Ann IM 1983;98:360; 1983;99:38; Nejm 1981;305:1444

Cause:Campylobacter jejuni

Contaminated water, surface water, and municipal water supplies (Ann IM 1982;96:293); similar epidemiology to giardia. Also may be sporadic, foodborne, often by eggs. Cattle, goats, horses, and perhaps wild animals excrete in feces. 3× more frequent than giardia; more common than salmonella and shigella (Harvard Medical School CME lecture 3/85)

Sx:

1- to 7-d incubation period

Diarrhea (100%), cramps (95%), fever (80%), bloody diarrhea (29%)

20% last over 1 wk

Chronic colitis; Guillain-Barré syndrome (Nejm 1995;333:1374); immunoproliferative small bowel disease (alpha chain disease), a mucosa-associated lymphoid tissue (MALT) lymphoma w plasma cell infiltration of bowel wall and monoclonal -heavy chain, prevalent around Mediterranean, causes a chronic wasting diarrhea, can cause diffuse B-cell lymphomas and is rx'd w combinations of antibiotics like amoxicilin + clarithromycin + metronidazole

r/o ulcerative colitis relapses

Lab:Bact:Culture in 10% CO₂ × 48 h, special media

Rx:Caution using erythromycin if sx >3 d bcs widespread resistance internationally; ciprofloxacin (Arch IM 1990;150:541), or other quinolone (azithromycin 1 gm once); drug resistance appearing because of antibiotic use in poultry industry (Nejm 1999;340:1525)