Difference between revisions of "Campylobacter jejuni"

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==Background==
 
==Background==
* Gram negative, non spore forming bacteria
+
*[[Gram negative]], non spore forming bacteria
* Commonly found in animal feces
+
*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)
+
*Acute diarrheal illness (<3 weeks)
* Severe abdominal pain
+
*Severe [[abdominal pain]]
* Fever
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*[[Fever]]
* Bloody/voluminous/purulent stools  
+
*Bloody/voluminous/purulent stools  
* Systemic illness/symptoms
+
*Systemic illness/symptoms
 
 
  
 
==Differential Diagnosis==
 
==Differential Diagnosis==
* Infectious:
+
*Infectious:
** Salmonella
+
**[[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  
+
**[[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}}
  
==Diagnostic Evaluation==
+
==Evaluation==
* Initiate work up in patients:
+
''Not every patient with fever and diarrhea requires work-up - use clinical judgement''
** Appearing toxic
 
** Febrile
 
** Diarrheal illness 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
 
* 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
 
  
 +
*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
 +
**N.B. - In many labs, stool culture tests for [[Salmonella]], [[Shigella]], and [[Campylobacter]]
 +
*Stool ova and parasites if concern for parasitic infection
 +
*Consider [[C. difficile]] PCR if patient has risk factors
  
 
==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  
+
*Fluid resuscitation - oral rehydration therapy preferred  
* Avoid antimotility agents with bloody diarrhea  
+
*Avoid antimotility agents with bloody diarrhea  
* Many recover without antimicrobial therapy
+
*Many recover without antimicrobial therapy
* Antibiotics if severe illness:
+
*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
+
*Most patients can be discharged
* Admit for rehydration in those with severe illness/inability to tolerate PO
+
*Admit for rehydration in those with severe illness/inability to tolerate PO
 +
 
 
==See Also==
 
==See Also==
[[Diarrhea]]
+
*[[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]]
 
[[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