Campylobacteriosis

Campylobacteriosis is intestinal infection by Campylobacter jejuni (and C. coli), the commonest bacterial cause of infectious diarrhoea worldwide. It is acquired by eating undercooked poultry, drinking unpasteurised milk or contaminated water, and contact with animals.

• Children under 5 years and young adults are most affected.
• People with HIV and hypogammaglobulinaemia have prolonged or relapsing illness and bacteraemia.

Incubation 2 to 5 days, then fever, malaise, severe cramping abdominal pain and watery then bloody diarrhoea lasting about a week.

• Pain can mimic appendicitis; vomiting is uncommon.
• Differential diagnosis: shigellosis, salmonellosis, amoebic colitis, enterohaemorrhagic E. coli, yersiniosis, inflammatory bowel disease, appendicitis, CMV colitis, Clostridioides difficile, cholera.
• Complications: dehydration, bacteraemia, Guillain Barre syndrome (1 to 3 weeks later), reactive arthritis, post infectious irritable bowel syndrome, cholecystitis, pancreatitis, haemolytic uraemic syndrome (rare), toxic megacolon.

Stool culture on selective medium under microaerophilic conditions at 42 degrees Celsius, or multiplex PCR.

• Full blood count, urea, electrolytes, CRP; blood cultures if febrile and immunocompromised.
• Stool microscopy shows leucocytes and red cells.
• Sigmoidoscopy if inflammatory bowel disease is suspected.

Mostly self limiting; treat dehydration and give antibiotics for selected patients.

• Supportive: oral rehydration solution 200 to 400 mL after each loose stool (adults) and 50 to 100 mL/kg over 4 hours in moderate dehydration in children; IV Ringer lactate 30 mL/kg over 30 minutes then 70 mL/kg over 2.5 hours for severe dehydration; zinc 20 mg daily for 10 to 14 days in children; continue feeding; hand washing.
• Pharmacological: azithromycin 500 mg once daily for 3 days (children 10 mg/kg once daily for 3 days) for dysentery, high fever, prolonged illness over 1 week, pregnancy, immunocompromise or severe disease; alternative erythromycin 500 mg four times daily for 5 days (children 10 mg/kg four times daily). Fluoroquinolone resistance is common, so give ciprofloxacin 500 mg twice daily for 3 days only if susceptibility is proven. Bacteraemia: gentamicin 5 mg/kg IV daily or meropenem 1 g IV every 8 hours, 14 days. Avoid loperamide in bloody diarrhoea.
• Procedures: surgery for toxic megacolon or perforation (rare).
• Special groups: pregnancy, azithromycin; children, weight based dosing; HIV, treat for 7 to 14 days and consider relapse; elderly, careful fluids.
• Red flags: bloody diarrhoea with high fever, severe dehydration, weakness or tingling in limbs (Guillain Barre syndrome), abdominal distension, haemolytic uraemic syndrome, immunosuppression.
• Follow-up: review at 48 to 72 hours; food handlers return to work after 48 hours without symptoms; advise on safe poultry handling.