Case

Ms. V is a 45-year-old woman who comes to see you in the office; she complains of 4 days of diarrhea. She reports feeling tired and weak. She is moving her bowels about 6–8 times a day. She says that she has significant abdominal pain. She came in today because she has begun to pass bloody stools.

On physical exam, her vital signs are temperature, 38.3°C; BP, 130/84 mm Hg; pulse, 90 bpm; RR, 12 breaths per minute. She is orthostatic. Her abdomen has hyperactive bowel sounds. It is diffusely tender, without peritoneal signs. Her stool is a mixture of soft brown stool and blood.

The patient’s first symptoms, 4 days ago, were fever and lethargy. She felt terrible for the entire day and thought she was getting the flu. The following day, she began to have diarrhea and diffuse abdominal pain. Two days later, the day she comes to your office, she began to have blood in her stool.

She reports that her husband is also sick with similar symptoms. His diarrhea developed the day before hers did but he has not noticed blood in his stool. He refused to come in because he figured it was “just a virus.”

The patient is given IV fluids in the office. After receiving acetaminophen and 2 L of fluid she is feeling somewhat better. Stool cultures are sent. A CBC and Chem-7 are normal.

The patient was treated with supportive therapy. Anti­diarrheals were withheld because of her bloody diarrhea. Ciprofloxacin was prescribed empirically. Her stool was sent for culture.

Her stool cultures were negative, and her symptoms resolved within 3 days.

 

S: 45 y/o female who presented with complaints of diarrhea, fatigue, and weakness. Bagan 4 days ago feeling feverish and lethargic, which later progressed into diarrhea and diffuses abdominal pain. She noticed blood in the stool and having the bowel movement 6-8 times a day.

O: T 100.94 | BP 130/84 | P 90 | RR 12

Ms. V is a well-developed female who is alert oriented to person, place and time. Small build, well groomed, good posture, good hygiene and looks of her stated age. on inspection, the stool is a mixture of blood and soft brown stool. She is orthostatic. Physical examination reveals hyperactive bowel sounds in the abdomen and diffusely tender to palpation, without peritoneal signs. CBC and Chem 7 are normal. Stool culture was negative.

A: Campylobacter infection

R/O: Shigella species

P: Acetaminophen and 2 L of IV fluid were given with no improvement. Antidiarrheals were withheld and prescribed Ciprofloxacin and follow up if the symptom does not resolve in 3-4 days. If the symptom reoccurs then seek medical attention.

Farhana Chowdhury- Physician Assistant Student

 

Summary

Campylobacter infection presents with diarrhea and abdominal pain along with fever which could be short lasting. Sometimes the symptom of Campylobacter infection can be confused with appendicitis. In Ms. V. case, she was presented with severe abdominal pain companied with fever, fatigue, weakness, and bloody diarrhea. Based on her history, the clinician can suspect bacterial diarrhea: Campylobacter and Shigella. Campylobacter infection is a common cause of bloody stool and annually 2.4 million people get affected by Campylobacter diarrhea. The bacteria can stay in the system for 4-5 weeks which increases the chance of reinfection. Even though it is benign in most case, but clinician should stay alter as it can be associated with reactive arthritis and Guillain-Barré syndrome. If the patient comes with bloody diarrhea symptom which followed by 2-3 watery diarrhea then a stool culture test can help to distinguish between Campylobacter and Shigella infections. In addition, high bendemia would indicate Shigella infections.

Where the infection can be acquired from:

• Undercooked poultry
• unpasteurized milk
• water and sewage system in a developing country

Who are more susceptible:

Infants and children have a greater chance of developing Campylobacter infection, but any age group could be affected. It is more common in summertime compare to winter time and male are more susceptible to the infection compare to female.