eMedicine Specialties > Infectious Diseases > Bacterial Infections

Campylobacter Infections: Differential Diagnoses & Workup

Author: Mahmud H Javid, MD, Chief, Section of Infectious Diseases, Shifa Hospital, Islamabad, Pakistan
Coauthor(s): Shadab Hussain Ahmed, MD, FACP, FIDSA, MACGS, AAHIVS, Associate Professor of Clinical Medicine, State University of New York at Stony Brook; Attending Physician, Division of Infectious Diseases, Director of HIV Prevention Services, Nassau University Medical Center
Contributor Information and Disclosures

Updated: Feb 17, 2009

Differential Diagnoses

Arteriovenous Malformations
Shigellosis
Clostridium Difficile Colitis
Yersinia Enterocolitica
Inflammatory Bowel Disease
Mesenteric Artery Ischemia
Salmonellosis

Other Problems to Be Considered

Entamoeba histolytica infection
Intussusception
Toxigenic Escherichia coli infection
Enteropathogenic E coli infection

Workup

Laboratory Studies

  • Clinical diagnosis of enteric Campylobacter infection is established by demonstrating the organism via direct examination of feces or by isolation of the organisms.
  • Campylobacter organisms multiply more slowly than other enteric bacteria; thus, unusual techniques are used for isolation from fecal specimens.
    • These include growth at 42°C, use of antibiotic-containing media, and micropore filtration to keep larger bacilli from contaminating the culture.
    • Specific types of selective media are blood-based, antibiotic-containing media such as Skirrow, Butzler, and Campy-BAP.
    • Micropore filtration is based on filters with pores small enough to prevent the passage of microbes but large enough to allow passage of organism-free fluid. Filters with a pore diameter of 25 nm to 0.45 µm are usually used in this procedure, which can also be used to remove microorganisms from water and air for microbiological testing.
    • Multiple media types can be used to cultivate C jejuni, although Mueller-Hinton broth and agar best support C jejuni growth. The optimum atmosphere for C jejuni growth is 85% N2, 10% CO2, and 5% O2.5
  • Results of stool cultures usually do not remain positive beyond 2 weeks.
  • Darkfield or phase-contrast microscopy of fecal specimens can also be used to assess for characteristic darting motility within 2 hours of passage.
  • A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%.
  • Fecal leukocytes and erythrocytes are present in 75% of patients with Campylobacter enteritis and can be detected with direct light microscopic examination using methylene blue or Gram stain.
  • Peripheral blood leukocytosis may be present.
  • Dehydration may be clinically evident in patients who are moderately to severely ill.
  • If infection with C fetus or another atypical species is suspected, incubation at 37°C and use of media without cephalosporins are required.
  • Serodiagnosis of C jejuni infections can be improved by using highly specific recombinant antigens in an enzyme-linked immunoassay (ELISA) technique.6
  • Real-time polymerase chain reaction (PCR) can be used to quickly and accurately detect C jejuni directly in diarrheal stool.7

Procedures

Up to 80% of patients with Campylobacter infection demonstrate evidence of proctocolitis on sigmoidoscopy. However, findings may be identical to those observed in pseudomembranous colitis or inflammatory bowel disease. Sigmoidoscopic abnormalities range from focal mucosal edema and hyperemia with patchy petechiae to diffuse or aphthoid ulceration.

More on Campylobacter Infections

Overview: Campylobacter Infections
Differential Diagnoses & Workup: Campylobacter Infections
Treatment & Medication: Campylobacter Infections
Follow-up: Campylobacter Infections
References
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References

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Further Reading

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Keywords

Campylobacter infection, diarrhea, dysentery, enteric infection, enteritis, gastroenteritis, campylobacteriosis, Campylobacter jejuni, C jejuni, Campylobacter fetus, C fetus, Campylobacter lari, C lari, Campylobacter upsaliensis, C upsaliensis, Campylobacter hyointestinalis, C hyointestinalis, Campylobacter pylori, C pylori, Helicobacter pylori, H pylori, Helicobacter cinaedi, H cinaedi, Helicobacter fennelliae, H fennelliae, enterocolitis, proctocolitis, bacteremia, acquired immunodeficiency syndrome, AIDS, human immunodeficiency virus, HIV, traveler's diarrhea, toxic megacolon, pseudoappendicitis, inflammatory bowel disease, IBD, Guillain-Barré syndrome, Campylobacter enteritis

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Contributor Information and Disclosures

Author

Mahmud H Javid, MD, Chief, Section of Infectious Diseases, Shifa Hospital, Islamabad, Pakistan
Mahmud H Javid, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Coauthor(s)

Shadab Hussain Ahmed, MD, FACP, FIDSA, MACGS, AAHIVS, Associate Professor of Clinical Medicine, State University of New York at Stony Brook; Attending Physician, Division of Infectious Diseases, Director of HIV Prevention Services, Nassau University Medical Center
Shadab Hussain Ahmed, MD, FACP, FIDSA, MACGS, AAHIVS is a member of the following medical societies: American College of Physicians, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, and International AIDS Society
Disclosure: Nothing to disclose.

Medical Editor

Douglas A Drevets, MD, Assistant Professor, Department of Medicine, Section of Infectious Disease, Oklahoma University Health Sciences Center
Douglas A Drevets, MD is a member of the following medical societies: American Association of Immunologists, American Society for Microbiology, Central Society for Clinical Research, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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