Campylobacteriosis

Campylobacteriosis, also known as Campylobacter food poisoning or campylobacter enteritis, is a common infection caused by the bacterium Campylobacter, predominantly C. jejuni. It primarily manifests as a foodborne illness and leads to inflammatory, sometimes bloody, diarrhoea, accompanied by cramps, fever, and pain.

Signs and Symptoms

The initial symptoms include fever, headache, and myalgia, which can be severe and last up to 24 hours. These prodromal symptoms are followed, typically within 1–5 days, by diarrhoea (up to 10 watery, frequently bloody bowel movements per day), dysentery, cramps, abdominal pain, and a fever that can reach as high as 40°C (104°F). The illness generally persists for 2–10 days and is classified as invasive/inflammatory diarrhoea.

Complications

Complications of campylobacteriosis may include toxic megacolon, dehydration, and sepsis, particularly in young children and immunocompromised individuals. Chronic campylobacteriosis, characterised by long-term symptoms like sub-febrile temperature and asthenia, can lead to severe conditions such as eye damage, arthritis, and endocarditis if left untreated. Guillain–Barré syndrome, affecting the peripheral nerves, can develop in rare cases (1–2 in 100,000).

Cause

Campylobacter bacteria, particularly C. jejuni, are the leading cause of food-related gastrointestinal illness in the United States. They are spiral, motile, non-spore-forming, Gramme-negative rods found in cattle, swine, and birds.

Transmission

The infection can be transmitted through several routes:

• Faecal-oral contact.
• Person-to-person sexual contact.
• Ingestion of contaminated food (e.g., unpasteurized milk, undercooked poultry).
• Waterborne sources (contaminated drinking water).
• Contact with infected animals, including household pets.

The infectious dose ranges from 1000 to 10,000 bacteria, but as few as ten bacteria can be sufficient for human infection.

Diagnosis

Detection of Campylobacter can be achieved through Gramme staining of stool samples or stool cultures. Faecal leukocytes, indicative of inflammatory diarrhoea, are usually present. Emerging techniques include antigen testing via EIA or PCR.

Prevention

Preventive measures include:

• Pasteurising milk and chlorinating drinking water.
• Using separate cutting boards for animal and non-animal foods.
• Thoroughly cleaning food preparation surfaces.
• Avoiding contact with pet saliva and faeces.

The World Health Organisation (WHO) emphasises the importance of proper cooking, using safe water, and maintaining good hand hygiene.

Treatment

Campylobacteriosis is typically self-limiting, requiring only symptomatic treatment with liquid and electrolyte replacement. Antibiotics are generally not recommended unless there are clinical complications. Erythromycin is the preferred antibiotic for children, while tetracycline is used for adults. Antimotility agents should be avoided as they can prolong illness.

In animals, the use of fluoroquinolones like enrofloxacin has been banned due to the risk of developing antibiotic-resistant bacteria. The European Union advocates for primary production-level measures to mitigate Campylobacter risks.

Prognosis

Campylobacteriosis is usually self-limited and non-fatal if proper hydration is maintained. However, complications can arise, particularly in vulnerable populations.

Epidemiology

Campylobacter is a leading cause of bacterial gastroenteritis. In the U.S., approximately 2 million cases occur annually. In the UK, C. jejuni was responsible for 77.3% of laboratory-confirmed foodborne illnesses in 2000. Poultry, particularly chickens, are significant reservoirs, often harbouring the bacteria asymptomatically.

Outbreaks

Notable outbreaks include the 2016 incident in Havelock North, New Zealand, where 5,200 people were affected due to contaminated water, and a 2017 multistate outbreak in the U.S. linked to puppies sold through Petland stores.

Campylobacteriosis remains a significant public health concern due to its prevalence and the potential for severe complications.

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Self-assessment MCQs (single best answer)

What is the primary bacterium responsible for campylobacteriosis?

Which of the following is NOT a common symptom of campylobacteriosis?

How is campylobacteriosis most commonly transmitted?

What is the typical duration of campylobacteriosis symptoms?

What serious neurological condition is associated with campylobacteriosis?

Which antibiotic is preferred for treating campylobacteriosis in children?

What preventive measure does the World Health Organisation (WHO) recommend for campylobacteriosis?

What is the infectious dose range for Campylobacter bacteria?

Which of the following is NOT a recommended treatment for campylobacteriosis?

What was the cause of the 2016 campylobacteriosis outbreak in Havelock North, New Zealand?