Campylobacter jejuni

Background

• Gram negative, non spore forming bacteria
• Commonly found in animal feces
• Caused by oral-fecal transmission
• Associated with Guillain-Barre syndrome and Reiter syndrome
• Incubation period of about 2-5 days, with duration of illness around 2-10 days

Clinical Features

• Acute diarrheal illness (<3 weeks)
• Severe abdominal pain
• Fever
• Bloody/voluminous/purulent stools
• Systemic illness/symptoms

Differential Diagnosis

• Infectious:
  • Salmonella
  • Shigella
  • Shiga toxin-producing E. coli
  • E. coli 0157:H7
  • Entamoeba histolytica
  • Yersinia
  • Vibrio
  • C. difficile
• Non-infectious:
  • Inflammatory bowel disease
  • GI bleed
  • Adrenal insufficiency
  • Mesenteric ischemia
  • Thyroid storm
  • Toxicologic exposure
  • Radiation syndrome

Acute diarrhea

Infectious

• Viral (e.g. rotavirus)
• Bacterial
  • Campylobacter
  • Shigella
  • Salmonella (non-typhi)
  • Escherichia coli
    • E. coli 0157:H7
  • Yersinia enterocolitica
  • Vibrio cholerae
  • Clostridium difficile
• Parasitic
  • Giardia lamblia
  • Cryptosporidium
  • Entamoeba histolytica
  • Cyclospora
  • Microsporidium
• Toxin
  • Staphylococcus aureus
  • Bacillus cereus

Noninfectious

• GI Bleed
• Appendicitis
• Mesenteric Ischemia
• Diverticulitis
• Adrenal Crisis
• Thyroid Storm
• Toxicologic exposures
• Antibiotic or drug-associated

Watery Diarrhea

• Enterotoxigenic E. coli (most common cause of watery diarrhea)
• Norovirus (often has prominent vomiting)
• Campylobacter
• Non-typhoidal Salmonella
• Enteroaggregative E. coli (EAEC)
• Enterotoxigenic Bacteroides fragilis

Traveler's Diarrhea

• Giardia lamblia
• Cryptosporidiosis
• Entamoeba histolytica
• Cyclospora

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
  • 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

• Fluid resuscitation - oral rehydration therapy preferred
• Avoid antimotility agents with bloody diarrhea
• Many recover without antimicrobial therapy
• Antibiotics if severe illness:
  • Macrolides (e.g. Azithromycin)
  • Fluroquinolones (e.g. Ciprofloxacin)
  • Note - resistance is becoming prevalent (up to 25% resistance with ciprofloxacin)

Disposition

• Most patients can be discharged
• Admit for rehydration in those with severe illness/inability to tolerate PO

See Also

• Diarrhea