Campylobacter enteritis

Campylobacter enteritis is an inflammatory gastroenteritis with an incubation period of 2-5 days. Outbreaks have been associated with poor restaurant hygiene and the ingestion of unpasteurized milk, undercooked poultry, and contaminated water.

CASES/YEAR
845,024 (US); 808,000,000 (Global)
CATEGORY
Gastroenteritis--Inflammatory
AGENT TYPE
Bacteria
OTHER NAMES
Campylobacter jejuni infection; Campylobacter fetus infection (Related Infection);
ACUITY
Acute-Moderate
INCUBATION
2-5 days; range of 1-10 days; [CCDM]
INITIAL SYMPTOMS
Acute gastroenteritis, often with bloody diarrhea; [CCDM]
PRECAUTIONS
"Use Contact Precautions for diapered or incontinent persons for the duration of illness or to control institutional outbreaks." [CDC 2007 Guideline for Isolation Precautions] Person-to-person transmission is uncommon. "Enteric precautions for hospitalized patients." [CCDM, p. 86-7]
COMMENTS
FINDINGS:
Symptoms usually resolve within a week, but some adults have a prolonged course that mimics inflammatory bowel disease. Complications include Reiter's syndrome (~1% of cases) and Guillain-Barre syndrome (~0.1% of cases). [CCDM, p. 85] "Although only 1 case of GBS [Guillain-Barre Syndrome] is estimated to occur per 2000 C. jejuni infections, about 25 to 40% of patients who develop GBS have had a prior C. jejuni infection." [Merck Manual, p. 1581] Toxic megacolon may complicate severe infections. Some patients present with abdominal pain and pseudoappendicitis. Meningitis and endocarditis are rare complications. [PPID, p. 22654-5] C. jejeuni can grow in bile and cause cholecystitis and pancreatitis. [Cohen, p. 1602] Other complications are reactive arthritis, uveitis, hemolytic-uremic syndrome, erythema nodosum, encephalitis, and carditis. [Cecil, p. 1922]

EPIDEMIOLOGY:
Outbreaks have been associated with the ingestion of unpasteurized milk, undercooked poultry, and contaminated water. Reservoirs include poultry, cattle, puppies, kittens, swine, sheep, rodents, and birds. [CCDM, p. 86] Also primates; [PPID 7th Ed., p. 4002] "Sexually acquired proctocolitis is most often due to Campylobacter or Shigella species." [Harrisons, p. 423] "The risk of infection is highest in travelers to Africa and South America, especially in areas with poor restaurant hygiene and inadequate sanitation." [CDC Travel, p. 181]

RELATED INFECTION:
About 90% of Campylobacter infections are caused by C. jejuni. [ABX Guide] Campylobacter fetus may also cause diarrhea, but it is an opportunistic infection that is usually isolated from the blood. Clinical manifestations of C. fetus infections include meningoencephalitis, mycotic aneurysms, cellulitis, abscesses, cholecystitis, septic arthritis, and osteomyelitis. [PPID, p. 2655-6] C. fetus may cause a prolonged relapsing illness in compromised hosts. It often infects vascular sites (endocarditis, mycotic aneurysms, and septic thrombophlebitis). Infection in pregnancy may cause fetal death. [Harrison ID, p. 551]
DIAGNOSTIC
Stool culture on selective media & at 42 deg C (special lab request); [ABX Guide] Confirm rapid stool Ag tests with culture; [CDC Travel] Phase contrast or darkfield to identify motile, S-shaped rods; Antibody-based and PCR testing available; [CCDM]
SCOPE
Global
SIGNS & SYMPTOMS
  • >fever
  • >myalgia
  • G abdominal pain
  • G blood in stool
  • G diarrhea
  • G fecal leukocytes
  • G nausea, vomiting
  • H leukocytosis
  • N headache
  • N seizure
  • *acute renal failure
  • *arthritis
  • *encephalitis
  • *endocarditis
  • *erythema nodosum
  • *hepatitis
  • *meningitis
  • *myocarditis
  • *osteomyelitis
  • *pancreatitis
  • *paralysis
  • *pericarditis
  • *sepsis
  • *uveitis
ANTIMICROBIC

Yes

VACCINE

No

ENTRY
Ingestion, Sexual Contact
SOURCE
Person-to-Person, Human Fecal-Oral, Animal Excreta, Eating Contaminated Food, Eating Contaminated or Infected Meat, Eating Unpasteurized Milk or Cheese, Waterborne (Ingesting, Inhaling, or Swimming)
RESERVOIR
Birds and Poultry, Cattle, Goats and Sheep, Cats, Dogs, Monkeys, Rodents, Swine, Human, Wild Animals
RISK FACTORS
  • Cancer patients
  • Care for patients (fecal-oral pathogens)
  • Consume unpasteurized milk/cheese
  • Eat undercooked meat or fish
  • Handle infected chickens or birds
  • Have dog or cat contact (fecal-oral)
  • Ingest infectious agents in food/water
DRUG LINK
CDC: Campylobacter enteritis
REFERENCES FOR CASES/YEAR
1. (US) More than 2 million people per year infected; [Cecil, p. 1921] 12.78 cases/100,000 in 2007; [Gorbach, p. 10] Calculate 12.78 for population of 300 million = 38340; CDC 2011 estimate = 845,024; [http://www.cdc.gov/foodborneburden/2011-foodborne-estimates.html]
2. (Global) Hyperendemic in tropical countries: incidence in children <5 years "may be more than 100 times higher than the rate among children in developed nations." Guesstimate: 1/2 of population has US rate and 1/2 has US rate X 100; Calculate: 10 X 845,024 = 8 million;; 100 X 8 million = 800 million; Total = 808 million;