Distinguishing Features of Campylobacter jejuni Diarrhea
Campylobacter jejuni diarrhea is characterized by an inflammatory pattern with fever, severe abdominal pain, and bloody stools containing fecal leukocytes—features it shares with other invasive bacterial pathogens like Shigella and Salmonella, making clinical differentiation difficult without laboratory testing. 1
Key Clinical Features of C. jejuni Infection
Inflammatory Presentation
- Bloody diarrhea occurs in 21-97% of cases, with visible blood in approximately 8% and heme-positive stools in 38-83% of patients 2
- Fever and abdominal cramping are prominent features, similar to other invasive bacterial causes 1
- Fecal leukocytes, lactoferrin, and occult blood are present in stool specimens, indicating inflammatory colitis 1
- Tenesmus is a common feature that distinguishes it from non-inflammatory diarrhea 3
Temporal Pattern
- Incubation period of 2-5 days after exposure 4
- Stools frequently contain mucus initially, with frank blood appearing a few days after symptom onset 4
- Most infections are self-limiting, resolving in 3-5 days without treatment 2
- Untreated patients may shed organisms for up to 7 weeks following symptom onset 4
What Makes C. jejuni Similar to Other Invasive Bacterial Pathogens
The guidelines emphasize that C. jejuni shares inflammatory features with Shigella, Salmonella, and other culture-diagnosed bacterial pathogens, making clinical distinction challenging 1:
- All present with fever, abdominal pain, and bloody stools 1
- All show fecal leukocytes and inflammatory markers 1
- The predictive value of any single clinical feature is relatively low for identifying a specific pathogen 1
Distinguishing Features (When Present)
Less Common in C. jejuni
- Significant vomiting and dehydration are uncommon compared to other bacterial causes 4
- However, when vomiting and/or bloody diarrhea occur together, they characterize more severe disease requiring longer illness duration and hospital admission 5
Epidemiological Clues
- Poultry consumption (especially undercooked chicken), raw milk, or contaminated water exposure 6
- Unboiled tap water consumption shows a dose-response relationship with severity 5
- More common in children and young adults 6
Post-Infectious Sequelae (Unique Complications)
- Guillain-Barré syndrome develops in a small percentage of cases, which is particularly associated with C. jejuni 7, 8, 6
- Reactive arthritis and Reiter's syndrome may follow infection 7, 2, 6
Clinical Pitfalls
The most important caveat is that clinical features alone cannot reliably distinguish C. jejuni from other invasive bacterial causes of diarrhea 1. The 2017 IDSA guidelines explicitly state that fever, bloody stools, and abdominal pain are not highly discriminatory among bacterial pathogens 1.
When to Suspect C. jejuni Specifically
- Severe abdominal pain with bloody stools but minimal or no fever suggests C. jejuni, STEC, Salmonella, Shigella, or Yersinia 1
- Proctocolitis pattern with bloody diarrhea in the appropriate epidemiological context 7
- Illness lasting >1 day with fever and bloody stools warrants stool culture to differentiate among these pathogens 1
Diagnostic Approach
Stool culture remains essential because clinical features overlap significantly with other bacterial causes 1:
- Direct phase-contrast microscopy can provide rapid presumptive diagnosis during acute illness 4
- Culture requires selective medium with antibiotics and incubation at 42°C under reduced oxygen 4
- Fecal leukocyte testing supports inflammatory etiology but doesn't distinguish specific pathogens 7
The bottom line: C. jejuni presents as an inflammatory colitis indistinguishable from Shigella, Salmonella, and other invasive bacterial pathogens based on symptoms alone—laboratory confirmation is required for definitive diagnosis 1.