Campylobacter jejuni

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

  • Enterotoxigenic E. coli (most common cause of watery diarrhea)[2]
  • Norovirus (often has prominent vomiting)
  • Campylobacter
  • Non-typhoidal Salmonella
  • Enteroaggregative E. coli (EAEC)
  • Enterotoxigenic Bacteroides fragilis

Traveler's Diarrhea

Evaluation

Not every patient with fever and diarrhea requires work-up - use clinical judgement

  • Consider work-up for patient with:
    • Fever
    • Toxic appearance
    • Diarrhea 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

Management[3]

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

Disposition

  • Most patients can be discharged
  • Admit for rehydration in those with severe illness/inability to tolerate PO

See Also

External Links

References

  1. U.S. Dept of Health and Human Services. Campylobacter. https://www.foodsafety.gov/poisoning/causes/bacteriaviruses/campylobacter/index.html
  2. Marx et al. “Cholera and Gastroenteritis caused by Noncholera Vibrio Species”. Rosen’s Emergency Medicine 8th edition vol 1 pg 1245-1246.
  3. http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat
  4. CDC. Campylobacter (Campylobacteriosis) - Antibiotic resistance. Last modified October 2, 2017. https://www.cdc.gov/campylobacter/campy-antibiotic-resistance.html