Campylobacter Enteritis

Campylobacter enteritis is infection of the gut by Campylobacter jejuni (most common) or Campylobacter coli, curved microaerophilic Gram-negative bacilli.

• Reservoirs: poultry, cattle, pets and wild animals; infection follows undercooked chicken, unpasteurised milk, contaminated water and contact with animals.
• Incubation is 2 to 5 days; infective dose is as low as 500 organisms.
• It is a leading cause of bacterial diarrhoea worldwide and frequent in children under 5 years in Africa.

Prodrome of fever, malaise and headache for 12 to 24 hours, then abdominal cramps and diarrhoea (watery then bloody) with up to 10 stools daily.

• Abdominal pain may mimic appendicitis or ileocolitis.
• Illness lasts about 1 week; excretion continues for 2 to 3 weeks.
• Differential diagnosis: Salmonella, Shigella, Yersinia, enterohaemorrhagic E coli, amoebic colitis, appendicitis, inflammatory bowel disease.
• Complications: dehydration, bacteraemia (elderly, immunosuppressed), cholecystitis, pancreatitis, reactive arthritis (1 to 5 percent), Guillain-Barre syndrome (about 1 in 1000 cases, 1 to 3 weeks later), Miller Fisher syndrome, erythema nodosum, haemolytic uraemic syndrome, toxic megacolon, post-infectious irritable bowel syndrome.

Stool culture on selective media at 42 C in a microaerophilic atmosphere; multiplex PCR is more sensitive.

• Full blood count (leucocytosis), electrolytes and creatinine in dehydration; blood cultures if septic.
• Stool microscopy shows faecal leucocytes and comma shaped organisms.
• Nerve conduction tests and lumbar puncture if neurological features develop.

Supportive: oral rehydration (50 to 100 mL/kg over 4 hours), intravenous Ringer lactate for severe dehydration; continue feeding.

Pharmacological

• Most cases need no antibiotics.
• Treat for severe disease, high fever, bloody stools, symptoms over 1 week, pregnancy, or immunosuppression: azithromycin 500 mg once daily for 3 days (children 10 mg/kg once daily for 3 days), or erythromycin 500 mg four times daily for 5 days (children 10 mg/kg four times daily).
• Ciprofloxacin 500 mg twice daily for 3 days only if susceptibility is confirmed (resistance is common).
• Bacteraemia: gentamicin 5 mg/kg daily or meropenem 1 g every 8 hours IV for 7 to 14 days.
• Avoid loperamide in bloody diarrhoea.

Special groups: HIV and hypogammaglobulinaemia (longer courses of 14 days, relapse likely); pregnancy (azithromycin); Guillain-Barre syndrome (intravenous immunoglobulin 0.4 g/kg daily for 5 days).

Red flags: bloody diarrhoea with severe pain, bacteraemia, ascending weakness, haemolytic uraemic features.

Follow-up: no stool clearance test needed; counsel on food hygiene; exclude food handlers until 48 hours symptom free.