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Back to Infectious Diseases
Campylobacter infection
Campylobacters are motile, non-spore-forming, curved gram-negative
rods. These species are currently divided into three genera: Campylobacter,
Arcobacter, and Helicobacter. The human pathogens can be divided into
two major groups: those that primarily cause
diarrheal disease and those
that cause extraintestinal infection. The principal
diarrheal pathogen
is C. jejuni, which accounts for 80 to 90% of all cases of recognized
illness due to campylobacters.
Clinical presentation
It is usually a self limited dysentery with lesions similar to ulcerative
colitis. There is often a prodrome, with fever, headache, myalgia, and/or
malaise, 12 to 48 h before the onset of
diarrheal symptoms. The most common
symptoms of the intestinal phase are
diarrhea, abdominal pain, and fever.
The degree of
diarrhea varies from several loose stools to grossly bloody
stools; most patients presenting for medical attention have 10 or more
bowel movements on the worst day of illness. Abdominal pain usually consists
of cramping and may be the most prominent symptom. Pain usually is generalized
but may become localized; C. jejuni infection may cause pseudoappendicitis.
Fever may be the only initial manifestation of C. jejuni infection, a
situation mimicking the early stages of typhoid fever. Febrile young children
may develop convulsions. Campylobacter enteritis generally is self-limited;
however, symptoms persist for longer than 1 week in 10 to 20% of patients
seeking medical attention, and relapses occur in 5 to 10% of untreated
patients.
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Like ulcerative colitis it can be complicated by autoimmune disease:
- Reiter’s
- Guillan – Barré
- Hemolytic uremic syndrome.
Treatment
Campylobacter is usually sensitive to macrolide antibiotics
such as erythromycin. Patients with severe
diarrhea who are immunocompromised
may require hospitalization and supportive therapy in rare cases. For
systemic infections, treatment with gentamicin (1.7 mg/kg intravenously
every 8 h after a loading dose of 2 mg/kg), imipenem (500 mg intravenously
every 6 h), or chloramphenicol (50 mg/kg intravenously each day in three
or four divided doses) should be started empirically, but susceptibility
testing should then be performed. Ciprofloxacin and amoxicillin/clavulanate
are alternative agents for susceptible strains.
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