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Campylobacter and Related Infections

by Larry M. Bush, MD, Maria T. Perez, MD

Campylobacter infections commonly cause diarrhea and occasionally bacteremia, with consequent endocarditis, osteomyelitis, or septic arthritis.

Campylobacter sp are motile, curved, microaerophilic, gram-negative bacilli that normally inhabit the GI tract of many domestic animals and fowl. Several species are human pathogens. The major pathogens are C. jejuni and C. fetus. C. jejuni causes diarrhea in all age groups, although peak incidence appears to be from age 1 to 5 yr. C. jejuni accounts for more cases of diarrhea in the US than Salmonella and Shigella combined. C. fetus and several others typically cause bacteremia and systemic manifestations in adults, more often when underlying predisposing diseases, such as diabetes, cirrhosis, cancer, or HIV/AIDS, are present. In patients with immunoglobulin deficiencies, these organisms may cause difficult-to-treat, relapsing infections. C. jejuni can cause meningitis in infants.

Contact with infected animals (eg, puppies) and ingestion of contaminated food (especially undercooked poultry) or water have been implicated in outbreaks. Person-to-person transmission through fecal-oral and sexual contact may also occur. However, in sporadic cases, the source of the infecting organism is frequently obscure.

Complications

C. jejuni diarrheal illness is associated with subsequent development (up to 30% of cases) of Guillain-Barré syndrome because of cross-reaction between C. jejuni antibodies and surface components of peripheral nerves.

Postinfectious (reactive) arthritis may occur in HLA-B27–positive patients a few days to several weeks after an episode of C. jejuni diarrhea.

Focal extraintestinal infections (eg, endocarditis, meningitis, septic arthritis) occur rarely with C. jejuni but are more common with C. fetus.

Symptoms and Signs

The most common manifestation is watery and sometimes bloody diarrhea. Fever (38 to 40° C), which follows a relapsing or intermittent course, is the only constant feature of systemic Campylobacter infection, although abdominal pain (typically in the right lower quadrant), headache, and myalgias are frequent.

Patients can also present with subacute bacterial endocarditis (more often due to C. fetus), reactive arthritis, meningitis, or an indolent FUO rather than with diarrheal illness. Joint involvement with reactive arthritis is usually monoarticular, affecting the knees; symptoms resolve spontaneously over 1 wk to several months.

Diagnosis

  • Stool culture

  • Sometimes blood cultures

Diagnosis, particularly to differentiate Campylobacter infection from ulcerative colitis (see Ulcerative Colitis), requires microbiologic evaluation. Stool culture should be obtained plus blood cultures for patients with signs of focal infection or serious systemic illness. WBCs are present in stained smears of stool.

Treatment

  • Sometimes erythromycin

Most enteric infections resolve spontaneously; if they do not, erythromycin 500 mg po q 6 h for 5 days may be helpful. Azithromycin 500 mg po once/day for 3 days is an alternative. Because resistance to ciprofloxacin is increasing, this drug should be used judiciously. For patients with extraintestinal infections, antibiotics (eg, imipenem, gentamicin, ampicillin, a 3rd-generation cephalosporin, erythromycin) should be given for 2 to 4 wk to prevent relapses.

Drugs Mentioned In This Article

  • Drug Name
    Select Trade
  • ERY-TAB, ERYTHROCIN
  • GENOPTIC
  • ZITHROMAX
  • CILOXAN, CIPRO
  • No US brand name

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