Campylobacter Infections

Campylobacter Infections: Excerpt from The 5-Minute Pediatric Consult

Eric J. Haas, MDLouis M. Bell, Jr., MD

Campylobacter Infections - BASICS

Campylobacter Infections - description

• Campylobacter species involved in human infections include C. jejuni (which causes enteritis) and C. fetus (implicated in systemic illness)
• Campylobacter is a motile, curved, microaerophilic, non–lactose-fermenting, Gram-negative rod that requires oxygen and carbon dioxide for optimal growth.

Campylobacter Infections - epidemiology

• Campylobacter infections equal and perhaps exceed the number of cases of inflammatory enteritis as a result of other causes, with the highest attack rates observed in young children.
• 30–100% of chickens, turkeys, and water fowl are infected asymptomatically in addition to swine, cattle, sheep, horses, rodents, and household pets (especially young). Contaminated water and milk sources also act as reservoirs for infections.
• Resistant strains are increasingly thought to be related to widespread use of antibiotics in agriculture.
• Transmission of disease is by the fecal-oral route from contaminated food and water or by direct contact with fecal material from animals or persons infected with the organism.
• Person-to-person transmission of C. jejuni has been reported when the index cases were young children who were incontinent of feces; vertical transmission from mother to neonate has also been reported.
• Asymptomatic hospital personnel or food handlers have not been implicated as sources.
• The peak rate of isolation occurs in the warmer months of the year (late summer, early fall).

Campylobacter Infections - pathophysiology

• C. jejuni adheres to epithelial cells and mucus, secretes cytotoxins (which play a role in the development of watery diarrhea), and induces an inflammatory ileocolitis.
• Enteritis, the best-known disease of C. jejuni, has been isolated more often than Salmonella or Shigella, with an incidence of 4–12% of diarrheal illness.
• Bacteremia, although uncommon, can occur, especially in the neonate and immunocompromised host; C. fetus is the species most likely to be isolated.
• C. upsaliensis has been identified in immunocompromised individuals and is usually associated with a self-limiting enteritis.

Campylobacter Infections - DIAGNOSIS

Campylobacter Infections - signs & symptoms

Campylobacter Infections - history

• Exposure to unpasteurized milk products? Source of Campylobacter infection
• Well water used? Contaminated water serves as a reservoir.
• Inadequately cooked poultry? Chickens are asymptomatic carriers.
• Fever, abdominal pain, bloody diarrhea? Illness is characterized by fever, abdominal pain, and bloody diarrhea. Symptoms can last for 24 hours and be indistinguishable from a viral gastroenteritis, or can be relapsing, thus mimicking inflammatory bowel disease.
• Inflammatory ileocolitis? The most common manifestation in children.
• Duration of symptoms? Incubation period is 1–7 days and is usually self-limited by 5–7 days.
• Abdominal pain, diarrhea, malaise, and fever: Signs and symptoms of C. jejuni infection.
• If the infection establishes a chronic phase (20% of infected patients), symptoms may mimic inflammatory bowel disease and other immunoreactive complications such as reactive arthropathy, Guillain-Barré syndrome (GBS), Reiter syndrome, and erythema nodosum may occur.

Campylobacter Infections - tests

• Examination of fecal specimen for darting motility of C. jejuni by darkfield or phase-contrast microscopy: If examined within 2 hours of passage, it can permit presumptive diagnosis.
• Stool culture: Can be used, but selective media (Skirrow, Butzler, or campy-BAP) must be used to isolate Campylobacter species.
• DNA-based testing: Development of this diagnostic tool will improve the ability to detect and differentiate Campylobacter species much faster than the gold standard of stool culture.

Not all bacterial colitis presents with blood or mucus-appearing diarrhea. Therefore, suspicion should exist if the diarrhea is prolonged or environmental exposures pose a risk for developing infection.

Campylobacter Infections - differencial diagnosis

Campylobacter infection should be considered in all patients with a diarrheal illness, especially those with a history of bloody or mucous stools, recurrent gastritis, or in immunocompromised hosts.

Campylobacter Infections - TREATMENT

Campylobacter Infections - medication

• Immunocompetent children with diarrhea usually improve with rehydration alone.
• Select patient populations (HIV and other immunocompromised individuals, pregnant women) may benefit from early therapy.
• If treated early in the course of disease (<4 days), erythromycin or azithromycin for 5–7 days appears to be effective in eradicating the organism from the stool within 2–3 days.
• Ciprofloxacin, tetracycline, aminoglycosides, and imipenem are alternative antimicrobials if resistant or bacteremic strains are present, although quinolone resistance in particular is rising.
• Appropriate treatment of bacteremia should be based on antimicrobial susceptibility testing.

Campylobacter Infections - FOLLOW UP

• When treated, symptoms should improve in 2–3 days.
• In the untreated patient, the median excretion of organism is up to 2–3 weeks, and it was 3 months before all patients in one study were free of the organism. Asymptomatic carriage is uncommon.
• The expected course of treatment of C. jejuni infection is variable because in vitro sensitivities are not reliable predictors of the response to treatment.

Campylobacter Infections - prognosis

For patients with enteritis, the prognosis is very good, regardless of whether antibiotic treatment is given.

Campylobacter Infections - complications

• Postinfectious immunologic complications include reactive arthritis, GBS, Miller-Fisher syndrome, Reiter syndrome, and erythema nodosum.
• C. jejuni is the most frequently identified cause of GBS with serotypes O:19 and O:41, and is responsible for up to 40% of GBS cases.
• HLA-B27 antigen is associated with reactive arthropathy.
• Seizures may develop in young children with enteritis and high fevers.
• A typhoidlike syndrome and meningitis have also been reported in patients with Campylobacter infection.
• Spontaneous abortion and hemolytic-uremic syndrome have been described with C. upsaliensis.

Campylobacter Infections - bibliography

American Academy of Pediatrics. Campylobacter Infections. In: Pickering LK, Baker CJ, Long SS, et al., eds. Red Book: 2006 Report of the Committee on Infectious Diseases, 27th ed. Elk Grove, IL: American Academy of Pediatrics; 2006:240–242.
1. Bereswill S, Kist M. Recent developments in Campylobacter pathogenesis. Curr Opin Infect Dis. 2003;16(5):487–491.
2. Blaser MJ, Reller LB. Campylobacter enteritis. N Engl J Med. 1981;305:1444–1452.
3. Bourke B, Chan VL, Sherman P. Campylobacter upsaliensis: Waiting in the wings. Clin Microbiol Rev. 1998;11:440–449.
4. Crushell E, Harty S, Sharif F, et al. Enteric Campylobacter: Purging its secrets? Pediatr Res. 2004;55:3–12.
5. Fields PI, Swerdlow DL. Campylobacter jejuni. Clin Lab Med. 1999;19:489–504.
Heresi G, Murphy J, Cleary T. Campylobacter infections. In: Feigin RD, Cherry JD, eds. Pediatric Infectious Diseases, 5th ed. Philadelphia: WB Saunders; 2004:1612–1628.
6. McCarthy N, Giesecke J. Incidence of Guillain-Barre syndrome following infection with Campylobacter jejuni. Am J Epidemiol. 2001;153(6):610–614.
7. Shea KM. Antibiotic resistance: What is the impact of agricultural uses of antibiotics on children’s health? Pediatrics. 2003;112:253–258.
8. Tauxe RV, Hargrett-Bean N, Patton CM, et al. Campylobacter isolates in the United States, 1982–1986. MMWR Morb Mortal Wkly Rep. 1987;37:10–25.
9. Thorson SM, Lohr JA, Dudley S, et al. Value of methylene blue examination, dark-field microscopy, and carbol-fuchsin Gram stain in the detection of Campylobacter enteritis. J Pediatr. 1985;106:941–943.

Campylobacter Infections - CODES

Campylobacter Infections - icd9

008.43 Campylobacter

Campylobacter Infections - PATIENT TEACHING-MED

Campylobacter Infections - prevent

• The importance of handwashing after contact with animals or animal products, proper cooling and storage of foods, pasteurization of milk, and chlorination of water supplies will decrease the overall risk for infection.
• In the hospital setting, enteric precautions are recommended for infected infants and children who are incontinent of stool and should be maintained until the patient receives at least 48 hours of antibiotic treatment.

Campylobacter Infections - FAQ

• Q: Is treatment necessary if the child is asymptomatic by the time the Campylobacter is isolated as the pathogen causing the enteritis?
• A: No treatment is needed in this situation. Therapy for symptomatic patients, although it may be of benefit, has not been proven efficacious.
• Q: Are there any risks of Campylobacter infection to pregnant patient?
• A: Women infected symptomatically or asymptomatically may experience recurrent abortions or preterm deliveries. Life-threatening infections to the fetus or newborn are also possible.
• Q: Can you develop immunity to Campylobacter infections?
• A: Immunity to C. jejuni is acquired after one or more infections. For children living in endemic areas, effective natural immunity is a result of significant repeated early exposure with a progressive decrease in the illness/infection ratio as age increases.
• Q: What is the relationship between GBS and C. jejuni infection?
• A: Many strains of C. jejuni have surface glycolipids that are similar to gangliosides, which are abundant in the central and peripheral nervous systems. Antibody formation from this infection binds to the gangliosides causing the demyelinating process characteristic of GBS.

Book Source Details

• Book Title: The 5-Minute Pediatric Consult
• Author(s): M. William Schwartz MD; et al.
• Year of Publication: 2008
• Copyright Details: The 5-Minute Pediatric Consult, Copyright © 2008 Lippincott Williams & Wilkins.

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• Back to disease: Campylobacter food poisoning: Introduction
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Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.

More About This Book: Title: The 5-Minute Pediatric Consult Authors: M. William Schwartz MD; et al. Publisher: Lippincott Williams & Wilkins Copyright: 2008 ISBN: 0-7817-7577-9

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