Campylobacteriosis

Definition

Campylobacteriosis refers to infection by the group of bacteria known as Campylobacter. The term comes from the Greek word meaning "curved rod" referring to the bacteria's curved shape. The most common disease caused by these organisms is diarrhea, which most often affects children and younger adults. Campylobacter infections account for a substantial percent of food-borne illness encountered each year.

Description

There are over 15 different subtypes, all of which are curved Gram-negative rods. C. jeuni is the subtype that most often causes gastrointestinal disease. However, some species such as C. fetus produce disease outside the intestine, particularly in those with altered immune systems, such as people with AIDS, cancer, and liver disease.

Campylobacter are often found in the intestine of animals raised for food produce and pets. Infected animals often have no symptoms. Chickens are the most common source of human infection. It is estimated that 1% of the general population is infected each year.

Causes and symptoms

Improper or incomplete food preparation is the most common way the disease is spread, with poultry accounting for over half the cases. Untreated water and raw milk are also potential sources.

The incubation period after exposure is from one to 10 days. A day or two of mild fever, muscle aches, and headache occur before intestinal symptoms begin. Diarrhea with or without blood and severe abdominal cramps are the major intestinal symptoms. The severity of symptoms is variable, ranging from only mild fever to dehydration and rarely death (mainly in the very young or old). The disease usually lasts about one week, but persists longer in about 20% of cases. At least 10% will have a relapse, and some patients will continue to pass the bacteria for several weeks.

Complications

Dehydration is the most common complication. Especially at the extremes of age, this should be watched for and treated with either Oral Rehydration Solution or intravenous fluid replacement.

Infection may also involve areas outside the intestine. This is unusual, except for infections with C. fetus. C. fetus infections tend to occur in those who have diseases of decreased immunity such as AIDS, cancer, etc. This subtype is particularly adapted to protect itself from the body's defenses.

Areas outside the intestine that may be involved are:

• Nervous system involvement either by direct infection of the meninges (outer covering of the spinal and brain) or more commonly by producing the Guillain-Barré syndrome (progressive and reversible paralysis or weakness of many muscles). In fact, Campylobacter may be responsible for 40% of the reported cases of this syndrome.
• Joint inflammation can occur weeks later (leading to an unusual form of arthritis).
• Infection of vessels and heart valves is a special characteristic of C. fetus. Immunocompromised patients may develop repeated episodes of passage of bacteria into the bloodstream from these sites of infection.
• The gallbladder, pancreas, and bone may be affected.

Diagnosis

Campylobacter is only one of many causes of acute diarrhea. Culture (growing the bacteria in the laboratory) of freshly obtained diarrhea fluid is the only way to be certain of the diagnosis.

Treatment

The first aim of treatment is to keep up nutrition and avoid dehydration. Medications used to treat diarrhea by decreasing intestinal motility, such as Loperamide or Diphenoxylate are also useful, but should only be used with the advice of a physician. Antibiotics are of value, if started within three days of onset of symptoms. They are indicated for those with severe or persistent symptoms. Either an erythromycin type drug or one of the fluoroquinolones (such as ciprofloxacin) for five to seven days are the accepted therapies.

Prognosis

Most patients with Campylobacter infection rapidly recover without treatment. For certain groups of patients, infection becomes chronic and requires repeated courses of antibiotics.

Prevention

Good hand washing technique as well as proper preparation and cooking of food is the best way to prevent infection.

Resources

ORGANIZATIONS

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. 〈http://www.cdc.gov〉.

OTHER

Centers for Disease Control. 〈http://www.cdc.gov/nccdphp/ddt/ddthome.htm〉.

KEY TERMS

Antibiotic— A medication that is designed to kill or weaken bacteria.

Anti-motility medications— Medications such as loperamide (Imodium), dephenoxylate (Lomotil), or medications containing codeine or narcotics which decrease the ability of the intestine to contract. This can worsen the condition of a patient with dysentery or colitis.

Fluoroquinolones— A relatively new group of antibiotics that have had good success in treating infections with many Gram-negative bacteria. One drawback is that they should not be used in children under 17 years of age, because of possible effect on bone growth.

Food-borne illness— A disease that is transmitted by eating or handling contaminated food.

Gram-negative— Refers to the property of many bacteria that causes them to not take up color with Gram's stain, a method which is used to identify bacteria. Gram-positive bacteria which take up the stain turn purple, while Gram-negative bacteria which do not take up the stain turn red.

Guillain-Barré syndrome— Progressive and usually reversible paralysis or weakness of multiple muscles usually starting in the lower extremities and often ascending to the muscles involved in respiration. The syndrome is due to inflammation and loss of the myelin covering of the nerve fibers, often associated with an acute infection.

Meninges— Outer covering of the spinal cord and brain. Infection is called meningitis, which can lead to damage to the brain or spinal cord and even death.

Oral Rehydration Solution (ORS)— A liquid preparation developed by the World Health Organization that can decrease fluid loss in persons with diarrhea. Originally developed to be prepared with materials available in the home, commercial preparations have recently come into use.

Stool— Passage of fecal material; a bowel movement.

Campylobacteriosis

Campylobacteriosis is a bacterial infection of the intestinal tract of humans. The infection, which typically results in diarrhea, is caused by members of the genus Campylobacter. In particular, Campylobacter jejuni is the most commonly cause of bacterial diarrhea in the United States (and likely other countries as well), with more occurrences than salmonella (another prominent disease causing bacteria associated with food poisoning). Worldwide, approximately five to fourteen per cent of all diarrhea is thought to be the result of campylobacteriosis.

Humans contract campylobacteriosis by eating or drinking contaminated food or water. Less often, direct contact with infected people or animals can spread the infection. The infection begins from two to five days after the contaminated food or water has been ingested.

The illness caused by Campylobacter bacteria has been known for decades, and was recognized as a cause of disease in animals since 1909. However, it is only in the last two decades of the twentieth century that the bacteria were identified as the cause of the human disease campylobacteriosis. Over 10,000 cases are now reported to the Unites States Centers for Disease Control (CDC) each year. As the illness is often not identified, the actual number of cases is much higher. Indeed, CDC estimates that 2 million people contract campylobacteriosis each year in the United States.

In under-developed countries, campylobacteriosis is a significant health threat. Organization such as the World Health Organization have devoted much effort to improving the water quality of villages in an effort to decrease the incidence of water-borne campylobacteriosis.

The Campylobacter organism is distinctive on several counts. The bacteria have a spiral shape. Also, they are fragile, not tolerating drying or the presence of pure oxygen.

As with other bacterial intestinal upsets, campylobacteriosis is more of a transient inconvenience than a dire health threat in the developed world. The symptoms of the disease (malaise, fever, abdominal cramps, diarrhea, nausea, vomiting) are often mistaken for stomach flu. Still, severe forms of the infection can produce bloody diarrhea. In some people, especially in infants, the elderly, and those whose immune systems are not operating efficiently, the resulting diarrhea and fluid loss can produce dehydration if fluid intake is not maintained during the period of illness. Very rarely, seizures can occur due to high fever or because of the exacerbation of a neurological disorder such as Guillain-Barre syndrome. Guillan-Barre syndrome occurs when a person's own immune system begins to attack the body's own nerves. Paralysis can result. It has been estimated that one in every 1000 cases of campylobacteriosis leads to Guillan-Barre syndrome.

Most people afflicted with campylobacteriosis recover on their own. Occasionally, antibiotics need to be given to rid the body of the infection. While the main bout of the malady passes in about a week, abdominal cramps can recur for up to three months after an infection.

Campylobacteriosis is an example of a zoonosis (an ailment passed to humans via animals or animal products). Campylobacter bacteria naturally inhabit the intestinal tract of many animals, including swine, cattle, ostriches, dogs, shellfish and poultry. These creatures can carry the bacteria without displaying any symptoms of illness. Soil is another habitat. A principle reason for the wide distribution of Campylobacter is the ability of the bacteria to survive anywhere there is moisture, food source, less than an atmospheric level of oxygen and room temperature conditions. In particular, poultry are a reservoir of the microorganism. These sources can contaminate meat products, water and milk. Studies monitoring poultry carcasses in processing plants have demonstrated that over 50% of raw chicken is contaminated with Campylobacter.

The prevalence of Campylobacter jejuni in poultry carcasses results from the contamination of the meat by the intestinal contents of the bird (including the bacteria) when an infected bird is slaughtered. Because chickens can carry the organism without showing any symptoms of infection, they can escape inspection.

Despite the high contamination rate of foodstuffs such as poultry, Campylobacter jejuni does not grow readily on or in foods. Furthermore, the organism is sensitive to temperatures much above room temperature. Proper cooking of food will readily destroy the bacteria. Other sensible hygienic practices, such as washing the cutting board after dealing with a chicken, also reduce the chances of illness. Unfortunately, undercooking of foods such as poultry, poor hygiene , and inadequate disinfection of drinking water accounts for most of the cases of campylobacteriosis.

See also Food safety; Water quality

Campylobacteriosis

What is Campylobacter?

What Happens When People Get Campylobacteriosis?

Resources

Campylobacteriosis is an infection of the intestinal tract that is caused by the Campylobacter bacterium. The infection may cause diarrhea, nausea and vomiting, and abdominal cramps.

KEYWORDS

for searching the Internet and other reference sources

Campylobacter jejuni

Enteritis

Food Poisoning

Guillain-Barré syndrome

What is Campylobacter?

Campylobacter (kamp-pi-lo-BAK-ter) is a type of bacteria that is a normal inhabitant of the digestive tract of many animals. People, however, do not normally carry Campylobacter, and exposure to it usually causes an intestinal infection called campylobacteriosis (kamp-pi-lo-bak-ter-ee-O-sis).

The most common source of Campylobacter in the United States is chicken. When chickens (and other animals) are killed for food, the bacteria from their digestive tract can contaminate the meat. People get infected when they eat raw or uncooked meats and eggs (thorough cooking kills the bacteria), drink raw (unpasteurized) milk, or drink contaminated water. Oftentimes, juices from raw meats drip and contaminate other foods. In rare cases, contact with people or animals who are infected spreads the illness.

Campylobacter is the most common bacterial cause of diarrhea in the United States, where more than 2 million cases occur each year. The illness most frequently affects infants and children younger than age 10, although anyone can get it. Most cases occur in the summer and fall.

What Happens When People Get Campylobacteriosis?

Within two to five days after exposure to Campylobacter, a person may develop diarrhea, fever, abdominal cramps, and blood in the stool. Most people with Campylobacteriosis recover within about ten days without any treatment other than drinking lots of fluids to prevent dehydration (a dangerous loss of fluids and salts).

In serious cases, people with Campylobacteriosis may require antibiotics* and intravenous* (IV) rehydration. In rare cases, Campylobacteriosis may lead to other illnesses, such as colitis, arthritis, meningitis (men-in-JY-tis), and Guillain-Barre (gee-YAN-ba-RAY) syndrome, a disorder that can result in temporary paralysis.

* antibiotics

(an-ty-by-OT-iks) are drugs that kill bacteria.

* intravenous

(in-tra-VEE-nus) means injected directly into the veins.

Prevention

The best way to prevent infection is to treat all meat and eggs as if they were contaminated: never letting meat drip on other food; always cooking meat thoroughly; always washing cooking utensils and cooking areas thoroughly; and always washing hands after using the bathroom, touching pets, and before handling food.

See also

Arthritis

Bacterial Infections

Colitis

Diarrhea

Food Poisoning

Gastroenteritis

Meningitis

Shock

Resources

Book

Scott, Elizabeth, and Paul Sockett. How to Prevent Food Poisoning: A Practical Guide to Safe Cooking, Eating, and Food Handling. New York: John Wiley, 1998.

Organizations

The U.S. Food and Drug Administration (FDA) posts a Bad Bug Book at its website with a fact sheet about Campylobacter jejuni and campylobacteriosis. http://vm.cfsan.fda.gov/-mow/chap4.html

The U.S. Centers for Disease Control and Prevention (CDC). CDC has a National Center for Infectious Diseases that posts a fact sheet about Campylobacter infections at its website. http://www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htm