• Definitive diagnosis by stool culture

General Considerations

• 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

Clinical Findings

Symptoms and Signs

• 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

Differential Diagnosis

• Viral gastroenteritis

• Salmonellosis

• Shigellosis

• Amebiasis

• Other infectious diarrheas

• Ulcerative colitis

• Crohn disease

• Intussusception

• Appendicitis

Diagnosis

• 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

Treatment

• 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

Outcome

Complications

• 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

Prevention

• No vaccine is available

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

Prognosis

• 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

References