Campylobacteriosis

Campylobacteriosis is an infection by the bacteria campylobacter ^[1], most commonly C. jejuni. It is among the most common bacterial infections of humans. The common routes of transmission are fecal-oral, person-to-person sexual contact, ingestion of contaminated food or water. It produces an inflammatory, sometimes bloody, diarrhea or dysentery syndrome, mostly including cramps, fever and pain. The infection is usually self-limiting and in most cases, symptomatic treatment by reposition of liquid and electrolyte replacement is enough in human infections. The use of antibiotics, on the other hand, is controversial.

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Cause

Main article: Campylobacter

Campylobacteriosis is caused by Campylobacter organisms. These are curved or spiral, motile, non–spore-forming, gram-negative rods. This is most commonly caused by C. jejuni, a spiral and comma shaped bacterium normally found in cattle, swine, and birds, where it is non-pathogenic. But the illness can also be caused by C. coli (also found in cattle, swine, and birds) C. upsaliensis (found in cats and dogs) and C. lari (present in seabirds in particular).

One cause of the effects of campylobacteriosis is tissue injury in the gut. The sites of tissue injury include the jejunum, the ileum, and the colon. C jejuni appears to achieve this by invading and destroying epithelial cells.

Some strains of C jejuni produce a cholera-like enterotoxin, which is important in the watery diarrhea observed in infections. The organism produces diffuse, bloody, edematous, and exudative enteritis. In a small number of cases, the infection may be associated with hemolytic uremic syndrome and thrombotic thrombocytopenic purpura through a poorly understood mechanism.

Transmission

The common routes of transmission for the disease-causing bacteria are fecal-oral, person-to-person sexual contact, ingestion of contaminated food (generally unpasteurized (raw) milk and undercooked or poorly handled poultry), and waterborne (ie, through contaminated drinking water). Contact with contaminated poultry, livestock, or household pets, especially puppies, can also cause disease. ^[2].

The infectious dose is 1000-10,000 bacteria (although ten to five hundred bacteria can be enough to infect humans). Campylobacter species are sensitive to hydrochloric acid in the stomach, and acid reduction treatment can reduce the amount of inoculum needed to cause disease.

Exposure to bacteria is often more common during travelling, and therefore campylobacteriosis is a common form of travelers' diarrhea.

Epidemiology

Infection with a Campylobacter species is one of the most common causes of human bacterial gastroenteritis ^[3]. For instance, an estimated 2 million cases of Campylobacter enteritis occur annually in the U.S., accounting for 5-7% of cases of gastroenteritis. Furthermore, in the United Kingdom during 2000 campylobacter jejuni was involved in 77.3% ^[4] in all cases of foodborne illness. 15 out of every 100,000 people are diagnosed with campylobacteriosis every year, and with many cases going unreported, up to 0.5% of the general population may unknowingly harbor Campylobacter in their gut annually.

A large animal reservoir is present as well, with up to 100% of poultry, including chickens, turkeys, and waterfowl, having asymptomatic infections in their intestinal tracts. An infected chicken may contain up to 10⁹ bacteria per 25 grams, and due to the installations, the bacteria is rapidly spread to other chicken. This vastly exceeds the infectious dose of 1000-10,000 bacteria for humans.

Symptoms

The prodrome is fever, headache, and myalgias, lasting as long as 24 hours. The actual latent period is 2-5 days (sometimes 1-6 days) In other words, it typically takes 1-2 days until actual symptoms develop. These are diarrhea (as many as 10 watery, frequently bloody, bowel movements per day) or dysentery, cramps, abdominal pain, and fever as high as 40°C, and in most people, the illness lasts for 7–10 days.

Symptoms may also depend on route of transmission. In participants of anoreceptive intercourse, campylobacteriosis is more localized to the distal end of the colon and may be termed as a proctocolitis.

There are other diseases showing similar symptoms. For instance, abdominal pain and tenderness may be very localized, mimicking acute appendicitis. Furthermore, Helicobacter pylori is closely related to Campylobacter and causes peptic ulcer disease.

Worsening factors

In patients with HIV, infections may be more frequent, may cause prolonged or recurrent diarrhea, and may be more commonly associated with bacteremia and antibiotic resistance. The severity and persistence of infection in patients with AIDS and hypogammaglobulinemia indicates that both cell-mediated and humoral immunity are important in preventing and terminating infection.

Diagnosis

Campylobacter organisms can be detected on gram stain of stool with high specificity and a sensitivity of ~60%, but are most often diagnosed by stool culture. Fecal leukocytes are present and indicate an inflammatory diarrhea.

Treatment

The infection is usually self-limiting and in most cases, symptomatic treatment by reposition of liquid and electrolyte replacement is enough in human infections. ^[5]

The use of antibiotics, on the other hand, is controversial.

Antimotility agents, such as loperamide, can lead to prolonged illness or intestinal perforation in any invasive diarrhea, and should be avoided.

Antibiotics

Antibiotic treatment has only a marginal benefit (1.32 days) on the duration of symptoms and should not be used routinely.^[6]

Erythromycin can be used in children, and tetracycline in adults. However, some studies show that erythromycin rapidly eliminates Campylobacter from the stool without affecting the duration of illness. Nevertheless, children with dysentery due to C. jejuni benefit from early treatment with erythromycin. Treatment with antibiotics, therefore, depends on the severity of symptoms.

Trimethoprim-sulfamethoxazole and ampicillin are ineffective against Campylobacter.

In animals

In the past, poultry infections were often treated by mass administration of enrofloxacin and sarafloxacin for single instances of infection. The FDA banned this practice, as it, instead of eliminating the bacteria, only promoted the development of fluoroquinolone-resistant populations. ^[7] A major wide-ranged fluoroquinolone used in humans is ciprofloxacin.

Prognosis

Campylobacteriosis is usually self-limited without any mortality. However, there are several possible complications.

Complications

Some (less than 1 in 1000 cases) individuals develop Guillain-Barré syndrome, in which the nerves that join the spinal cord and brain to the rest of the body are damaged, sometimes permanently.

Other complications include toxic megacolon, dehydration and sepsis. Such complications generally form in little children ( < 1 year of age) and immunocompromised people. Chronic course of the disease is possible; such form of the process is likely to develop without a distinct acute phase. Chronic campylobacteriosis features long period of sub-febrile temperature and asthenia; eye damage, arthritis, endocarditis may develop if infection is untreated.

Occasional deaths occur in young, previously healthy individuals because of volume depletion and in persons who are elderly or immunocompromised.

Prevention

• Pasteurization of milk and chlorination of drinking water destroy the organism.
• Treatment with antibiotics can reduce fecal excretion.
• Infected health care workers should not provide direct patient care
• Separate cutting boards should be used for foods of animal origin and other foods. After preparing raw food of animal origin, all cutting boards and countertops should be carefully cleaned with soap and hot water.

See also

• Campylobacter
• enteritis
• gastroenteritis