eMedicine Specialties > Infectious Diseases > Bacterial Infections

Campylobacter Infections: Follow-up

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

Follow-up

Further Inpatient Care

  • In some cases, systemic Campylobacter infections are diagnosed retrospectively following empirical antibiotic therapy with clinical resolution. In such cases, follow-up blood cultures should be obtained.
  • Oral erythromycin may not be adequate for systemic C jejuni or C fetus endovascular infections.

Deterrence/Prevention

  • Pasteurization of milk and chlorination of drinking water destroy Campylobacter organisms.
  • Unpasteurized milk and untreated surface water should not be consumed. Consumption of unpasteurized milk is the most commonly reported cause of Campylobacter infection outbreaks.
  • Treatment with antibiotics can reduce fecal excretion.
  • Health care workers with Campylobacter infections should not provide direct patient care or prepare food while they have diarrhea or are shedding Campylobacter organisms in the stool. However, person-to-person transmission is unusual.
  • Separate cutting boards should be used for foods of animal origin and other foods. After preparing raw food of animal origin, all cutting boards and countertops should be carefully cleaned with soap and hot water.14,15
  • Chicken should be adequately cooked.
  • When outbreaks occur, community education can be directed at proper food-handling techniques, including thorough cooking of poultry.
  • As noted above, handling and consumption of poultry meat is a significant source of illness. One control strategy that has been suggested is to keep colonized and noncolonized flocks separate.16
  • Fresh chicken can be the dominant source of Campylobacter infection, and replacing this with frozen chicken can reduce Campylobacter levels.2

Complications

  • Toxic megacolon
  • Pseudomembranous colitis
  • Colonic hemorrhage
  • Hemolytic-uremic syndrome
  • Thrombotic thrombocytopenic purpura
  • Immunoproliferative small intestinal disease (This is a type of lymphoma that involves mucosa-associated lymphoid tissue [MALT]. It has been found to be associated with C jejuni infection.17 )
  • Reactive arthritis18,19
  • Bacteremia
  • Endocarditis
  • Cholecystitis
  • Urinary tract infection
  • Pancreatitis
  • Stillbirths, septic abortions (C fetus)
  • Guillain-Barré syndrome (GBS) (GBS may develop secondary to cross-immunoreactivity between human gangliosides GM1 and GD1a and C jejuni lipopolysaccharides. In one study, up to 25% of patients with GBS had stool cultures positive for C jejuni. However, because of shortcomings of standard serological methods, the role of C jejuni may have been underestimated.20,21 In a study using a highly specific ELISA based on recombinant antigens, 80% of 36 patients with acute GBS were found to have serological evidence of preceding C jejuni infection, compared with 3.5% of controls.22 )
  • Infected aortoiliac aneurysms8

Prognosis

  • Generally, Campylobacter infections carry an excellent prognosis. The disease is almost always self-limited, with or without specific therapy.
  • The illness usually lasts less than a week, but some patients develop a longer-relapsing diarrheal illness that lasts several weeks.
  • The occasional deaths attributable to C jejuni infection usually occur in elderly or immunocompromised hosts.
  • Attributable deaths may also occur in young, healthy individuals secondary to volume depletion.
  • The rarer C fetus infection may also be fatal in debilitated hosts.

Patient Education

  • Many Campylobacter infections are potentially preventable through education.
  • Meat and poultry should be cooked well.
  • Hands should be washed carefully after preparing food.
  • Parents should be informed that sick pets (eg, puppies, kittens) may harbor human pathogens and must be kept away from young children.
  • Untreated surface water and unpasteurized milk should be avoided.

Miscellaneous

Medicolegal Pitfalls

  • Steroids worsen Campylobacter infections; therefore, treatable infections such as Campylobacter infections should be excluded before inflammatory bowel disease is diagnosed.
  • A single negative stool culture result does not exclude infection.
  • Physicians who diagnose campylobacteriosis and laboratories that identify the organism should report their findings to the local health department.

Special Concerns

  • C fetus is missed on most routine stool cultures for C jejuni.
  • C jejuni is capable of surviving in milk, other foods, or water maintained at 4°C for several weeks. However, it cannot withstand drying or freezing temperatures and is destroyed by pasteurization and chlorine at concentrations used for water disinfection.
 


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

  1. Ailes E, Demma L, Hurd S, Hatch J, Jones TF, Vugia D, et al. Continued decline in the incidence of Campylobacter infections, FoodNet 1996-2006. Foodborne Pathog Dis. Jun 2008;5(3):329-37. [Medline].

  2. Baker M, Wilson N, Ikram R, Chambers S, Shoemack P, Cook G. Regulation of chicken contamination is urgently needed to control New Zealand's serious campylobacteriosis epidemic. N Z Med J. 2006;119(1243):U2264. [Medline].

  3. Gillespie IA, O'brien SJ, Frost JA, Tam C, Tompkins D, Neal KR. Investigating vomiting and/or bloody diarrhoea in Campylobacter jejuni infection. J Med Microbiol. Jun 2006;55(Pt 6):741-6. [Medline].

  4. Pacanowski J, Lalande V, Lacombe K, Boudraa C, Lesprit P, Legrand P, et al. Campylobacter bacteremia: clinical features and factors associated with fatal outcome. Clin Infect Dis. Sep 15 2008;47(6):790-6. [Medline].

  5. Davis L, DiRita V. Growth and laboratory maintenance of Campylobacter jejuni. Curr Protoc Microbiol. Aug 2008;Chapter 8:Unit 8A.1.1-8A.1.7. [Medline].

  6. Schmidt-Ott R, Brass F, Scholz C, Werner C, Gross U. Improved serodiagnosis of Campylobacter jejuni infections using recombinant antigens. J Med Microbiol. Aug 2005;54(Pt 8):761-7. [Medline].

  7. Lin S, Wang X, Zheng H, Mao Z, Sun Y, Jiang B. Direct detection of Campylobacter jejuni in human stool samples by real-time PCR. Can J Microbiol. Sep 2008;54(9):742-7. [Medline].

  8. Cochennec F, Gazaigne L, Lesprit P, Desgranges P, Allaire E, Becquemin JP. Aortoiliac aneurysms infected by Campylobacter fetus. J Vasc Surg. Oct 2008;48(4):815-20. [Medline].

  9. Gilbert DN, Moellering RC Jr, eds. The Sanford Guide To Antimicrobial Therapy 2007. 37th ed. Antimicrobial Therapy, Inc.; 2007:15. [Full Text].

  10. Bardon J, Kolar M, Cekanova L, Hejnar P, Koukalova D. Prevalence of Campylobacter jejuni and its Resistance to Antibiotics in Poultry in the Czech Republic. Zoonoses Public Health. Sep 2 2008;[Medline].

  11. Hannula M, Hänninen ML. Effects of low-level ciprofloxacin challenge in the in vitro development of ciprofloxacin resistance in Campylobacter jejuni. Microb Drug Resist. Sep 2008;14(3):197-201. [Medline].

  12. Price LB, Johnson E, Vailes R, Silbergeld E. Fluoroquinolone-resistant campylobacter isolates from conventional and antibiotic-free chicken products. Environ Health Perspect. May 2005;113(5):557-60. [Medline].

  13. Taylor NM, Davies RH, Ridley A, Clouting C, Wales AD, Clifton-Hadley FA. A survey of fluoroquinolone resistance in Escherichia coli and thermophilic Campylobacter spp. on poultry and pig farms in Great Britain. J Appl Microbiol. Nov 2008;105(5):1421-31. [Medline].

  14. van Asselt ED, de Jong AE, de Jonge R, Nauta MJ. Cross-contamination in the kitchen: estimation of transfer rates for cutting boards, hands and knives. J Appl Microbiol. Nov 2008;105(5):1392-401. [Medline].

  15. de Jong AE, Verhoeff-Bakkenes L, Nauta MJ, de Jonge R. Cross-contamination in the kitchen: effect of hygiene measures. J Appl Microbiol. Aug 2008;105(2):615-24. [Medline].

  16. Wagenaar JA, Mevius DJ, Havelaar AH. Campylobacter in primary animal production and control strategies to reduce the burden of human campylobacteriosis. Rev Sci Tech. Aug 2006;25(2):581-94. [Medline].

  17. Lecuit M, Abachin E, Martin A. Immunoproliferative small intestinal disease associated with Campylobacter jejuni. N Engl J Med. Jan 15 2004;350(3):239-48. [Medline].

  18. Kosunen TU, Kauranen O, Martio J, et al. Reactive arthritis after campylobacter jejuni enteritis in patients with HLA-B27. Lancet. Jun 14 1980;1(8181):1312-3. [Medline].

  19. Pönkä A, Martio J, Kosunen TU. Reiter's syndrome in association with enteritis due to Campylobacter fetus ssp. jejuni. Ann Rheum Dis. Aug 1981;40(4):414-5. [Medline].

  20. Mishu B, Blaser MJ. Role of infection due to Campylobacter jejuni in the initiation of Guillain-Barre syndrome. Clin Infect Dis. Jul 1993;17(1):104-8. [Medline].

  21. Mishu B, Ilyas AA, Koski CL, et al. Serologic evidence of previous Campylobacter jejuni infection in patients with the Guillain-Barre syndrome. Ann Intern Med. Jun 15 1993;118(12):947-53. [Medline].

  22. Schmidt-Ott R, Schmidt H, Feldmann S, Brass F, Krone B, Gross U. Improved serological diagnosis stresses the major role of Campylobacter jejuni in triggering Guillain-Barré syndrome. Clin Vaccine Immunol. Jul 2006;13(7):779-83. [Medline].

  23. Allos BM. Campylobacter jejuni Infections: update on emerging issues and trends. Clin Infect Dis. Apr 15 2001;32(8):1201-6. [Medline].

  24. Blaser MJ. Campylobacter fetus--emerging infection and model system for bacterial pathogenesis at mucosal surfaces. Clin Infect Dis. Aug 1998;27(2):256-8. [Medline].

  25. Blaser MJ, Wells JG, Feldman RA, et al. Campylobacter enteritis in the United States. A multicenter study. Ann Intern Med. Mar 1983;98(3):360-5. [Medline].

  26. Butzler JP. Campylobacter, from obscurity to celebrity. Clin Microbiol Infect. Oct 2004;10(10):868-76. [Medline].

  27. Caldwell DB, Wang Y, Lin J. Development, stability, and molecular mechanisms of macrolide resistance in Campylobacter jejuni. Antimicrob Agents Chemother. Nov 2008;52(11):3947-54. [Medline].

  28. Carbone KM, Heinrich MC, Quinn TC. Thrombophlebitis and cellulitis due to Campylobacter fetus ssp. fetus. Report of four cases and a review of the literature. Medicine (Baltimore). Jul 1985;64(4):244-50. [Medline].

  29. Crushell E, Harty S, Sharif F, Bourke B. Enteric campylobacter: purging its secrets?. Pediatr Res. Jan 2004;55(1):3-12. [Medline].

  30. Drake AA, Gilchrist MJ, Washington JA 2nd, et al. Diarrhea due to Campylobacter fetus subspecies jejuni. A clinical review of 63 cases. Mayo Clin Proc. Jul 1981;56(7):414-23. [Medline].

  31. Fennell CL, Totten PA, Quinn TC, et al. Characterization of Campylobacter-like organisms isolated from homosexual men. J Infect Dis. Jan 1984;149(1):58-66. [Medline].

  32. Francioli P, Herzstein J, Grob JP, et al. Campylobacter fetus subspecies fetus bacteremia. Arch Intern Med. Feb 1985;145(2):289-92. [Medline].

  33. Friis LM, Pin C, Pearson BM, Wells JM. In vitro cell culture methods for investigating Campylobacter invasion mechanisms. J Microbiol Methods. May 2005;61(2):145-60. [Medline].

  34. Giesendorf BA, Quint WG. Detection and identification of Campylobacter spp. using the polymerase chain reaction. Cell Mol Biol (Noisy-le-grand). Jul 1995;41(5):625-38. [Medline].

  35. Kosunen TU, Ponka A, Kauranen O, et al. Arthritis associated with Campylobacter jejuni enteritis. Scand J Rheumatol. 1981;10(2):77-80. [Medline].

  36. Mee AS, Shield M, Burke M. Campylobacter colitis: differentiation from acute inflammatory bowel disease. J R Soc Med. Mar 1985;78(3):217-23. [Medline].

  37. Pasternak J, Bolivar R, Hopfer RL, et al. Bacteremia caused by Campylobacter-like organisms in two male homosexuals. Ann Intern Med. Sep 1984;101(3):339-41. [Medline].

  38. Perlman DM, Ampel NM, Schifman RB, et al. Persistent Campylobacter jejuni infections in patients infected with the human immunodeficiency virus (HIV). Ann Intern Med. Apr 1988;108(4):540-6. [Medline].

  39. Robinson DA. Infective dose of Campylobacter jejuni in milk. Br Med J (Clin Res Ed). May 16 1981;282(6276):1584. [Medline].

  40. Taylor DN, Blaser MJ. The epidemiology of Helicobacter pylori infection. Epidemiol Rev. 1991;13:42-59. [Medline].

  41. Taylor DN, Blaser MJ, Echeverria P, et al. Erythromycin-resistant Campylobacter infections in Thailand. Antimicrob Agents Chemother. Mar 1987;31(3):438-42. [Medline].

  42. Taylor DN, McDermott KT, Little JR, et al. Campylobacter enteritis from untreated water in the Rocky Mountains. Ann Intern Med. Jul 1983;99(1):38-40. [Medline].

  43. Taylor DN, Perlman DM, Echeverria PD, et al. Campylobacter immunity and quantitative excretion rates in Thai children. J Infect Dis. Sep 1993;168(3):754-8. [Medline].

  44. Tee W, Mijch A. Campylobacter jejuni bacteremia in human immunodeficiency virus (HIV)-infected and non-HIV-infected patients: comparison of clinical features and review. Clin Infect Dis. Jan 1998;26(1):91-6. [Medline].

  45. Tee W, Mijch A, Wright E, Yung A. Emergence of multidrug resistance in Campylobacter jejuni isolates from three patients infected with human immunodeficiency virus. Clin Infect Dis. Sep 1995;21(3):634-8. [Medline].

  46. Walker RI, Caldwell MB, Lee EC, et al. Pathophysiology of Campylobacter enteritis. Microbiol Rev. Mar 1986;50(1):81-94. [Medline].

  47. Wassenaar TM, Blaser MJ. Pathophysiology of Campylobacter jejuni infections of humans. Microbes Infect. Oct 1999;1(12):1023-33. [Medline].

  48. Yamashita K, Aoki Y, Hiroshima K. Pyogenic vertebral osteomyelitis caused by Campylobacter fetus subspecies fetus. A case report. Spine. Mar 15 1999;24(6):582-4. [Medline].

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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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