Campylobacter
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 people who are healthy and people who are immunocompromised. It causes diarrhea in all age groups, although peak incidence appears to be from age 1 to 5 years. In some years, C. jejuni accounts for more cases of diarrhea in the United States than Salmonella or Shigella combined. C. jejuni can cause meningitis in infants.
C. fetus and several other Campylobacter species (eg, C. coli, 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 adults, and pregnant patients. 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.
Complications
C. jejuni diarrheal illness is associated with subsequent development of Guillain-Barré syndrome (GBS) because of cross-reaction between C. jejuni antibodies and human gangliosides (1). Although only 1 case of GBS is estimated to occur per 1000 C. jejuni infections in the United States (2), about 20 to 50% of patients who develop GBS have had a prior C. jejuni infection (3, 4).
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, acute infectious arthritis) occur rarely with C. jejuni but are more common with C. fetus.
References
1. Nachamkin I, Allos BM, Ho T. Campylobacter species and Guillain-Barré syndrome. Clin Microbiol Rev. 1998;11(3):555-567. doi:10.1128/CMR.11.3.555
2. Centers for Disease Control and Prevention: Guillain-Barré Syndrome. Accessed April 15, 2024.
3. Rees JH, Soudain SE, Gregson NA, Hughes RA. Campylobacter jejuni infection and Guillain-Barré syndrome. N Engl J Med. 1995;333(21):1374-1379. doi:10.1056/NEJM199511233332102
4. Mishu B, Blaser MJ. Role of infection due to Campylobacter jejuni in the initiation of Guillain-Barré syndrome. Clin Infect Dis. 1993;17(1):104-108. doi:10.1093/clinids/17.1.104
Symptoms and Signs of Campylobacter and Related Infections
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, which can mimic appendicitis), headache, and myalgias are frequent.
Patients can also present with subacute bacterial endocarditis (more often due to C. fetus), reactive arthritis, meningitis, or an indolent fever of unknown origin 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.
Diagnosis of Campylobacter and Related Infections
Stool culture or nucleic acid amplification test (NAAT)
Sometimes blood cultures
Diagnosis, particularly to differentiate Campylobacter infection from ulcerative colitis, requires microbiologic evaluation. Stool culture should be obtained, and blood cultures should be obtained for patients with signs of focal infection or serious systemic illness. White blood cells are present in stained smears of stool.
Rapid molecular (multiple enteric pathogen NAAT panels) and antigen assay stool tests are also available.
Treatment of Campylobacter and Related Infections
Sometimes azithromycin
Most enteric infections caused by C. jejuni
For patients with extraintestinal Campylobacter
