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Campylobacter Infections

by Larry M. Bush, 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, usually Campylobacter jejuni, 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.

Symptoms of Campylobacter Infections

Campylobacter 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, headache, muscle aches, and fever ranging from 100 to 104° F (38 to 40° C).

Complications

Complications can include

Bacteremia (a bloodstream infection) occurs temporarily in some people with colitis. 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:

Guillain-Barré syndrome (a nerve disorder) develops in about 1 of 1,000 of people with Campylobacter colitis because antibodies that the body makes to fight off the infection sometimes also attack the nerves. 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 up to 30% of all cases of Guillain-Barré syndrome.

Reactive arthritis may develop days to weeks after the diarrhea resolves. Usually, the disorder causes inflammation and pain in the knees, hips, and Achilles tendon.

Diagnosis of Campylobacter Infections

  • Culture of a stool sample

  • Sometimes culture of a blood sample

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. However, if people have bloody diarrhea or appear seriously ill, the stool is usually tested.

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 of Campylobacter Infections

  • Usually no specific treatment

  • Sometimes an antibiotic such as azithromycin

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 erythromycin are required for 2 to 4 weeks.

More Information

Drugs Mentioned In This Article

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