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home - Colon - Colonic Infection - Campylobacter Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Campylobacter

Antimicrobial therapy Indications:Reduces sx on average by 1.3 days-Only indicated if toxic patient. Can use erythromycin/ azithromycin.Also have mac-rolides, fluoroquinolones (50% resistance in Spain/ Hungary), aminoglycosides, tetracyclines, and chloramphenicol sensitivity.Resistant to trimethoprim, penicillin and most cephalosporins. Treat serious systemic Campylobacter infections with aminoglycoside/carbapenem. Prepare chicken thoroughly. Person-person spread unusual so dont need isolation- very low infectivity. Nosocomial infection only in neonatal nurseries. No food handling when ill. Clinical PresentationProdrome-1/3rd get fever and malaise + no GI sx accompanied by rigors, generalized aches, dizziness, and delirium for < 3 days. During the diarrhoeal stage-BO >10X/day with blood on the 3rd day.-Nausea common-only 20% vomit.-High/ low grade fever + mild WCC inc. occurs.-Transient bacteremia common.Pseudoappendicitis — Due to acute ileoce-citis. Rebound tenderness and guarding are absent.3% of pseudo have real appendicitis.Resolution in 20% takes > 1 week. Longer if fluoroquinolone resistant.Diarrhoea usually resolves before abdominal pain.Excretion falls exponentially over time.Chronic carriage occurs in immune deficient patients. Even in food handlers, presence of campylo-bacter is of no consequence Incubation period: 1-7 days In jejunum and ileum then spreads to the colon -jejuni -coli.Also..... C. hyointesti-nalis, C. lari, and C. Upsalien-sis..... can also cause diarrhea. Acquisition:-Food-Water-borne outbreaks-Direct contact with animals or their products esp poultry Relapse 10% Early Onset Complications:Cholecystitis- with or without preceding diarrhoea.Pancreatitis.Hepatitis (possibly hepatotoxin from C. jejuni).Peritonitis in patients on CAPD- usually with preceding diarrhoea.Massive hemorrhage from TI ulcer.HUS, glomerulonephritis, and IgA nephropathy.Rashes eg. urticaria, erythema nodosum, vasculitis cellulitis. Peri/myocarditis. Focal infections eg septic arthritis, osteitis, soft tissue infections.Foetal/placental infection Campylobacter abortion is also caused by C. fetus. Reactive arthritis — In 2.6%- is HLA-B27 related- Joint pain and swelling (in ankles, knees, wrists, and small joints of the hands in 10%). Can be disabling. Ultimately resolves. Guillain-Barré syndrome C. jejuni most common antecedent event (40%) in (esp axonal) GBS. 1-2 weeks before the onset of neurologic symptoms.Due to cross-reacting antibodies to GM1 ganglio-side (in peripheral nerve myelin) Campylobacter Oxalase and Catalase Positive (Cool stool)1)Culture on campylobacter selective media and incubate in 5% O2 5 % CO2 and H2)Rapid ID-microscopy of fresh stools using dark-field, phase-contrast, and stained smears. Sens 75%. Not practiced routinely. Gram's stain (g-ve curved rods) even less sensitive.3)Serology-complement fixation or ELISA 10X/day Late Onset Complications Duration: 1 week to many months. 1- many weeks after diarrhea Penner O19 and 041 strains more likely to trigger GBS. Miller-Fisher variant of GBS has cross-reacting antibodies to GQ1b ganglioside (in cranial nerve myelin). Assoc with Penner O2 strain. Campylobacter species These are usually rare. Written by Dr Sebastian Zeki Treatment Prevention: Diagnosis

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