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Campylobacter infection

Campylobacters are motile, non-spore-forming, curved gram-negative rods. These species are currently divided into three genera: Campylobacter, Arcobacter, and Helicobacter. The human pathogens can be divided into two major groups: those that primarily cause diarrheal disease and those that cause extraintestinal infection. The principal diarrheal pathogen is C. jejuni, which accounts for 80 to 90% of all cases of recognized illness due to campylobacters.

Clinical presentation

It is usually a self limited dysentery with lesions similar to ulcerative colitis. There is often a prodrome, with fever, headache, myalgia, and/or malaise, 12 to 48 h before the onset of diarrheal symptoms. The most common symptoms of the intestinal phase are diarrhea, abdominal pain, and fever. The degree of diarrhea varies from several loose stools to grossly bloody stools; most patients presenting for medical attention have 10 or more bowel movements on the worst day of illness. Abdominal pain usually consists of cramping and may be the most prominent symptom. Pain usually is generalized but may become localized; C. jejuni infection may cause pseudoappendicitis. Fever may be the only initial manifestation of C. jejuni infection, a situation mimicking the early stages of typhoid fever. Febrile young children may develop convulsions. Campylobacter enteritis generally is self-limited; however, symptoms persist for longer than 1 week in 10 to 20% of patients seeking medical attention, and relapses occur in 5 to 10% of untreated patients.

Like ulcerative colitis it can be complicated by autoimmune disease:

  • Reiter?s
  • Guillan ? Barr?/li>
  • Hemolytic uremic syndrome.

Treatment

Campylobacter is usually sensitive to macrolide antibiotics such as erythromycin. Patients with severe diarrhea who are immunocompromised may require hospitalization and supportive therapy in rare cases. For systemic infections, treatment with gentamicin (1.7 mg/kg intravenously every 8 h after a loading dose of 2 mg/kg), imipenem (500 mg intravenously every 6 h), or chloramphenicol (50 mg/kg intravenously each day in three or four divided doses) should be started empirically, but susceptibility testing should then be performed. Ciprofloxacin and amoxicillin/clavulanate are alternative agents for susceptible strains.

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