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Clinical Review Quiz

Campylobacter jejuni Infections

Olayinka Adedayo, MD

Dr. Adedayo is a fellow, Infectious Disease Unit, Department of Medicine, Fletcher Allen Health Care and the University of Vermont College of Medicine, Burlington, VT.

The questions below are based on the article
Campylobacter jejuni Infections: Update on Presentation, Diagnosis, and Management”.

Choose the single best answer for each question.

1. A 64-year-old man presents to the clinic with 2 weeks of diarrhea after travel to South Asia. Although he had no illness during his trip, he developed small-volume, bloody diarrhea immediately upon his return. He experienced marked abdominal cramping and moderate fever (38.3°C) and self-medicated with ciprofloxacin 500 mg orally twice daily for 3 days, without resolution of symptoms. Stool cultures on selective media demonstrated heavy growth of Campylobacter jejuni, with antibiotic resistance to fluoroquinolone antibiotics. What is the best antibiotic option for this patient?
  1. Azithromycin 500 mg/day orally for 3 days
  2. Azithromycin 500 mg/day orally for 3 days; perform blood cultures and HIV testing
  3. Ciprofloxacin 750 mg orally twice daily for 7 days
  4. No antibiotic treatment; check human leukocyte antigen (HLA)-B27
  5. No antibiotic treatment, symptoms should resolve spontaneously
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2. Which of the following most increases a person’s risk for developing Campylobacter infection?

  1. Consumption of undercooked poultry
  2. Consumption of other meats (nonpoultry) in a restaurant
  3. Contact with farm animals
  4. Drinking unpasteurized (raw) milk
  5. Drinking water from a stream, river, or lake
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3. Which factor most increases an individual’s chance of having postinfectious reactive arthritis following Campylobacter infection?

  1. Absence of antibiotic therapy
  2. Duration of symptoms
  3. History of irritable bowel syndrome
  4. Presence of the HLA-B27 antigen
  5. Prior history of arthritis
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4. Which of the following best describes a typical case of acute C. jejuni infection?
  1. Afebrile patient with abdominal cramping and frequent small-volume watery stools
  2. Afebrile patient with large-volume watery stools
  3. Febrile patient with abdominal cramping and frequent small- or large-volume stools, which may contain blood or mucous
  4. Febrile patient with abdominal cramping, rigors, hypotension, and large joint arthritis
  5. Febrile patient with abdominal cramps, small-volume bloody stools, and acute flaccid paralysis
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5. Which of the following medications is a first-line agent for treatment of Campylobacter infections?

  1. Ciprofloxacin
  2. Ertapenem
  3. Erythromycin
  4. Tetracycline
  5. Trimethoprim-sulfamethoxazole
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6. Which of the following statements regarding the development of Guillain-Barré syndrome after Campylobacter infection is true?

  1. Guillain-Barré syndrome occurs in approximately 1 in every 500 cases of Campylobacter infection
  2. The majority of patients with Guillain-Barré syndrome have a prior history of Campylobacter infection
  3. Persons with Guillain-Barré syndrome and antibodies to GQ1b are at increased risk for cranial nerve involvement (Miller-Fisher variant of Guillain-Barré syndrome)
  4. The risk of Guillain-Barré syndrome is increased if the patient is HLA-B27 antigen-positive
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Updated 7/18/08 • nvf