Organisms:  motile, non-spore-forming Gram-negative rods.  They are a common cause of bacterial diarrheal disease  (C.jejuni) & systemic infection (C.fetus).  

Mode of transmission:  contamination of milk & other animal food sources, or direct conta t with infected animals & contaminated water.

SX:

• Most cases occur 2-4 days after exposure.  Bacteremia is rare in C.jejuni infections.
• C.jejuni illness typically presents with a prodrome of fever, headache, myalgia, & malaise for up to 24 hours before intestinal Sx develop.  The fever may be as high as 40^oC (104^oF), & diarrhea varies from a few loose stools to copious watery discharge.  Blood is frequently present in the stool but varies in amount.  The illness usually lasts less than a week, but the untreated pts may excrete the organisms for several weeks.
  
• C.fetus illness frequently produces systemic disease, often in vascular sites:  endocarditis, pericarditis, & mycotic aneurysms of the abdominal aorta.  CNS infections such as meningoencephalitis also occur, as do other localized infections including septic arthritis, spontaneous bacterial peritonitis, salpingitis, lung abscess, empyema, cellulitis, UTI, vertebral osteomyelitis, & cholecystitis.  In pts with the AIDS, campylobacter spp. other than C. fetus & C.jejuni may also cause bacteremia.

DX:

• Presumptive Dx of Campylobacter jejuni infection may be made by examination of stool passed within 2 hours using direct dark-field or phase-contrast microscopy.  Leukocytes & red cells are also frequently seen in stool samples.
• Confirmation of the C.jejuni infection is based on a positive stool or blood culture.
• DNA proves, PCR, & serologic testing have all been used to confirm diagnosis but are not routinely available.
• C. fetus may be isolated from  blood held in culture up to 14 days.  The fastidious nature of the organisms means that failure to culture Campylobacter does not rule them out as the cause of significant clinical disease.

RX:

• Fluid replacement in diarrheal patients.
• Mild & self-limited campylobacter infections do not require specific treatment.  Antibiotics are recommended only for patients with severe infection, including those with significant fever or volume loss, frequent bloody diarrhea, prolonged or severe symptoms, & for the immunocompromised pts.
• Antibiotics: Erythromycin 500 mg  PO qid x 1 wk, tetracyclines, aminoglycosides, chloramphenicol, quinolones (as (Ciprofloxacin 500 mg PO bid x 1 wk), nitrofurans,  & clindamycin.  Extraubtestubak ubfectuib wutg C.jejuni needs at least 10 days of Rx, and systemic C.fetus infection warrants 2-3 wks of therapy.