PANCE Blueprint Infectious Disease (6%)

Campylobacter jejuni infection

Patient will present as → a 23-year-old PA student with a 3-day history of bloody diarrhea, abdominal pain, and fever. She reports having passed liquid stools up to nine times that day. She started noticing blood earlier this morning. There is no history of recent travel or sick contacts but she reports eating grilled chicken during a recent study group. Stool microscopy revealed numerous WBCs and RBCs in the stool. A sample was cultured on Skirrow agar and incubated in a gas mixture with 5% oxygen.

Ingestion of what food should make you think of campylobacter?
Poultry

The most common cause of acute bacterial diarrhea. Can be severe: blood appears in stool in 50% of cases

  • Food (e.g., contaminated meat, especially poultry), animals (e.g., puppies, kittens)
  • Headache, fatigue followed by diarrhea (blood and pus in stools) ten or more stools per day, and abdominal pain
  • Guillain-Barré syndrome - antigenic cross-reactivity between Campylobacter oligosaccharides and glycosphingolipids on neural tissues cause of 30% of GBS cases in U.S.
  • Reactive arthritis - inflammatory arthritis of unknown etiology occurs post-infection

Culture on Skirrow agar at 42° ("CAMPing in the heat")

  • Comma or S-shaped bacteria with polar flagella and Oxidase positive

Treat with fluoroquinolone or azithromycin

  • Relapses may occur
IM_Trichomonas_Vaginalis_ASSETS_ Campylobacter jejuni is a curved gram negative bacilli with characteristic corkscrew motility. It is also oxidase positive and is known to grow well at high temperatures of 42 degrees C. This organism has been recognized as one of the main causes of bacterial foodborne disease. The common routes of transmission are fecal-oral and ingestion of contaminated food or water. Sources include undercooked poultry, unpasteurized milk, and there is an association with contracting disease from puppies with diarrhea. In the GI tract, the organism produces an inflammatory response with bloody diarrhea with cramping and pain. The infection is usually self-limiting and often can be treated with liquid and electrolyte replacement. In some cases, an infection by Campylobacter is a common antecedent to Guillain-Barre syndrome or Reiter’s syndrome.

Campylobacter jejuni Picmonic

Fluoroquinolones are a family of broad spectrum antibiotic drugs that commonly end with suffix floxacin like ciprofloxacin and moxifloxacin. These drugs are bactericidal and eradiate bacteria by interfering with DNA replication. Fluroquinolones inhibit topoisomerase II enzymes including bacterial DNA gyrase. These enzymes cut both strands of the DNA helix in order to unwind DNA tangles and supercoils which is necessary for proper DNA replication. These drugs are broad spectrum antibiotics that play an important role in the treatment of serious bacterial infections, especially against gram negative rod infections. Fluoroquinolones, especially ciprofloxacin, is commonly used in the treatment of urinary tract infections and also used in the treatment of Psuedomonas and Neisseria infections. Products containing multivalent cations, like aluminum or magnesium containing antacids, result in drastic reduction of oral absorption and should not be taken together.</p>↵<p>In general, adverse effects to fluoroquinolones are generally mild to moderate and include diarrhea, skin rashes, and headaches. On occasion, more serious adverse effects can occur. Fluoroquinolones can damage cartilage and ligaments and can cause spontaneous tendon rupture. They are also associated with fibromyalgia like symptoms including leg cramps and myalgias in children. Because they can damage cartilage and ligaments, they are not recommended for use in pregnant women or children and are considered a teratogen.

Fluoroquinolones Toxicities

 

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