eMedicine Specialties > Pediatrics: General Medicine > Infectious Disease

Campylobacter Infections: Follow-up

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

Follow-up

Further Inpatient Care

  • Evaluate protracted cases of Campylobacter infection further to rule out other causes of fever, diarrhea, and sepsis.
  • Provide close monitoring and support in the intensive care unit for immunoreactive complications such as Guillain-Barré syndrome (GBS).

Further Outpatient Care

  • Assess the resolution of illness and patient compliance with medication.

Inpatient & Outpatient Medications

  • Rehydrate intravenously or orally.
  • Administer antibiotics as indicated.

Transfer

  • Patients with immunoreactive complications such as GBS may require transfer to a chronic care facility for rehabilitation after their condition stabilizes.

Complications

  • Guillain-Barré syndrome
    • GBS is a disorder of peripheral nerves and is characterized by ascending paralysis.
    • Strong evidence suggests an association between preceding C jejuni infection and GBS. The antigenic similarity between specific regions (terminal tetrasaccharide) of lipopolysaccharide of C jejuni and human gangliosides (GM1) led to the concept of molecular mimicry.25 This concept implies the sharing of homologous epitopes between the bacterial lipopolysaccharide and ganglioside surface components of the peripheral nerve. Immune response from simple C jejuni infection could induce antibodies that cross-react to the gangliosides and trigger GBS.
    • Other variants of GBS associated with c jejuni infection include the following:
      • Acute motor axonal neuropathy (AMAN), or Chinese paralytic syndrome, is characterized by a rapid onset of paralysis with progression to tetraplegia and respiratory failure and occurs in children in northern China during summer and fall.26
      • Fisher syndrome is characterized by ophthalmoplegia, areflexia, and cerebellar ataxia.
  • Reactive arthritis
    • Incidence and prevalence of Campylobacter- associated reactive arthritis varies among different reports, ranging from 0.6-24%.27
    • Development of reactive arthritis has been associated with human leukocyte antigen (HLA)-B27 allele; in these individuals, the disease is more severe than in individuals without HLA-B27.28 However, a more recent population-based study did not show the association.29
    • Arthritis starts a few days to several weeks after the episode of diarrhea. The course is usually self-limited, ranging from 1 week to several months (<6 mo).27
  • Other infrequently reported complications are as follows:

Prognosis

  • Most patients fully recover after C jejuni infection, with or without antibiotics.
  • Campylobacter septicemia in patients with immune deficiencies (including congenital hypogammaglobulinemia, acquired hypogammaglobulinemia, malnutrition, HIV) and in neonates is associated with a high mortality rate.
  • Even with plasmapheresis and intravenous immunoglobulin, as many as 20% of patients with GBS may require mechanical ventilation. Between 15% and 20% of all patients may develop severe neurologic deficit. GBS disease may result in mortality in 5-10% of all patients. Because GBS secondary to C jejuni may be more severe, the number of patients who require mechanical ventilation, experience severe neurologic sequelae, and die may also be higher.
  • Previously healthy persons infected with C fetus usually recover without sequelae. This infection may be lethal to patients with altered immune status and neonates. Prognosis for these patients depends on the early administration of fluids and appropriate antimicrobial therapy.

Patient Education

  • Tips for preventing campylobacteriosis
    • Thoroughly cook all poultry products. If served undercooked poultry in a restaurant, return it for further cooking.
    • Wash hands with soap before and after handling raw foods of animal origin.
    • Prevent cross-contamination in the kitchen
      • Use separate cutting boards for foods of animal origin and other foods.
      • Carefully clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw food of animal origin.
    • Avoid consuming unpasteurized milk and untreated surface water.
    • Make sure that persons with diarrhea, especially children, carefully and frequently wash their hands with soap to reduce the risk of spreading infection.
    • Wash hands with soap after contact with pet feces.

Miscellaneous

Medicolegal Pitfalls

  • Failure by physicians and clinical laboratories to report diagnosis of campylobacteriosis to local health departments to further prevent possible outbreaks.

Special Concerns

  • Because of the widespread use of antibiotics, especially quinolones, in humans and animal food, increasing resistance to these agents is reported.
 


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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