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Updated: Dec 7 2018

Campylobacter jejuni

  • 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
        • a 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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