Comparison of rheumatological and gastrointestinal symptoms after infection with Campylobacter jejuni/coli and enterotoxigenic Escherichia coli

Abstract

Objectives: To estimate the incidence of postinfectious joint complaints after Campylobacter jejuni/coli enteritis compared with enteritis caused by enterotoxigenic E coli (ETEC). To compare gastrointestinal symptoms, antibiotic treatment, and antibody levels among patients with and without joint symptoms.

Method: Questionnaires were sent to 210 consecutive patients with Campylobacter infection and an equal number of patients with E coli (ETEC). Blood samples for anti-Campylobacter antibodies were collected after two weeks, three months, six months, and two years.

Results: Twenty seven of 173 (16%) patients with Campylobacter and 10/177 (6%) with E coli (ETEC) reported joint symptoms (p=0.004). In the Campylobacter group duration of diarrhoea was a median of 13 days for patients with arthralgia and seven days for those without joint pain (p=0.0058). Patients with E coli had diarrhoea of longer duration than patients infected with Campylobacter (14 days v seven days; p=0.0005). E coli patients had fewer gastrointestinal symptoms than Campylobacter patients (p=0.0001). Fifty nine per cent of Campylobacter patients with joint pain had received antibiotic treatment because of enteritis compared with 26% with enteritis only (p=0.03). Campylobacter species and serotypes were equally distributed in both groups and there was no difference in anti-Campylobacter antibody levels between the groups.

Conclusion: There was a significantly increased risk of developing joint symptoms after contracting Campylobacter infection compared with E coli. Campylobacter patients with joint pain had more severe gastrointestinal symptoms and longer duration of diarrhoea. Antibiotic treatment does not seem to prevent reactive joint symptoms. Levels of anti-Campylobacter antibodies were the same in both groups.

Figure 1

Duration of diarrhoea among 146 patients with Campylobacter enteritis (grey columns), 27 patients with Campylobacter ReA (black columns), and 167 patients with non-ReA E coli (ETEC) enteritis (white columns).

Figure 2

Individual gastrointestinal symptoms among 146 patients with Campylobacter enteritis (grey columns), 27 patients with Campylobacter ReA (black columns) (*p= 0.02, Campylobacter enteritis v Campylobacter ReA), and 167 patients with non ReA E coli (ETEC) enteritis (white columns) (**p= 0.0001, Campylobacter enteritis v E coli (ETEC) enteritis).

Figure 3

Proportions of patients treated with antibiotics for enteritis after infection with Campylobacter or E coli (ETEC). (Black columns, antibiotic treated; grey columns, untreated; white columns, don't remember). Campylobacter ReA v non-ReA; p=0.03.