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; therefore, 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 the passage of organism-free fluid. Filters with a pore diameter of 25 nm to 0.45 µm usually are used in this procedure, which also can be used to remove microorganisms from water and air for microbiologic 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.^[24]

Campylobacter organisms are oxidase-positive with C jejuni hydrolysing hippurate.^[25]

Results of stool cultures usually do not remain positive beyond 2 weeks.

Darkfield or phase-contrast microscopy of fecal specimens can 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.^[26]

Real-time polymerase chain reaction (PCR) can be used to quickly and accurately detect C jejuni directly in the diarrheal stool.^[27]

The newer methods such as molecular biology techniques (PCR) and immunoenzymatic methods^[28]are more sensitive than traditional culture methods.^{[29, 30]}

Culture-independent tests, such as rapid tests for the detection of antigens in stool specimens, are available.^{[31, 32, 33]}However, their use as standalone tests has been questioned.^[34]

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.

Treatment & Management

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Media Gallery

Scanning electron microscope image of Campylobacter jejuni, illustrating its corkscrew appearance and bipolar flagella. Source: Virginia-Maryland Regional College of Veterinary Medicine, Blacksburg, Virginia.

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Author

Mahmud H Javid, MBBS Consultant in Infectious Diseases, Quaid-e-Azam International Hospital, Pakistan

Mahmud H Javid, MBBS 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, AAHIVS Professor of Clinical Medicine, Renaissance School of Medicine at Stony Brook University Medical Center; Adjunct Clinical Associate Professor, Department of Medicine, New York College of Osteopathic Medicine of New York Institute of Technology; Chief, Division of Infectious Diseases, Department of Medicine, Nassau University Medical Center

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Chief Editor