Campylobacter Infection

Background

• Campylobacter is 1 of the most frequently occurring bacterial agents of gastroenteritis.
  • Infection occurs worldwide, with the highest incidence in children < 5 years old, particularly in resource-limited settings.
  • Campylobacter is estimated to have caused foodborne illness in 96 million persons in 2010 worldwide and to cause an estimated 1.3 million cases of infection annually in United States.
• Infection is typically manifested by self-limiting fever, abdominal cramping, and diarrhea (with or without blood in the stool).
• Common sources of infection include poultry, unpasteurized milk, and contaminated drinking water.
• Major sequelae of campylobacteriosis are Guillain-Barre syndrome, reactive arthritis, and irritable bowel syndrome.
• Risk factors for Campylobacter infection include international travel in the week prior to the onset of symptoms and use of proton pump inhibitors and histamine-2 receptor antagonists.

Evaluation

• Campylobacter jejuni and Campylobacter coli are responsible for the majority of human disease due to Campylobacter, with roles of other species less well understood.
• Symptoms may arise 1-3 days after exposure and may be dose-dependent.
  • Diarrhea is usually watery and occasionally bloody.
  • Other symptoms may include abdominal pain, nausea, occasional vomiting (especially in children), cramps, and weight loss with typical duration of illness of 1 week.
• Stool culture is considered the gold standard for diagnosis, but this organism is difficult to grow and identify.
• Culture-independent stool tests, including immunoassays and molecular assays, are increasingly available, with diagnostic performance varying among specific assays.

Management

• Most Campylobacter infections are self-limiting and require no therapeutic intervention other than supportive therapy, including fluid and electrolyte replacement.
• Antibiotics are, however, recommended for patients with traveler's diarrhea as the likelihood of bacterial infection is high enough to justify the potential adverse events associated with antibiotic use (Strong recommendation).
  • If Campylobacter is suspected, azithromycin, (1,000 mg as a single dose or 500 mg orally once daily for 3 days) should be used as an empiric first-line therapy.
  • Rifaximin should not be used if there is clinical suspicion of invasive diarrhea, including Campylobacter infection.