History and exam

Key diagnostic factors

common

abdominal pain

The abdominal pain associated with Campylobacter infection is usually more severe than that with the other bacterial causes of enteritis/colitis. The pain often becomes continuous and radiates to the right iliac fossa (frequently described as right lower quadrant of the abdomen).[32]​​

diarrhea

The major clinical manifestation of Campylobacter infection is diarrhea. The diarrhea may be watery, with up to 8-10 bowel movements daily. It becomes bloody in approximately 20% to 25% of cases. The diarrhea is considered inflammatory because of the prominent expression of fever and constitutional symptoms, and because the stools contain leukocytes and blood.[4]

Other diagnostic factors

uncommon

prodrome of headache, myalgias, chills, fever

Prodromal symptoms may precede diarrhea by 1 to 3 days.[21]

vomiting

Vomiting is most common in infants with Campylobacter infection.[32]​​

Risk factors

strong

recent foreign travel

Risk of infection is highest in people who have visited Africa, Asia, and South America, particularly areas with poor sanitation and restaurant hygiene.[14]​​

eating raw or undercooked meat (especially chicken)

Undercooked chicken is the most significant risk factor for Campylobacter jejuni and C coli infection.[6][18][23][24]

exposure to poultry, cattle, sheep, or other farm animals

Infection can be acquired directly from animals or their carcasses. This type of direct transmission is usually occupational and occurs in farmers, slaughterhouse workers, and poultry processors. Domestic infection can also occur from contact with a pet (puppy or kitten) with diarrhea.[23]

HIV infection

Incidence of Campylobacter infection is increased in patients with HIV/AIDS, although the incidence is lower in HIV-positive patients on antiretroviral therapy.[5] People with HIV are also at risk of becoming long-term carriers of Campylobacter. This is associated with recurrent enteritis and bacteremia.[25]

male sex

The incidence of reported Campylobacter infections is slightly higher in men than in women.[4][12]

weak

drinking untreated water

Drinking untreated water and swimming in recreational water carries a risk of transmission.[18] Campylobacterwas responsible for 36 out of 123 waterborne outbreaks in Nordic countries between 1998 and 2012.[26]​ In 2022, there were a total of 19 active cases of Campylobacter infection in Montana, USA, caused by the consumption of untreated water.[27]

drinking unpasteurized milk

In one study, 5% of cases of Campylobacter infection occurred from drinking unpasteurized milk. It is nearly impossible to prevent milk from becoming fecally infected; therefore, pasteurization is necessary to prevent transmission.[28]

close contact with infected person

People with Campylobacter infections do not need to be isolated. As the infection is acquired by fecal to oral transmission, person-to-person spread of infection is highly unlikely. However, hand-washing is still important when in close contact with a person with a diarrheal illness. Also, people with a diarrheal illness should not handle food.

use of proton pump inhibitors or H2 antagonists

It is increasingly recognized that patients, especially older patients, taking proton pump inhibitors or H₂ antagonists are at increased risk of developing Campylobacter infection.[24] In one study, 10% of Campylobacter cases were attributed to acid-suppressing medication.[29]

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