Campylobacter species are motile, curved, microaerophilic, gram-negative bacilli that normally inhabit the gastrointestinal tract of many domestic animals and fowl.
Several species are human pathogens. The major pathogens are C. jejuni, C. coli, and C. fetus.
C. jejuni is a common food-borne pathogen that affects healthy and compromised people. It causes diarrhea in all age groups, although peak incidence appears to be from age 1 to 5 years. C. jejuni accounts for more cases of diarrhea in the US than Salmonella Overview of Salmonella Infections The genus Salmonella is divided into 2 species, S. enterica and S. bongori, which include > 2500 known serotypes. Some of these serotypes are named. In such cases, common... read more and Shigella Shigellosis Shigellosis is an acute infection of the intestine caused by the gram-negative Shigella species. Symptoms include fever, nausea, vomiting, tenesmus, and diarrhea that is usually bloody... read more combined. C. jejuni can cause meningitis in infants.
C. fetus and several other Campylobacter species (eg, C. coli and C. lari) typically cause bacteremia and systemic manifestations in adults, more often when underlying predisposing diseases, such as diabetes, cirrhosis, cancer, or HIV/AIDS, are present. C. fetus is much less common than C. jejuni and is usually an opportunistic pathogen affecting people with underlying disease, older people, and pregnant women. In pregnant patients, the rate of fetal loss can be as high as 70%. C. fetus infections in healthy hosts occur in those with occupational exposure to infected animals. In patients with immunoglobulin deficiencies, these organisms, including C. jejuni, may cause difficult-to-treat, relapsing infections. Hypochlorhydria and achlorhydria are predisposing factors because Campylobacter species are sensitive to gastric acid.
The following have been implicated in outbreaks:
Contact with infected animals (eg, puppies)
Contact with contaminated food or water (eg, handling contaminated food)
Ingestion of contaminated food (especially undercooked poultry), water, or unpasteurized raw milk
Person-to-person transmission through fecal-oral and sexual contact may also occur but is uncommon because a large number of Campylobacter organisms are required to cause infection. Transmission of Campylobacter infection does occur among men who have sex with men. However, in sporadic cases, the source of the infecting organism is frequently obscure.
C. jejuni diarrheal illness is associated with subsequent development of Guillain-Barré syndrome Guillain-Barré Syndrome (GBS) Guillain-Barré syndrome is an acute, usually rapidly progressive but self-limited inflammatory polyneuropathy characterized by muscular weakness and mild distal sensory loss. Cause is thought... read more (GBS) because of cross-reaction between C. jejuni antibodies and human gangliosides. Although only 1 case of GBS is estimated to occur per 2000 C. jejuni infections, about 25 to 40% of patients who develop GBS have had a prior C. jejuni infection.
Postinfectious (reactive) arthritis may occur in human leukocyte antigen (HLA)-B27–positive patients a few days to several weeks after an episode of C. jejuni diarrhea. Other postinfectious complications include uveitis, hemolytic anemia, hemolytic-uremic syndrome, myopericarditis, immunoproliferative small intestinal disease, septic abortion, and encephalopathy.
Focal extraintestinal infections (eg, endocarditis, meningitis, septic arthritis) occur rarely with C. jejuni but are more common with C. fetus.
Symptoms and Signs
The most common manifestation of Campylobacter infection is an acute, self-limited gastrointestinal illness characterized by watery and sometimes bloody diarrhea. Fever (38 to 40° C), which follows a relapsing or intermittent course, is the only constant feature of systemic Campylobacter infection, although abdominal pain (typically in the right lower quadrant), headache, and myalgias are frequent.
Patients can also present with subacute bacterial endocarditis Infective Endocarditis Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci or staphylococci) or fungi. It may cause fever, heart murmurs, petechiae, anemia, embolic... read more (more often due to C. fetus), reactive arthritis Reactive Arthritis Reactive arthritis is an acute spondyloarthropathy that often seems precipitated by an infection, usually genitourinary or gastrointestinal. Common manifestations include asymmetric arthritis... read more , meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly progressive bacterial infection of the meninges and subarachnoid space. Findings typically include headache, fever, and nuchal rigidity. Diagnosis is by... read more , or an indolent fever of unknown origin Fever of Unknown Origin (FUO) Fever of unknown origin (FUO) is body temperature ≥ 38.3° C (≥ 101° F) rectally that does not result from transient and self-limited illness, rapidly fatal illness, or disorders with clear-cut... read more rather than with diarrheal illness. Joint involvement with reactive arthritis is usually monoarticular, affecting the knees; symptoms resolve spontaneously over 1 week to several months.
Sometimes blood cultures
Diagnosis, particularly to differentiate Campylobacter infection from ulcerative colitis Ulcerative Colitis Ulcerative colitis is a chronic inflammatory and ulcerative disease arising in the colonic mucosa, characterized most often by bloody diarrhea. Extraintestinal symptoms, particularly arthritis... read more , requires microbiologic evaluation. Stool culture should be obtained plus blood cultures for patients with signs of focal infection or serious systemic illness. White blood cells are present in stained smears of stool.
Rapid molecular and antigen assay stool tests are also available.
Most enteric infections caused by C. jejuni resolve spontaneously; if they do not, azithromycin 500 mg orally once a day for 3 days may be helpful.
Because resistance to ciprofloxacin is increasing, this drug should be used only when susceptibility has been established, but even then resistance has been reported to emerge with fluoroquinolone therapy.
For patients with extraintestinal Campylobacter infections, antibiotics (eg, imipenem, gentamicin, ampicillin, a 3rd-generation cephalosporin, erythromycin) should be given for 2 to 4 weeks to prevent relapses.