Updated: 12/7/2018

Campylobacter jejuni

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Snapshot
  • A 53-year-old woman presents to an urgent care clinic for diarrhea and abdominal cramping for the past 2 days. She reports having a subjective fever with nausea and frequent watery diarrhea that is occasionally bloody. She recently went on a backpacking trip throughout Southeast Asia and returned 5 days ago. On physical exam, she has dry mucous membranes and her abdomen is soft, nontender, and nondistended. She is started on intravenous hydration and a stool culture is sent. Given her recent travel history, she is started on appropriate antibiotics.
Introduction
  • Classification
    • Campylobacter jejuni
      • comma/S-shaped, oxidase-positive gram-negative rod with a polar flagella
        • grows at 42°C
      • transmission via fecal-oral route
      • causes watery or bloody diarrhea
  • Epidemiology
    • incidence
      • the most common cause of bacterial diarrhea in the US
    • demographics
      • children > adults
    • risk factors
      • travel
      • undercooked poultry or meat
      • unpasteurized dairy products
      • contact with infected domestic animals
      • acid reflux medications (proton pump inhibitors)
  • Pathogenesis
    • invades gastrointestinal tract mucosa and disseminate
  • Prognosis
    • symptoms occur 1-3 days after exposure
    • the disease is usually self-limited
Presentation
  • Symptoms
    • fever
    • abdominal cramps
    • diarrhea can be watery or bloody with pus
    • frequent stools
    • nausea
  • Physical exam
    • weight loss
    • signs of dehydration
Studies
  • Labs
    • stool culture
      • gold standard for diagnosis
  • Making the diagnosis
    • based on clinical presentation and laboratory studies
Differential
  • Enteroinvasive Escherichia coli (EIEC) infection
    • distinguishing factor
      • clinically very similar but presents more frequently with bloody diarrhea
      • distinguish based on culture or polymerase chain reaction
Treatment
  • Management approach
    • mainstay of treatment is supportive care as the disease is usually self-limited
  • Conservative
    • supportive care
      • indication
        • all patients
      • modalities
        • intravenous hydration
        • electrolyte repletion
  • Medical
    • azithromycin
      • indication
        • severe infections or suspected traveler’s diarrhea, as the likelihood of a bacterial infection such as Campylobacter infection is high
Complications
  • Reactive arthritis (Reiter syndrome)
    • classic triad of conjunctivitis, urethritis, and arthritis
  • Guillain-Barre syndrome
    • antigenic cross-reactivity between Campylobacter oligosaccharides and glycosphingolipids on neural tissues

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