When should campylobacter infection be suspected in children with acute gastrointestinal symptoms?

When to Suspect Campylobacter Infection in Children

Suspect Campylobacter infection in children presenting with bloody diarrhea accompanied by fever, severe abdominal pain, or abdominal cramping, particularly when symptoms evolve over 2-4 days with blood appearing after initial watery diarrhea. 1

Key Clinical Presentations

Classic Presentation

• Fever (present in 47-91% of cases) combined with diarrhea that becomes bloody 2-4 days after symptom onset 1, 2, 3
• Bloody or mucoid stools (present in 90% of pediatric cases), often with mucosanguineous character 2, 3
• Severe abdominal pain or cramping (present in >90% of older children), which may be localized and can mimic acute appendicitis 1, 2, 4
• Minimal vomiting (only 22-30% of cases) and typically no significant dehydration, distinguishing it from viral gastroenteritis 2, 3

High-Risk Clinical Scenarios Requiring Testing

Test for Campylobacter when children present with: 1

• Diarrhea with fever documented in a medical setting
• Bloody or mucoid stools with abdominal tenderness
• Severe abdominal cramping or signs of peritoneal irritation
• Signs of sepsis (particularly in infants <3 months)
• Symptoms suggesting bacillary dysentery (frequent scant bloody stools with tenesmus)

Atypical Presentations to Recognize

Be alert for less common patterns that still warrant testing: 5

• Acute abdomen presentation with localized pain and abdominal tenderness but less prominent diarrhea (74% vs 97% in typical cases) 4
• Chronic diarrhea without significant systemic symptoms
• Asymptomatic bloody stools, particularly in neonates
• Fever and abdominal pain without diarrhea (mimicking appendicitis or mesenteric adenitis)

Epidemiologic Risk Factors

Age Distribution

• 70% of cases occur in children ≤2 years old, with a second peak in adolescents and young adults aged 15-44 years 5, 6
• Infants under 1 year represent a significant proportion of cases 5, 3

Seasonal Pattern

• Peak incidence during warm months (May-October), with highest rates in July 5

Exposure History

• Recent consumption or handling of poultry products 6
• International travel (particularly to developing countries) 6
• Contact with farm animals or inadequately treated water 6

Critical Diagnostic Timing

Order stool testing immediately when: 1

• Fever is present with bloody diarrhea
• Abdominal pain is severe or localized (especially right lower quadrant pain in school-aged children)
• Signs of sepsis develop
• Patient is immunocompromised
• Infant is <3 months old with suspected bacterial etiology

Important Clinical Pitfalls

Avoid Misdiagnosis as Appendicitis

• Campylobacter can present with right lower quadrant pain mimicking appendicitis, particularly in school-aged children 4, 5
• Patients with this presentation are 3.6 times more likely to receive surgical consultation or radiological examination 4
• Look for the characteristic evolution: initial watery diarrhea followed by bloody stools 2-4 days later 2

Do Not Delay Testing Based on Hydration Status

• Unlike viral gastroenteritis, dehydration is typically NOT a prominent feature of Campylobacter infection 2
• The absence of significant dehydration should not dissuade testing when other features are present

Recognize Severe Complications Early

• Test promptly to identify cases at risk for hemolytic-uremic syndrome, sepsis with septic arthritis/osteomyelitis, or failure to thrive 5
• Guillain-Barré syndrome occurs in approximately 1 in 1000 Campylobacter infections 6

Testing Strategy

The IDSA recommends stool testing for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and STEC in children with the clinical features described above 1

• Direct phase-contrast microscopy of fresh stool can provide rapid diagnosis in acute presentations 2
• Culture remains the gold standard using selective media 2, 6
• Multiplex molecular panels can detect Campylobacter along with other pathogens simultaneously 1