Campylobacter jejuni
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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[1]
- 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
- Macrolides
- 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
- Kman N. Disorders Presenting Primarily with Diarrhea. In: Tintinalli's Emergency Medicine. 7th ed. McGraw-Hill. 2011: 531-536.