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