Pediatric Campylobacter Infections Follow-up

Updated: May 16, 2018
  • Author: Jocelyn Y Ang, MD, FAAP, FIDSA; Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Outpatient Care

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

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Further Inpatient Care

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  • 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).

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Inpatient & Outpatient Medications

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  • Rehydrate intravenously or orally.

  • Administer antibiotics as indicated.

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Transfer

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

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Complications

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  • 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. [33] The antigenic similarity between specific regions (terminal tetrasaccharide) of lipopolysaccharide of C jejuni and human gangliosides (GM1) led to the concept of molecular mimicry. [34] 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. [35]

      • 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%. [36, 37]

    • 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. [38] However, a more recent population-based study did not show the association. [39]

    • 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). [36]

  • Other infrequently reported complications are as follows:

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Prognosis

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  • 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.

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Patient Education

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  • 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 [40] 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.

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