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Chapter 6 : Clinical Aspects of Campylobacter jejuni and Campylobacter coli Infections
Category: Bacterial Pathogenesis
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This chapter describes the clinical aspects of infection with Campylobacter jejuni (C. jejuni subsp. jejuni) and Campylobacter coli, which are the main causes of Campylobacter enteritis in humans. The prodrome can be highly misleading in the absence of abdominal symptoms, which may not appear for two or even three days. Patients with prodromal symptoms tend to have more severe illness than those whose illness starts with diarrhea. The chapter discusses special aspects of infection, intestinal complications, and extraintestinal infection. The urinary tract seems an unlikely place to find campylobacters because they do not tolerate acid conditions well, but there are two reports of apparent C. jejuni urinary infection. In the first, the main site of infection was thought to be the prostate, but in the other, there appeared to be cystitis in a 6-year-old girl. Infections will be missed unless cultures specific for campylobacters are set up when morphologically suspect bacteria are seen in urine samples. The association of Campylobacter enteritis with Guillain-Barré syndrome, which emerged during the mid-1980s, greatly improved one's understanding of the morbidity of the disease. The chapter also describes the role of endoscopy and rectal biopsy in the management of patients. No specific treatment is required for most patients with Campylobacter enteritis, other than the oral replacement of fluid and electrolytes lost through diarrhea and vomiting. Erythromycin was the first antimicrobial agent to be used. Serious systemic infection should be treated with an aminoglycoside, such as gentamicin, or imipenem.
Diagram illustrating an overview of illnesses due to C. jejuni and C. coli.
Diagram illustrating the typical course of Campylobacter enteritis. Reprinted from D. Greenwood, R. Slack, and J. Peutherer (ed.), Medical Microbiology, 15th ed. (Churchill Livingstone, Edinburgh, 1997).
Distribution of Campylobacter bacteremia cases in England and Wales, 1981 to 1991. Solid line indicates number of cases (n = 374); dashed line, cases per 1,000 intestinal infections. Reprinted from Skirrow et al. (1993) .
Trends in quinolone resistance rates among C. coli and C. jejuni isolates from humans from 11 countries, 1989 to 2006. The bars represent both nalidixic acid and fluoroquinolone resistance and are based on mean values of resistance from numerous reports. Year in parentheses is year of licensure for use in veterinary medicine in each country. Canada and the United States banned veterinary use of fluoroquinolones in 1997 and 2005, respectively. Updated and modified from Engberg et al. (2001) . References therein plus the following: Bodhidatta et al. (2002) ; Boonmar et al. (2005) ; Centers for Disease Control and Prevention (2003 , 2004 , 2007 ); Danish Zoonosis Centre (2004a , 2004b, 2005 , 2006 , 2007 ); Engberg et al. (2004) ; Feierl (2004) ; Feierl et al. (2001 , 2003 , 2007 ); Gallay et al. (2007) ; Mégraud and Prouzet-Mauléon (2004) ; Pezzotti et al. (2003) ; Rautelin et al. (2003) ; Sanders et al. (2002) ; Tribble et al. (2007) ; VANTURES (2003 , 2004 , 2005 ); Wickins et al. (2001) ; Prouzet-Mauléon and Mégraud (personal communication); J. Engberg (unpublished data).
Clinical features of Campylobacter enteritis derived from surveys of community outbreaks in which 50 or more people were affected and analyzed a
Comparison of histological features that help to differentiate Campylobacter and other infective causes of proctocolitis from acute inflammatory bowel disease (IBD) a
Focal infections due to C. jejuni and C. coli
Macrolide resistance among C. jejuni, C. coli, and C. jejuni and C. coli combined, isolated from human sources around the world since 1997 a
Studies evaluating the duration of illness in patients infected with quinolone-resistant or quinolone-susceptible Campylobacter strains a