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Campylobacter Infections

by Matthew E. Levison, MD

Several species of Campylobacter (most commonly Campylobacter jejuni) can infect the digestive tract, often causing diarrhea.

  • People can be infected when they consume contaminated food or drink or have contact with infected people or animals.

  • These infections cause diarrhea, abdominal pain, and fever.

  • Identifying the bacteria in a stool sample confirms the diagnosis.

  • For some people, replacing lost fluids is all that is needed, but if symptoms are severe, antibiotics are also needed.

Campylobacter bacteria normally inhabit the digestive tract of many farm animals (including cattle, sheep, pigs, and fowl). The feces of these animals may contaminate water in lakes and streams. Meat (usually poultry) and unpasteurized milk may also be contaminated. People may be infected in several ways:

  • Eating or drinking contaminated (untreated) water, unpasteurized milk, undercooked meat (usually poultry), or food prepared on kitchen surfaces touched by contaminated meat

  • Contact with an infected person (particularly oral-anal sexual contact)

  • Contact with an infected animal

Campylobacter bacteria cause inflammation of the colon (colitis) that results in fever and diarrhea. These bacteria are a common cause of infectious diarrhea in the United States and among people who travel to countries where food or water may be contaminated. Infections are most commonly caused by Campylobacter jejuni.

Symptoms

Symptoms usually develop 2 to 5 days after exposure and continue for about 1 week. Symptoms of Campylobacter colitis include diarrhea, abdominal pain, and cramps, which may be severe. The diarrhea may be bloody and can be accompanied by nausea, vomiting, and fever ranging from 100 to 104° F (38 to 40° C).

In some people with colitis, the bloodstream is temporarily infected (called bacteremia). This infection usually causes no symptoms or complications. However, the bloodstream is repeatedly or continuously infected in a few people. This type of bacteremia usually develops in people with a disorder that weakens the immune system, such as AIDS, diabetes, or cancer. This infection causes a long-lasting or recurring fever. Other symptoms develop as the bloodstream carries the infection to other structures, such as the following:

  • The space within the tissues covering the brain and spinal cord (causing meningitis)

  • Bones (causing osteomyelitis)

  • Joints (causing infectious arthritis)

  • Rarely, heart valves (causing endocarditis)

Guillain-Barré syndrome (see Guillain-Barré Syndrome) develops in about 1 of 1,000 of people with Campylobacter colitis. Guillain-Barré syndrome causes weakness or paralysis. Most people recover, but muscles may be greatly weakened. People may have difficulty breathing and need to use a mechanical ventilator. Weakness does not always completely resolve. Campylobacter colitis is thought to trigger about 20 to 40% of all cases of Guillain-Barré syndrome.

Weeks to months after the diarrhea resolves, reactive arthritis may develop. Usually, the disorder causes inflammation and pain in the knees, hips, and Achilles tendon.

Diagnosis

Doctors may take a sample of stool and send it to a laboratory to grow (culture) the bacteria. However, stool is not always tested. Stool cultures take days to complete, and doctors do not usually need to know which bacteria caused the diarrhea to effectively treat it. If the bacteria are identified, they are tested to see which antibiotics are effective (a process called susceptibility testing).

If doctors suspect that the bloodstream is infected, they take a sample of blood to be cultured.

Treatment

Many people get better in a week or so without specific treatment. Some people require extra fluids intravenously or by mouth. People who have a high fever, bloody or severe diarrhea, or worsening symptoms may need to take azithromycin for 3 days or erythromycin for 5 days. Both drugs are taken by mouth. If the bloodstream is infected, antibiotics such as imipenem, gentamicin, or azithromycin are required for 2 to 4 weeks.

Drugs Mentioned In This Article

  • Generic Name
    Select Brand Names
  • ZITHROMAX
  • ERY-TAB, ERYTHROCIN
  • GENOPTIC