Campylobacter jejuni: Difference between revisions

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


==Clinical Features==
==Clinical Features==
* Acute diarrheal illness (<3 weeks)
*Acute diarrheal illness (<3 weeks)
* Severe [[abdominal pain]]
*Severe [[abdominal pain]]
* [[Fever]]
*[[Fever]]
* Bloody/voluminous/purulent stools  
*Bloody/voluminous/purulent stools  
* Systemic illness/symptoms
*Systemic illness/symptoms


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


{{Diarrhea DDX}}
{{Diarrhea DDX}}


==Diagnostic Evaluation==
==Diagnostic Evaluation==
* Initiate work up in patients:
*Initiate work up in patients:
** Appearing toxic  
**Appearing toxic  
** Febrile  
**Febrile  
** Diarrheal illness lasting >3 days
**Diarrheal illness lasting >3 days
** Blood or pus in stool
**Blood or pus in stool
** Immunocompromised patients with presumed infectious diarrhea
**Immunocompromised patients with presumed infectious diarrhea
* Bacterial stool culture
*Bacterial stool culture
* Stool ova and parasites if concern for parasitic infection
*Stool ova and parasites if concern for parasitic infection
* Consider [[C. difficile]] PCR if patient has risk factors
*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- 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  
*Note- not every patient with fever and diarrhea needs work up, use clinical judgment  


==Management<ref>http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat</ref>==
==Management<ref>http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat</ref>==
* Fluid resuscitation- oral rehydration therapy preferred  
*Fluid resuscitation- oral rehydration therapy preferred  
* Avoid antimotility agents with bloody diarrhea  
*Avoid antimotility agents with bloody diarrhea  
* Many recover without antimicrobial therapy
*Many recover without antimicrobial therapy
* Antibiotics if severe illness:
*Antibiotics if severe illness:
** [[Macrolides]]
**[[Macrolides]]
*** [[Azithromycin]]
***[[Azithromycin]]
** [[Fluroquinolones]]
**[[Fluroquinolones]]
*** [[Ciprofloxacin]]
***[[Ciprofloxacin]]
* Note- resistance is becoming prevalent
*Note- resistance is becoming prevalent


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


==See Also==
==See Also==

Revision as of 07:31, 6 July 2016

Background

Clinical Features

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

Differential Diagnosis

Acute diarrhea

Infectious

Noninfectious

Watery Diarrhea

Traveler's Diarrhea

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[2]

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

Disposition

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

See Also

External Links

References

  1. ↑ Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  2. ↑ http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat
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