|
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 in adults, more often when underlying predisposing diseases, such as diabetes, cirrhosis, or cancer, 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 and ingestion of contaminated food (especially undercooked poultry) or water have been implicated in outbreaks. 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.
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 and hepatosplenomegaly are frequent.
Patients can also present with subacute bacterial endocarditis, 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
Diagnosis, particularly to differentiate Campylobacter infection from ulcerative colitis (see Inflammatory Bowel Disease (IBD): 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
Most enteric infections resolve spontaneously; if they do not, erythromycin 500 mg po q 6 h for 5 days may be helpful. For patients with extraintestinal infections, antibiotics (eg, imipenem, gentamicin, ampicillin, erythromycin) should be given for 2 to 4 wk to prevent relapses.
Last full review/revision August 2009 by Burke A. Cunha, MD
|
