What are the diagnostic and treatment approaches for Campylobacter jejuni infection?

Diagnosis and Treatment of Campylobacter jejuni Infection

Stool culture is the gold standard for diagnosing Campylobacter jejuni infection, with azithromycin being the preferred first-line treatment due to high fluoroquinolone resistance rates worldwide. 1, 2

Diagnostic Approach

Clinical Presentation

• Campylobacter jejuni typically presents with diarrhea, fever, and abdominal cramps, and may progress to more severe disease including bloody diarrhea and bacteremia, particularly in immunocompromised patients 1
• The risk for more severe illness increases with the degree of immunosuppression 1
• Bloody diarrhea can occur with Campylobacter infection, though it is more frequent with Shigella 1

Diagnostic Testing

• Stool culture remains the best method for diagnosing Campylobacter jejuni infection 3
• Blood cultures should be obtained from patients with fever and diarrhea, especially those who are immunocompromised, due to the high rate of bacteremia associated with enteric infections 1
• Stool testing should be performed for Campylobacter in people with diarrhea accompanied by fever, bloody or mucoid stools, severe abdominal cramping, or signs of sepsis 1
• Standard laboratory protocols may fail to identify non-jejuni non-coli Campylobacter species, which require special culture conditions; clinical laboratories should be notified of suspected Campylobacter infection 1
• Molecular diagnostic methods such as PCR can detect Campylobacter DNA in stool or biopsy specimens and may be more sensitive than culture 4

Special Considerations for Diagnosis

• HIV-infected persons are at increased risk for infection with non-jejuni non-coli Campylobacter species, including C. fetus, C. upsaliensis, and C. lari 1
• Endoscopy with biopsy may reveal focal active colitis, which can be tested for Campylobacter using molecular methods 4
• Immunocompromised patients should undergo broader testing for enteric pathogens, including Campylobacter 1

Treatment Approach

First-Line Treatment

• Azithromycin is the preferred first-line treatment for Campylobacter infections with a dosing regimen of 1000 mg single dose or 500 mg daily for 3 days 2
• Early treatment with azithromycin within 72 hours of symptom onset is most effective in reducing symptom duration 2

Alternative Treatment Options

• Fluoroquinolones (ciprofloxacin, levofloxacin) should only be used in areas with known low fluoroquinolone resistance 2, 5
• Ciprofloxacin is FDA-approved for infectious diarrhea caused by Campylobacter jejuni 5
• Fluoroquinolone resistance among Campylobacter has increased dramatically worldwide, exceeding 90% in Southeast Asia 2
• Clinical failure occurs in approximately 33% of patients treated with fluoroquinolones when the isolate is resistant 2

Special Populations

• Immunocompromised patients should always receive antibiotic treatment, even for mild infections, due to the risk of systemic spread 2
• HIV-infected patients may experience more severe and prolonged diarrheal disease with Campylobacter infection and are at risk for relapse after appropriate treatment 1

Supportive Care

• Rehydration is critical, particularly for patients with severe diarrhea or signs of dehydration 2
• Avoid antimotility agents as they may prolong bacterial shedding and worsen symptoms 2

Prevention Strategies

Food Safety

• Scrupulous handwashing can reduce risk for diarrhea caused by enteric bacteria 1
• Avoid consumption of raw or undercooked poultry, meat, and seafood 1
• Poultry and meat are safest when adequate cooking is confirmed by thermometer (internal temperature of 165°F/74°C for red meats and 180°F/82°C for poultry) 1
• Mishandling of raw poultry and consumption of undercooked poultry are the major risk factors for human campylobacteriosis 6

Common Pitfalls and Considerations

• Using fluoroquinolones empirically without considering local resistance patterns can lead to treatment failure and prolonged illness 2
• Delaying treatment beyond 72 hours can reduce the effectiveness of antibiotics 2
• Routine stool cultures may fail to identify non-jejuni Campylobacter species; laboratories should be notified if Campylobacter is suspected 1, 7
• Campylobacter infection can lead to post-infectious complications such as Guillain-Barré syndrome and reactive arthritis, though these occur in less than 1 per 1000 infections 3, 8