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Campylobacter

Possibly the most common bacterial cause of infectious diarrhea in childhood (more frequent than E. coli, Salmonella, or Shigella infections) is Campylobacter jejuni.

Campylobacter infection is a similar illness to Salmonella and Shigella disease, with fever, abdominal pain, and diarrhea. The symptoms usually are self-limited, lasting 5 to 7 days. Chronic or relapsing diarrheal illness has been described, however. Fortunately, systemic illness - spread through the bloodstream (sepsis) - is rare with Campylobacter jejuni infection.

The ultimate source (reservoir) of the infectious bacteria is farm animals, particularly chickens. Transmission of C. jejuni is via the infamous fecal-oral route, meaning eating improperly prepared, germ-contaminated food.

Diarrhea with Campylobacter jejuni infection may be profuse and watery, with or without blood or mucus. Abdominal pain can be severe and localized to the right lower abdomen, erroneously suggesting appendicitis. First infections usually cause disease and produce significant immunity; repeated exposures to the germ may cause less severe, or even no discernible illness. Vomiting occurs in about a third of infections, but is typically mild and does not result in dehydration. The incubation period for Campylobacter infection is 1-10 days, with a mean of 3-5 days.

The disease may be mild enough to warrant no treatment in older children, but young infants and children or immunosuppressed patients (AIDS or chemotherapy patients) are usually treated. The preferred treatment is erythromycin for 5 to 7 days. Antimotility drugs such as loperamide (Imodium-AD®) should not be used in any case of Campylobacter or other suspected bacterial diarrhea. Diarrhea is a natural cleansing mechanism of the gut that reduces the chance that bacteria can invade the bloodstream from the intestine.

Campylobacter fetus is closely related to C. jejuni. It is a very uncommon disease-causing bacterium in humans, striking mainly newborns and immunosuppressed individuals. Newborns acquire the disease by passage through the mother's genital tract. C. fetus infection can present as bloody diarrhea. Unlike C. jejuni, C. fetus frequently is associated with sepsis and serious secondary infections, such as meningitis, endocarditis, or pneumonia.

Campylobacter species are interesting in that a very similar bacterium previously classified as a member of the family which inhabits the upper GI tract - the stomach - is the now infamous Helicobacter pylori. This is the bacterium responsible for stomach inflammation (gastritis), ulcer disease, and in later life may be responsible for gastric cancers.

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