Infectious Disease Compendium

Campylobacter

Microbiology

Gram negative, comma shaped, rods. Includes C. coli, C. fetus subsp. fetus (Review), C. hyointestinalis, C. jejuni, C. lari, C. sputorum subsp. bubul, C. sputorum subsp. sputorum, C. upsaliensis.

Epidemiologic Risks

A worldwide zoonosis found in the gi tract of wild or domesticated cattle, cats, dogs, goats, rodents sheep, swine, and all varieties of fowl.

Cases have been increasing in the US, along with ciprofloxicin resistance (PubMed).

Upscale cooking trends, like eating less than completely cooked chicken livers, are also a risk (Pubmed) as is undercooked veal liver (PubMed). Chicken and cow sushi. Bad idea.

Castrating sheep with your teeth, as they do in Wyoming, can lead to disease (MMWR). Probably in the sheep as well.

And more from the CDC (PubMed): "Increased risk for enteric infection among workers in agriculture, health care, food, and personal care occupations might be related to workplace exposures to pathogens. Campylobacteriosis or salmonellosis should be considered when workers have symptoms compatible with these diseases." What? I should think of those organisms in patients with compatible symptoms? What a concept.

Those who take care of cattle.

And raw milk (PubMed), with some outbreaks quinolone resistant (PubMed).

And men who have sex with men (PubMed) including C. fetus (PubMed).

And drinking cattle or swine fecally contaminated water or slurry by mistake (one hopes) during events like obstacle adventure races (PubMed).

Campylobacter fetus subsp. testudinum subsp. nov.: reptiles (PubMed).

Syndromes

Primarily gastroenteritis. Immunoglobulin deficient patients often develop prolonged, severe, and recurrent C. jejuni infections.

A reactive arthritis in HLA-B27 can occur.

Getting Campylobacter can increase you risk of Guillain Barre syndrome 77 times. Whoa! (PubMed).

Bacteremia can occur in elderly or immunocompromised with C. fetus or C. jejuni being the most common (PubMed).  C. jejuni and C. coli bacteremia occurs mainly in moderately young individuals without severe underlying diseases, are susceptible to antimicrobial agents, and the outcome is good, whether or not appropriate or inappropriate antimicrobial treatment given in the hospital (PubMed). At least in Finland. Your mileage may vary.

While usually self limited, one person had isolated from their stool for more than a decade. The organism had "adapted to the internal environment of the patient" (PubMed). Poor bacteria. So much for location, location, location.

Treatment

The effect of antibiotic treatment is not impressive, it will shorten symptoms by 1.3 days, hardly enough time to finish a good novel (PubMed). A single dose of one gram of azithromycin can be curative (PubMed), although the usual dose is 500 mg a day for 3 days.

Erythromycin 250 mg po qid for 3 days OR doxycycline 100 po bid x 7 d. Gentamicin OR imipenem if iv needed.

Quinolone resistance is increasing (probably from the use of quinolones in chickens)(PubMed)(PubMed), do NOT use first generation cephalosporins or penicillins.

There is an ongoing issue of erythromycin and ciprofloxacin resistant Campylobacter jejuni subspecies jejuni in MSW in Quebec, Canada (PubMed).

Campylobacter species most likely in the blood are C. fetus and C. jejuni and are likely susceptible to imipenem or another carbapenem. Many bloodstream isolates are resistant to fluoroquinolones and erythromycin. Combine the beta lactam with gentamicin in patients with severe bacteremia and endovascular infections.

Notes

Guillain Barre Syndrome can follow C. jejuni infections as can a reactive arthritis in patients with HLA-B27.

C. jejuni is also associated with Immunoproliferative Small Intestinal Disease, a form of lymphoma (PubMed).

Last update: 06/02/18