Campylobacter jejuni

Background

• Gram negative, non spore forming bacteria
• Commonly found in animal feces
• Caused by oral-fecal transmission
• Associated with Guillain-Barre syndrome and Reiter syndrome

Clinical Features

• Acute diarrheal illness (<3 weeks)
• Severe abdominal pain
• Fever
• Bloody/voluminous/purulent stools
• Systemic illness/symptoms

Differential Diagnosis

• Infectious:
  • Salmonella
  • Shigella
  • Shiga toxin-producing E. coli
  • E. coli 0157:H7
  • Entamoeba histolytica
  • Yersinia
  • Vibrio
  • C. difficile
• Non-infectious:
  • Inflammatory bowel disease
  • GI bleed
  • Adrenal insufficiency
  • Mesenteric ischemia
  • Thyroid storm
  • Toxicologic exposure
  • Radiation syndrome

Diagnostic Evaluation

• Initiate work up in patients:
  • Appearing toxic
  • Febrile
  • Diarrheal illness lasting >3 days
  • Blood or pus in stool
  • Immunocompromised patients with presumed infectious diarrhea
• Bacterial stool culture
• Stool ova and parasites if concern for parasitic infection
• Consider C. difficile PCR if patient has risk factors
• Note- in many labs, stool culture tests for Salmonella, Shigella, and Campylobacter; discuss with your lab for further testing
• Note- not every patient with fever and diarrhea needs work up, use clinical judgment

Management

• Fluid resuscitation- oral rehydration therapy preferred
• Avoid antimotility agents with bloody diarrhea
• Many recover without antimicrobial therapy
• Antibiotics if severe illness:
  • Macrolides
    • Azithromycin
  • Fluroquinolones
    • Ciprofloxacin
• Note- resistance is becoming prevalent

Disposition

• Home for most patients
• Admit for rehydration in those with severe illness/inability to tolerate PO

See Also

• Diarrhea

References

• Kman N. Disorders Presenting Primarily with Diarrhea. In: Tintinalli's Emergency Medicine. 7th ed. McGraw-Hill. 2011: 531-536.