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Gulf War and Health: Volume 5. Infectious Diseases
first). Common characteristics of the abdominal pain are unlocalized cramping that may be so severe as to mimic acute appendicitis; however, diarrhea predominates over abdominal pain in most patients.
On the first day of diarrheal illness, the patient usually has four to 20 loose stools, and 25% of them may contain visible blood. Laboratory examination of stool specimens usually reveals gross or microscopic blood in all and leukocytes in 70%. Fever continues from the prodrome and persists for 24-48 hours.
Symptoms usually begin to recede after 48 hours and resolve during the next few days. In rare cases, the illness may last longer. In the absence of antibiotic treatment, relapse occurs in about 20% of cases; relapses are usually milder than the initial episodes.
Some people with Campylobacter infections are bacteremic (Mandell et al. 2005); this condition represents either a primary bacteremia or, rarely, the seeding of a distant organ (Blaser et al. 1986).
Diagnosis During and After Acute Illness
Diagnosis of the acute illness is based on culture of feces and, rarely, of blood. Culture-based tests even in the acute phase can have false-negative results, especially in infection by non-jejuni species, because Campylobacter spp. are difficult to grow in culture. Alternatively, the bacteria can be detected with polymerase-chain-reaction (PCR) assay of genetic material from stool specimens. Antibody testing, which is not commercially available, is less reliable because of the diversity of Campylobacter strains, the time required for a response to occur, and differences in magnitudes of responses among hosts.
Infected people shed Campylobacter in stool for a mean of 2-3 weeks after the onset of symptoms; virtually no immunocompetent hosts are still shedding the organism after 8 weeks (Karmali and Fleming 1979; Svedhem and Kaijser 1980; Taylor et al. 1988). Thus, a culture or PCR test conducted more than 2 months after an acute episode of Campylobacter enteric disease would rarely be positive. After 2 months have elapsed, there is no reliable diagnostic test for exposure to Campylobacter in people who manifest diseases that could be late adverse health outcomes of a Campylobacter infection.
Treatment of Acute Illness
Fluid and electrolyte replacement is the treatment of choice for diarrheal illnesses. In patients who are still symptomatic at the time of diagnosis, antimicrobial treatment is recommended, particularly with fluoroquinolones and macrolides. Clinicians should be cognizant of Campylobacter’s growing resistance to those antimicrobials; the degree of resistance will reflect the use of antimicrobials in animal farming and in the local human population.
Long-Term Adverse Health Outcomes ofCampylobacterInfection
On occasion, infection by Campylobacter spp. leads to long-term adverse health outcomes. The most serious health outcome associated with campylobacteriosis is Guillain-Barré syndrome (GBS). Reactive arthritis appears to occur after campylobacteriosis at a frequency greater than the background frequency. There is some evidence that uveitis is associated with Campylobacter infection.
The first report of an association between Campylobacter jejuni infection and GBS was published in 1982 (Rhodes and Tattersfield 1982). Numerous scientists have since investigated