eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Campylobacter Infections: Differential Diagnoses & Workup

Author: Jocelyn Y Ang, MD, Assistant Professor, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan and Wayne State University
Coauthor(s): Sharon Nachman, MD, Chief of Pediatric Infectious Diseases, Associate Professor, Department of Pediatrics, Division of Infectious Diseases, State University of New York at Stony Brook
Contributor Information and Disclosures

Updated: Oct 5, 2009

Differential Diagnoses

Other Problems to Be Considered

  • Other bacterial causes of inflammatory diarrhea
    • Shigella organism
    • Enteroinvasive E coli
    • E coli O157:H7
    • Salmonella species
    • Yersinia enterocolitica
    • Aeromonas species 
    • Vibrio parahaemolyticus
  • Inflammatory bowel disease
  • Pseudomembranous enterocolitis secondary to Clostridium difficile infection
  • Intussusception in infants
  • Acute abdomen 
  • Acute appendicitis

Workup

Laboratory Studies

  • Microbiologic studies in Campylobacter infection
    • Presumptive diagnosis can be made by examination of fecal specimens by darkfield or phase-contrast microscopy, which demonstrates the characteristic darting motility, and a Gram stain of the stool, which shows Vibrio forms (slim, short, curved rods). RBCs and neutrophils are present in stool in approximately 75% of patients with Campylobacter enteritis.
    • Definitive diagnosis of infection is based on isolation of organisms from stool culture or from another site.
    • Culture of C jejuni from stool requires special isolation techniques and special media such as Campy-BAP or Skirrow. These media contain antibiotics that reduce the emergence of other enteric microorganisms. Inoculated media should be incubated in 5% oxygen and 10% carbon dioxide at 42°C. If C fetus or other atypical enteric species are suspected, isolation from stool requires inoculation on media lacking antibiotics and at 37°C. Filtration technique may be needed. Routine media are adequate for isolation of Campylobacter from normally sterile sites such as blood, body fluids, and tissues.
  • Hematology and blood chemistries
    • Peripheral WBC count is usually within the reference range; however, a left shift may occur.
    • The alanine aminotransferase level and the erythrocyte sedimentation rate (ESR) may be slightly elevated.
    • Other laboratory evaluations are within the reference ranges.
  • Serology
    • Diagnostic rise usually occurs after symptoms have resolved. Because the median duration of fecal excretion in the convalescent phase is less than 3 weeks, serology testing may be more sensitive than culture for the diagnosis of recent C jejuni infection.
    • Although serologic testing is also useful for epidemiologic investigations it is not recommended for routine diagnosis.

Other Tests

  • DNA probes and polymerase chain reaction are mainly research tools at this time and are not routinely performed.

Procedures

  • In patients with Campylobacter colitis with history of acute onset of diarrhea, abdominal pain and rectal bleeding, sigmoidoscopy done early (within 5 d) during the illness revealed hyperemic rectal mucosa with occasional shallow aphthous ulcers, whereas findings of granularity and hyperemia were seen in patients whose sigmoidoscopy were done later (³ 7 d) during the illness.20

Histologic Findings

  • The spectrum of histologic findings in the intestinal tract ranges from minimal edema with acute and chronic inflammatory cells without vascular congestion, to moderate inflammation and cryptitis, to crypt abscess formation.
  • For perinatal infections secondary to C jejuni and C fetus, the placenta may have areas of necrosis, infarction, microabscesses, and inflammation.16

More on Campylobacter Infections

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

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Further Reading

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Keywords

Campylobacter infections, campylobacteriosis, Campylobacteraceae, Campylobacter, Campylobacter jejuni, C jejuni, Campylobacter fetus, C fetus, Arcobacter, C jejuni subspecies doylei, Campylobacter coli, Campylobacter upsaliensis, Campylobacter Lari, C fetus subspecies fetus, Campylobacter hyointestinalis, Campylobacter concisus, Campylobacter sputorum, Campylobacter curvus, Campylobacter rectus, Campylobacter pylori, Helicobacter pylori, meningitis, cholecystitis , urinary tract infection, mesenteric adenitis, bacteremia, gravid uterus, enteritis, arthritis, pancreatitis, osteomyelitis

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Contributor Information and Disclosures

Author

Jocelyn Y Ang, MD, Assistant Professor, Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Michigan and Wayne State University
Jocelyn Y Ang, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Coauthor(s)

Sharon Nachman, MD, Chief of Pediatric Infectious Diseases, Associate Professor, Department of Pediatrics, Division of Infectious Diseases, State University of New York at Stony Brook
Sharon Nachman, MD is a member of the following medical societies: American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society
Disclosure: Nothing to disclose.

Medical Editor

Itzhak Brook, MD, MSc, Professor, Department of Pediatrics, Georgetown University School of Medicine
Itzhak Brook, MD, MSc is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Armed Forces Infectious Diseases Society, Association of Military Surgeons of the US, Infectious Diseases Society of America, International Immunocompromised Host Society, International Society for Infectious Diseases, Medical Society of the District of Columbia, New York Academy of Sciences, Pediatric Infectious Diseases Society, Society for Ear, Nose and Throat Advances in Children, Society for Experimental Biology and Medicine, Society for Pediatric Research, Southern Medical Association, and Surgical Infection Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Mark R Schleiss, MD, American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School
Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Robert W Tolan Jr, MD, Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine
Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility
Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; sanofi pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD, Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine
Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association
Disclosure: None None None

 
 
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