Difference between revisions of "Campylobacter jejuni"

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==Background==
 
==Background==
* Gram negative, non spore forming bacteria
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*[[Gram negative]], non spore forming bacteria
* Commonly found in animal feces
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*Commonly found in animal feces
* Caused by oral-fecal transmission
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*Caused by oral-fecal transmission
* Associated with [[Guillain-Barre syndrome]] and Reiter syndrome
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*Associated with [[Guillain-Barre syndrome]] and [[Reactive arthritis|Reiter syndrome]]
 +
*Incubation period of about 2-5 days, with duration of illness around 2-10 days<ref>U.S. Dept of Health and Human Services. Campylobacter. https://www.foodsafety.gov/poisoning/causes/bacteriaviruses/campylobacter/index.html</ref>
  
 
==Clinical Features==
 
==Clinical Features==
* Acute diarrheal illness (<3 weeks)
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*Acute diarrheal illness (<3 weeks)
* Severe abdominal pain
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*Severe [[abdominal pain]]
* Fever
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*[[Fever]]
* Bloody/voluminous/purulent stools  
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*Bloody/voluminous/purulent stools  
* Systemic illness/symptoms
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*Systemic illness/symptoms
 
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
* Infectious:
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*Infectious:
** Salmonella
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**[[Salmonella]]
** Shigella
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**[[Shigella]]
** Shiga toxin-producing E. coli
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**Shiga toxin-producing [[E. coli]]
** E. coli 0157:H7
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**[[E. coli]] 0157:H7
** Entamoeba histolytica  
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**[[Entamoeba histolytica]]
** Yersinia
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**[[Yersinia]]
** Vibrio
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**[[Vibrio]]
** C. difficile  
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**[[C. difficile ]]
* Non-infectious:
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*Non-infectious:
** Inflammatory bowel disease  
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**[[Inflammatory bowel disease]]
** GI bleed
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**[[GI bleed]]
** Adrenal insufficiency
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**[[Adrenal insufficiency]]
** Mesenteric ischemia  
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**[[Mesenteric ischemia]]
** Thyroid storm
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**[[Thyroid storm]]
** Toxicologic exposure  
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**[[Toxicologic exposure]]
** Radiation syndrome
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**[[Radiation syndrome]]
  
 +
{{Diarrhea DDX}}
  
 +
==Evaluation==
 +
''Not every patient with fever and diarrhea requires work-up - use clinical judgement''
  
==Diagnostic Evaluation==
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*Consider work-up for patient with:
* Initiate work up in patients:
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**Fever
** Appearing toxic
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**Toxic appearance
** Febrile
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**Diarrhea lasting >3 days
** Diarrheal illness lasting >3 days
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**Blood or pus in stool
** Blood or pus in stool
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**Immunocompromised patients with presumed infectious diarrhea
** Immunocompromised patients with presumed infectious diarrhea
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*Bacterial stool culture
* Bacterial stool culture
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**N.B. - In many labs, stool culture tests for [[Salmonella]], [[Shigella]], and [[Campylobacter]]
* Stool ova and parasites if concern for parasitic infection
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*Stool ova and parasites if concern for parasitic infection
* Consider C. difficile PCR if patient has risk factors
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*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<ref>http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat</ref>==
 
==Management<ref>http://www.cdc.gov/nczved/divisions/dfbmd/diseases/campylobacter/#treat</ref>==
* Fluid resuscitation- oral rehydration therapy preferred  
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*Fluid resuscitation - oral rehydration therapy preferred  
* Avoid antimotility agents with bloody diarrhea  
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*Avoid antimotility agents with bloody diarrhea  
* Many recover without antimicrobial therapy
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*Many recover without antimicrobial therapy
* Antibiotics if severe illness:
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*Antibiotics if severe illness:
** Macrolides
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**[[Macrolides]] (e.g. [[Azithromycin]])
*** Azithromycin
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**[[Fluroquinolones]] (e.g. [[Ciprofloxacin]])
** Fluroquinolones
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**Note - resistance is becoming prevalent (up to 25% resistance with [[ciprofloxacin]]<ref>CDC. Campylobacter (Campylobacteriosis) - Antibiotic resistance. Last modified October 2, 2017. https://www.cdc.gov/campylobacter/campy-antibiotic-resistance.html</ref>)
*** Ciprofloxacin
 
* Note- resistance is becoming prevalent
 
  
 
==Disposition==
 
==Disposition==
* Home for most patients
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*Most patients can be discharged
* Admit for rehydration in those with severe illness/inability to tolerate PO
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*Admit for rehydration in those with severe illness/inability to tolerate PO
 +
 
 
==See Also==
 
==See Also==
[[Diarrhea]]
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*[[Diarrhea]]
  
 
==External Links==
 
==External Links==
 +
  
 
==References==
 
==References==
 
<references/>  
 
<references/>  
* Kman N. Disorders Presenting Primarily with Diarrhea. In: ''Tintinalli's Emergency Medicine''. 7th ed. McGraw-Hill. 2011: 531-536.
+
 
 +
[[Category:ID]]

Latest revision as of 01:46, 12 October 2018

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

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