Campylobacter Gastroenteritis: Complete ICD-11 Coding Guide

1. Introduction

Campylobacter gastroenteritis is a bacterial intestinal infection caused by bacteria of the genus Campylobacter, with the species Campylobacter jejuni responsible for the majority of human cases. This condition represents one of the most common causes of acute bacterial diarrhea worldwide, affecting millions of people annually and constituting an important global public health problem.

The infection is typically acquired through the consumption of contaminated food, especially undercooked poultry meat, unpasteurized milk, contaminated water, or through direct contact with infected animals. The disease manifests primarily with watery or bloody diarrhea, intense abdominal pain, fever, nausea and vomiting, with an incubation period generally between two to five days after exposure.

The clinical importance of Campylobacter gastroenteritis extends beyond acute gastrointestinal symptoms. In some cases, it can lead to serious complications such as bacteremia, especially in immunocompromised patients, and post-infectious sequelae such as Guillain-Barré syndrome, reactive arthritis, and irritable bowel syndrome. Mortality is rare in healthy individuals but can be significant in vulnerable populations.

Precise coding of this condition in the ICD-11 system is fundamental for epidemiological surveillance, public health policy planning, adequate resource allocation, foodborne outbreak studies, and clinical research. Appropriate documentation allows tracking of antimicrobial resistance trends, identifying sources of contamination, and implementing effective preventive measures at the population level.

2. Correct ICD-11 Code

The specific code for Campylobacter gastroenteritis in the ICD-11 system is 1A06. This code belongs to the chapter of infectious or parasitic diseases, specifically within the category of bacterial intestinal infections.

Code: 1A06
Description: Campylobacter gastroenteritis
Parent category: Bacterial intestinal infections

This code is used when there is laboratory confirmation or strong clinical suspicion of intestinal infection caused by species of the genus Campylobacter. The coding encompasses all pathogenic species of the genus, including C. jejuni, C. coli, C. lari, and other less common species that cause gastrointestinal disease in humans.

The structure of code 1A06 in the ICD-11 system allows precise identification of the specific bacterial etiology, differentiating it from other causes of bacterial gastroenteritis. This specificity is crucial to distinguish Campylobacter infection from other bacterial enteritis that may present similar symptoms but require different therapeutic approaches and prognoses.

The code should be applied regardless of the severity of clinical presentation, from mild self-limited cases to severe manifestations with significant dehydration or systemic complications, as long as the etiologic agent is confirmed or strongly suspected to be Campylobacter.

3. When to Use This Code

The code 1A06 should be used in specific clinical situations where there is evidence of Campylobacter infection:

Scenario 1: Acute Diarrhea with Laboratory Confirmation
Patient presents with acute diarrhea lasting less than two weeks, accompanied by abdominal pain and fever. Stool culture or molecular testing (PCR) identifies Campylobacter jejuni in feces. Even if symptoms are mild and the patient is undergoing outpatient treatment, code 1A06 is appropriate due to definitive microbiological confirmation.

Scenario 2: Febrile Gastroenteritis Following Consumption of High-Risk Foods
Individual develops bloody diarrhea, intense abdominal cramping, and high fever three days after consuming undercooked chicken meat at a collective event. Other participants from the same event present with similar symptoms. While awaiting laboratory results, code 1A06 can be used based on strong clinical and epidemiological suspicion, especially in an outbreak context.

Scenario 3: Enteritis with Typical Clinical Characteristics
Patient presents with initially watery diarrhea that progresses to stools with blood and mucus, accompanied by cramping abdominal pain mimicking acute appendicitis, fever, and malaise. Microscopic examination of feces reveals leukocytes and red blood cells. This characteristic clinical pattern, especially the prodromal phase followed by inflammatory diarrhea, strongly suggests Campylobacter as the etiologic agent.

Scenario 4: Infection in Child with Animal Exposure
School-age child develops acute gastroenteritis after contact with farm animals or domestic pets, particularly puppies or kittens. Clinical presentation includes frequent diarrhea, vomiting, and fever. Fecal antigen tests or multiplex PCR confirm Campylobacter spp., justifying the use of code 1A06.

Scenario 5: Gastroenteritis in Traveler Returning from Endemic Area
Traveler returns from region with high prevalence of Campylobacter and develops traveler's diarrhea with inflammatory characteristics. Laboratory investigation identifies Campylobacter coli resistant to fluoroquinolones. Code 1A06 is appropriate and may be supplemented with additional codes to document antimicrobial resistance if relevant to the registration system.

Scenario 6: Bacteremic Complication in Immunocompromised Patient
Patient with immunosuppression develops gastroenteritis followed by persistent fever and signs of bacteremia. Blood cultures identify Campylobacter jejuni. Code 1A06 is used for the primary intestinal infection and may require an additional code to document the systemic bacteremic complication.

4. When NOT to Use This Code

It is essential to recognize situations where code 1A06 is not appropriate to avoid coding errors:

Viral Gastroenteritis: When acute diarrhea is caused by rotavirus, norovirus, enteric adenovirus, or other viral agents, specific codes for viral gastroenteritis should be used. The absence of high fever, lower intensity of abdominal pain, and epidemiological characteristics may suggest viral etiology.

Other Bacterial Intestinal Infections: Infections by Salmonella, Shigella, pathogenic Escherichia coli, Yersinia, or Vibrio require their specific codes. Even if the initial clinical presentation is similar, definitive laboratory identification determines the correct code. Code 1A06 is exclusive to Campylobacter.

Non-Infectious Diarrhea: Conditions such as inflammatory bowel disease (Crohn's disease, ulcerative colitis), irritable bowel syndrome, food intolerance, or adverse drug effects should not be coded as 1A06, even if they present with diarrhea and gastrointestinal symptoms. The absence of an identified infectious agent and the chronic or recurrent pattern differentiate these conditions.

Unspecified Gastroenteritis: When there is acute diarrhea without identification of the etiological agent and without clinical or epidemiological characteristics that strongly suggest Campylobacter, more general codes for gastroenteritis of unspecified cause are more appropriate. Code 1A06 requires reasonable evidence of Campylobacter infection.

Asymptomatic Carrier: Individuals who shed Campylobacter in feces without clinical manifestations of gastroenteritis should not receive code 1A06, which refers specifically to symptomatic disease. Codes for carrier status or asymptomatic colonization are more appropriate in these cases.

5. Step-by-Step Coding Process

Step 1: Assess Diagnostic Criteria

The diagnosis of Campylobacter gastroenteritis requires clinical evaluation and laboratory confirmation. Clinically, seek the characteristic triad: diarrhea (watery initially, progressing to bloody in many cases), intense cramping abdominal pain, and fever. The typical incubation period of two to five days after exposure to suspect food or water is indicative.

Laboratory confirmation is the gold standard and can be obtained through stool culture in specific selective media with microaerophilic conditions, fecal antigen tests by immunoassay, or molecular methods such as PCR. Microscopic examination of stool revealing fecal leukocytes and erythrocytes supports the diagnosis of invasive enteritis. Blood cultures should be considered in patients with persistent fever or signs of systemic disease.

Assessment tools include detailed clinical history focusing on recent food exposures, contact with animals, travel, and associated symptoms. Physical examination should document signs of dehydration, abdominal tenderness, and stool characteristics. Dehydration severity scales aid in assessing the need for intervention.

Step 2: Verify Specifiers

Document the severity of presentation: mild (tolerable symptoms, adequate oral hydration), moderate (mild to moderate dehydration, need for medical intervention), or severe (severe dehydration, systemic complications, need for hospitalization).

Record symptom duration, distinguishing between acute presentation (less than 14 days, more common) and rare cases of prolonged infection. Identify specific characteristics such as presence of blood in stool, persistent high fever, or extraintestinal symptoms.

If applicable, document complications such as bacteremia, especially in immunocompromised patients, pregnant women, or at extremes of age. Note if there are emerging post-infectious manifestations such as reactive arthritis or neurological symptoms suggestive of Guillain-Barré syndrome.

Identify the Campylobacter species when available (C. jejuni, C. coli, others) and antimicrobial resistance patterns if tested, as this information may be relevant for epidemiological surveillance systems.

Step 3: Differentiate from Other Codes

1A00 - Cholera: Cholera caused by Vibrio cholerae presents with profuse watery diarrhea described as "rice water," without blood or pus, rapidly leading to severe dehydration. It differs from Campylobacter by the absence of a prodromal phase with intense abdominal pain, lower fever presence, and much greater volume of fecal loss. Specific laboratory confirmation is definitive.

1A01 - Intestinal Infection by Other Bacteria of the Vibrio Genus: Infections by Vibrio parahaemolyticus or other non-cholera species cause gastroenteritis typically associated with seafood consumption. Although they may present with diarrhea and abdominal pain, the epidemiological history and specific laboratory identification differentiate from Campylobacter.

1A02 - Intestinal Infections by Shigella: Shigellosis presents with dysentery with bloody stools, tenesmus, and fever, and can be confused with Campylobacter. However, Shigella typically causes smaller stool volume, greater frequency of evacuations with intense tenesmus, and may present with neurological manifestations such as seizures in children. Definitive differentiation requires specific culture or PCR.

1A03 - Intestinal Infections by Enteropathogenic Escherichia coli: Different pathotypes of E. coli cause distinct syndromes. EHEC (enterohemorrhagic E. coli) may cause similar bloody diarrhea, but typically without high fever. Identification of Shiga toxin and serotyping differentiate from Campylobacter.

Step 4: Required Documentation

Checklist of Mandatory Information:

Date of symptom onset and duration
Detailed description of symptoms: type of diarrhea (watery, bloody), frequency, presence of mucus or blood
Associated symptoms: fever (documented temperature), abdominal pain (location and intensity), nausea, vomiting
Exposure history: foods consumed in the 72-120 hours prior, especially poultry, unpasteurized milk, untreated spring water
Contact with animals, especially domestic birds, dogs, cats
Recent travel or participation in group events
Preexisting medical conditions, especially immunodeficiencies
Laboratory test results: stool culture, PCR, microscopic examination of stool, complete blood count if performed
Assessment of dehydration and vital signs
Treatment instituted and clinical response

Documentation should be sufficiently detailed to justify the diagnosis and coding, allowing for subsequent review and contributing to reliable epidemiological data.

6. Complete Practical Example

Clinical Case

A 28-year-old patient, previously healthy, seeks medical care with a complaint of severe diarrhea for three days. He reports that symptoms began with general malaise, headache and muscle pain, followed by abdominal pain of colicky type with severe intensity, initially diffuse and subsequently localized to the lower abdominal region. On the second day, he developed watery diarrhea with a frequency of 8 to 10 bowel movements daily, accompanied by fever of 39°C.

At the current consultation, on the third day of symptoms, the patient reports that stools became bloody with presence of mucus, the frequency remains elevated (10-12 times per day) and abdominal pain intensified. He reports occasional nausea but vomiting only on the first day. He presents signs of mild dehydration with dry mucous membranes and reduced skin turgor.

In the dietary history, the patient mentions having participated in a family barbecue five days before symptom onset, where he consumed chicken meat that he considers to have been "somewhat pink inside." Three other family members who attended the same event developed similar symptoms.

On physical examination: axillary temperature 38.5°C, heart rate 98 bpm, blood pressure 110/70 mmHg. Abdomen with increased bowel sounds, diffusely tender on palpation, mainly in the right iliac fossa, without signs of peritoneal irritation. The remainder of the physical examination without significant abnormalities.

Complementary tests were requested including complete blood count (revealing leukocytosis of 13,500/mm³ with left shift), microscopic stool examination (abundant presence of leukocytes and red blood cells) and stool culture with specific screening for enteric pathogens.

After 48 hours, the microbiology laboratory reports growth of Campylobacter jejuni in stool culture, confirming the diagnosis. The patient was treated with vigorous oral rehydration and azithromycin for five days, presenting gradual improvement of symptoms starting on the fourth day of illness.

Step-by-Step Coding

Criteria Analysis:

Compatible clinical presentation: The patient presents the classic triad of Campylobacter gastroenteritis - progressive diarrhea (watery progressing to bloody), intense colicky abdominal pain and fever. The incubation period of five days is within the expected range.
Laboratory confirmation: The positive stool culture for Campylobacter jejuni provides definitive microbiological confirmation, satisfying the gold standard diagnostic criterion.
Epidemiological context: The history of consumption of undercooked chicken and the cluster of family cases reinforce the etiological hypothesis of Campylobacter, known to be associated with contaminated poultry.
Exclusion of alternative diagnoses: The clinical and laboratory characteristics, especially the specific microbiological confirmation, exclude other causes of bacterial gastroenteritis.

Chosen Code: 1A06 - Campylobacter gastroenteritis

Complete Justification:

Code 1A06 is the most appropriate for this case based on multiple converging factors. First, the unequivocal laboratory confirmation of Campylobacter jejuni in stool culture definitively establishes the etiological agent, meeting the fundamental criterion for use of this specific code.

The clinical presentation is characteristic of Campylobacter infection: prodromal phase with constitutional symptoms, followed by intense abdominal pain that may mimic acute surgical abdomen, and evolution of diarrhea from watery to inflammatory with blood and mucus. This temporal progression is distinctive of Campylobacter compared to other enteric pathogens.

The epidemiological context of exposure to undercooked poultry meat is the most important risk factor for campylobacteriosis, reinforcing diagnostic plausibility. The family cluster suggests a common source of infection, typical of outbreaks associated with contaminated food.

The laboratory findings of leukocytosis with left shift and presence of leukocytes and red blood cells on stool examination confirm the invasive nature of the infection, consistent with the pathophysiology of Campylobacter.

Complementary Codes:

In this specific case, code 1A06 is sufficient to document the primary diagnosis. There are no complications requiring additional codes. If the patient had developed documented bacteremia by positive blood culture, it would be appropriate to add a code for sepsis. If there had been severe dehydration requiring hospitalization, an additional code for dehydration could be considered according to institutional protocol.

7. Related Codes and Differentiation

Within the Same Category

1A00: Cholera

When to use 1A00: This code is specific for infection by toxigenic Vibrio cholerae. Use when there is profuse watery diarrhea with "rice water" appearance, rapid and severe dehydration, typically without blood or pus in stool, and laboratory confirmation of V. cholerae O1 or O139.

Main difference vs. 1A06: Cholera causes non-invasive secretory diarrhea with massive volume of fluid loss (several liters per day), rapidly leading to hypovolemic shock. Campylobacter causes invasive diarrhea with lower volume, common presence of blood and fecal leukocytes, more intense abdominal pain, and more prominent fever. The pathophysiology is fundamentally different: cholera toxin versus mucosal invasion.

1A01: Intestinal Infection by Other Bacteria of the Vibrio Genus

When to use 1A01: Use for infections by non-cholera Vibrio species, such as V. parahaemolyticus, V. vulnificus, or V. mimicus. Typically associated with consumption of raw or undercooked seafood, especially oysters.

Main difference vs. 1A06: Epidemiological history is crucial - non-cholera Vibrio is strongly associated with marine seafood, while Campylobacter relates to poultry and mammals. V. parahaemolyticus causes acute gastroenteritis similar to cholera, but with shorter incubation period (4-30 hours). V. vulnificus can cause severe systemic infection in patients with liver disease or immunocompromised individuals. Definitive differentiation requires specific laboratory identification.

1A02: Intestinal Infections by Shigella

When to use 1A02: Appropriate code for shigellosis, caused by Shigella species (S. dysenteriae, S. flexneri, S. sonnei, S. boydii). Characterized by dysentery with small volume of bloody stools, intense tenesmus, abdominal pain, and fever.

Main difference vs. 1A06: Shigellosis typically presents with lower stool volume but higher evacuation frequency with marked tenesmus. Cramping abdominal pain is less prominent than in Campylobacter. Shigella has very low infectious dose (10-100 organisms), facilitating person-to-person transmission, while Campylobacter requires higher dose and rarely transmits between people. Children with shigellosis may present with febrile seizures, uncommon in campylobacteriosis. Laboratory identification is definitive.

1A03: Intestinal Infections by Enteropathogenic Escherichia coli

When to use 1A03: For infections by different pathotypes of E. coli (ETEC, EPEC, EIEC, EHEC, EAEC). EHEC (such as E. coli O157:H7) causes hemorrhagic colitis that can be confused with Campylobacter.

Main difference vs. 1A06: EHEC causes bloody diarrhea typically without high fever or with low-grade fever, differing from Campylobacter where fever is common. EHEC carries risk of hemolytic-uremic syndrome, especially in children. ETEC causes watery traveler's diarrhea without invasive characteristics. Differentiation requires culture with pathotype identification and toxin detection.

Differential Diagnoses

Acute Appendicitis: Intense abdominal pain in the right iliac fossa in campylobacteriosis may simulate appendicitis. It is differentiated by the prominent presence of diarrhea, history of food exposure, and absence of Blumberg or Rovsing signs.

Inflammatory Bowel Disease: Ulcerative colitis or Crohn's disease may present with bloody diarrhea and abdominal pain. Chronicity, previous history of symptoms, characteristic endoscopic and histopathological findings differentiate from acute Campylobacter infection.

Ischemic Colitis: In elderly patients, it may present with abdominal pain and bloody diarrhea. Advanced age, vascular comorbidities, absence of high fever, and specific tomographic findings aid in differentiation.

8. Differences with ICD-10

In the ICD-10 system, Campylobacter gastroenteritis is coded as A04.5. The transition to code 1A06 in ICD-11 represents structural changes in the classification system.

The main change lies in the hierarchical organization and alphanumeric structure. ICD-11 uses a more flexible alphanumeric system, allowing a greater number of categories and better logical grouping of related conditions. Code 1A06 is clearly situated within the category of bacterial intestinal infections, with sequential numbering that facilitates identification of related codes.

ICD-11 offers greater granularity and the possibility of additional specifiers through extension codes, allowing more detailed documentation of clinical features, severity, complications, and antimicrobial resistance when relevant. This flexibility does not modify the base code 1A06, but allows complementation with additional information as needed.

Another important difference is digital integration. ICD-11 was developed natively digital, with a structure that facilitates implementation in electronic health systems, allowing more efficient searching, linking with clinical terminologies, and better interoperability between systems.

From a practical standpoint, professionals familiar with A04.5 in ICD-10 must adapt to the new code 1A06, but the diagnostic criteria and clinical situations for application remain essentially the same. The transition requires updating computerized systems, training of coders, and review of institutional protocols, but does not fundamentally alter clinical practice or diagnostic criteria.

9. Frequently Asked Questions

How is Campylobacter gastroenteritis diagnosed?

Definitive diagnosis requires laboratory confirmation through stool culture, which remains the gold standard. Stool samples are cultured in specific selective media under microaerophilic conditions (atmosphere with reduced oxygen) at 42°C, a temperature that favors Campylobacter growth. Alternatively, molecular methods such as PCR in multiplex panels for gastrointestinal pathogens offer faster diagnosis (hours versus days) and greater sensitivity. Fecal antigen tests by immunoassay are also available in some facilities. Clinically, suspicion is based on characteristic presentation: progressive diarrhea, intense abdominal pain, fever, and history of exposure to high-risk foods. Microscopic examination of stool revealing leukocytes and red blood cells supports the diagnosis of invasive enteritis, but is not specific for Campylobacter.

Is treatment available in public health systems?

Yes, treatment of Campylobacter gastroenteritis is generally available in public health systems. Most cases are self-limited and require only supportive treatment with adequate oral hydration using rehydration solutions. Antibiotic therapy is reserved for severe cases, immunocompromised patients, pregnant women, extremes of age, or when there is evidence of invasive disease. Azithromycin is the antibiotic of choice currently due to increasing fluoroquinolone resistance. The medications used (azithromycin, oral rehydration solutions) are generally included in lists of essential medicines and available in public services. Antiemetics and antispasmodics may be used for symptomatic control. Antidiarrheal agents such as loperamide should be avoided in invasive diarrhea with blood.

How long does treatment last?

The duration of treatment varies according to severity and the need for antibiotics. Mild self-limited cases resolve spontaneously in five to seven days without need for antibiotic therapy, requiring only adequate hydration and rest. When indicated, antibiotic therapy with azithromycin is typically prescribed for three to five days. In severe cases or immunocompromised patients, treatment may be extended for seven to ten days. Supportive hydration should be maintained throughout the symptomatic period. Complete clinical recovery generally occurs in one to two weeks, although fatigue and mild abdominal discomfort may persist for several additional weeks. Fecal shedding of Campylobacter may continue for two to three weeks after symptom resolution, during which hygiene measures should be rigorously maintained.

Can this code be used on medical certificates?

Yes, code 1A06 can and should be used on medical certificates when appropriate. Campylobacter gastroenteritis is a condition that frequently justifies temporary absence from work or school activities due to debilitating symptoms (frequent diarrhea, intense abdominal pain, fever) and transmission risk. The typical period of absence varies from three to seven days, depending on symptom severity and type of professional activity. Food handlers, healthcare professionals, and childcare workers may require longer absence until confirmation of two negative stool cultures. Proper documentation with the correct ICD-11 code strengthens the medical justification of the certificate and facilitates administrative processes. It is important that the certificate be accompanied by guidance on transmission prevention and safe timing for return to activities.

What are the possible complications of this infection?

Although most cases are self-limited, complications can occur. Bacteremia is rare in healthy individuals but can occur in immunocompromised patients, elderly, pregnant women, or patients with chronic diseases, requiring intravenous antibiotic therapy. Guillain-Barré syndrome, an acute demyelinating polyradiculoneuropathy, is the most serious post-infectious complication, occurring in approximately one in every thousand cases, typically one to three weeks after gastroenteritis. Reactive arthritis may develop weeks after infection, primarily affecting knees, ankles, and wrists. Some patients develop post-infectious irritable bowel syndrome with symptoms persisting for months. Severe dehydration can occur, especially in young children and elderly. Fulminant colitis, toxic megacolon, and intestinal perforation are extremely rare but potentially fatal complications.

How to prevent Campylobacter infection?

Prevention is based on food safety and hygiene measures. Thoroughly cook poultry meat until reaching an internal temperature of at least 74°C to eliminate the pathogen. Avoid cross-contamination by separating raw meat from ready-to-eat foods, using different cutting boards and utensils. Rigorously wash hands with soap and water after handling raw meat, using the bathroom, changing diapers, or touching animals. Consume only pasteurized milk and dairy products. Drink water from treated or boiled sources. Wash fruits and vegetables before consumption. Exercise caution when handling pets, especially puppies with diarrhea. Food handlers with gastrointestinal symptoms should be temporarily removed from work. At the population level, biosecurity programs in poultry farming, surveillance of food production chains, and education on safe food preparation practices are fundamental.

Do children and elderly have greater risk?

Yes, children under five years of age have the highest incidence rates of Campylobacter gastroenteritis, possibly due to immunological immaturity and greater exposure to infection sources. In this age group, infection can be more severe with greater risk of dehydration, requiring careful monitoring and early intervention. Elderly also constitute a risk group, particularly those with comorbidities, presenting greater probability of complications such as bacteremia and need for hospitalization. Mortality, although rare, is higher at extremes of age. Immunocompromised patients (HIV/AIDS, transplant recipients, undergoing chemotherapy, using immunosuppressants) have increased risk of severe, prolonged, and invasive disease. In these vulnerable groups, early antibiotic therapy is frequently indicated even in cases that would be considered mild in healthy adults.

Is there a vaccine against Campylobacter?

Currently there is no approved vaccine for human use against Campylobacter. Vaccine development faces challenges due to the antigenic diversity of multiple Campylobacter species and strains, the complexity of protective immune response, and concerns about possible association between Campylobacter infection and Guillain-Barré syndrome, which raises safety questions for vaccine development. Research is ongoing exploring different approaches, including vaccines based on surface proteins, capsular polysaccharides, and conjugate vaccines. Veterinary vaccines for use in laying hens are available in some regions, aiming to reduce colonization in chickens and consequently contamination of the food chain. Primary prevention continues to depend on food safety measures, hygiene, and control in animal production.

Conclusion

Precise coding of Campylobacter gastroenteritis using code 1A06 in the ICD-11 system is fundamental for adequate epidemiological surveillance, public health planning, and clinical research. Understanding when to use this specific code, differentiating it from other bacterial intestinal infections, requires knowledge of typical clinical characteristics, laboratory diagnostic criteria, and epidemiological context of the infection. Proper documentation not only facilitates administrative and statistical processes, but contributes to the global understanding of this important cause of bacterial gastroenteritis, allowing implementation of effective preventive strategies and monitoring of antimicrobial resistance trends.

External References

This article was prepared based on reliable scientific sources:

🌍 WHO ICD-11 - Campylobacter Gastroenteritis
🔬 PubMed Research on Campylobacter Gastroenteritis
🌍 WHO Health Topics
📋 CDC - Centers for Disease Control
📊 Clinical Evidence: Campylobacter Gastroenteritis
📋 Ministry of Health - Brazil
📊 Cochrane Systematic Reviews

References verified on 2026-02-04

Campylobacter Gastroenteritis

Partager