CAMPYLOBACTER ENTEROCOLITIS
DEFINITION:
A bacterial infection of the intestines caused by Campylobacter
resulting in a dysenteric diarrhea.
EPIDEMIOLOGY:
- incidence: #1 bacterial cause of diarrhea (5-15%)
- risk factors:
- age: usually < 10 yrs with peak < 1 yr.
- season: summer, fall
- route: direct: fecal-oral (animal -> human) venereal (gays);
person-to-person indirect: water, food (undercooked poultry,
un-pasteurized milk)
- environ: epidemics: nurseries, day-care centres endemic:
developing countries
- incubation period: 2-7 days
PATHOGENESIS:
- Campylobacter are gram negative rods
- 8 species
- major cause of enteritis (95-99%): C. jejuni
- minor cause of enteritis ( 1-5% ): C. coli, C. laridis
2. C. jejuni
- highly infective requiring only 100 organisms to cause an
enteritis
- over 90 serotypes
- communicability is greatest during the acute phase of the
ill-ness and can last up to 2-3 weeks
- asymptomatic carriage is uncommon but perinatal transmission
may occur from an asymptomatic mother
- may persist in stool for up to 7 weeks in untreated patient
- no enterotoxins or invasive factors have been identified so
the pathogenesis is unclear
3. Transmission from animals
- GI tract of many domestic and wild animals is main reservoir
- 30-100% of chickens, turkeys, & water fowl have C. jejuni in
feces
- most farm animals, pets, and meat sources can harbour C.
jejuni
- household transmission from dogs & cats with diarrhea can
occur
CLINICAL FEATURES:
- fever, malaise, myalgias, abdominal pain, nausea/vomiting
2. Diarrhea
- watery, profuse, and foul-smelling
- blood characteristically appears in stools 2-4 days after
onset of symptoms (bloody diarrhea)
- most recover in less than 1 week but may last up to 3 weeks
- 20% will have a relapse or prolonged or severe illness
- associated symptoms:
- abdominal pain (90%) - periumbilical with cramping
3. Complications
- meningitis, febrile seizures, Guillain-Barre Syndrome
- upper respiratory tract infection (33%)
- endocarditis
- cholecystitis, colitis, colonic perforation, mesenteric
adenitis, pancreatitis, proctitis, rectal hemorrhage, toxic
megacolon
- cystitis
- bacteremia (1%), methemoglobinemia
- septic and immune-mediated arthritis
- Death - risk factors include septicemia in newborns and
immuno-comprimised hosts
INVESTIGATIONS:
- culture - C. jejuni by specially-stained stool smears and
phase contrast microscopy
- WBC's, RBC's
2. Colonoscopy
- extensive hemorrhagic ulcerations of bowel wall and edema
from jejunum -> rectum (? invasive)
- distal small bowel & large intestine major sites of
involvement
- mimic mucosal changes found in inflammatory bowel disease
- mucous, pus, and blood in lumen
- hemorrhagic, edematous, and friable mucosa
3. Serum
- ? agglutination, complement fixation, bactericidal, and
immuno-fluoroscopy assays
- ? ELISA to IgGAM to C. jejuni
MANAGEMENT:
- oral rehydration fluid (ORF) or intravenous rehydration
2. Medications
- antibiotics only in severe cases (usually self-limiting)
- Erythromycin x 7 days
- decreases transmission and spread
- if starts within 3-5 days, shortens duration of diarrhea
- others: Tetracycline, furazolidone, neomycin
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