Campylobacter Infection and Food Poisoning – Campylobacteriosis

What is Campylobacteriosis?

Campylobacteriosis is a common bacterial infection that primarily affects the gastrointestinal tract, leading to gastroenteritis. Here is some information about campylobacteriosis:

1. Global Impact: Campylobacteriosis is a widespread bacterial disease that occurs worldwide, affecting both developed and developing countries. It is considered one of the most common causes of bacterial gastroenteritis.
2. Endemic Nature: The disease is endemic in various regions, including North America, Europe, Australia, Africa, Asia, and the Middle East. It tends to be more prevalent during the summer and early autumn months.
3. Vulnerable Populations: Campylobacteriosis mainly affects children, the elderly, and individuals with weakened immune systems. However, adults are less commonly affected, possibly due to acquired immunity over time.
4. Poultry as a Source: Poultry, such as chickens and turkeys, is recognized as the primary source of Campylobacter infection. The bacteria are also present in the gastrointestinal tracts of various wild and farm animals, as well as birds.
5. Gastrointestinal and Extragastrointestinal Infections: Campylobacter infections can cause diarrhea and gastroenteritis. Additionally, they can lead to extragastrointestinal infections such as lung infections, bacteremia (bacterial bloodstream infection), meningitis, and long-term autoimmune diseases like Guillain-Barre syndrome (GBS), Miller-Fisher syndrome (MFS), inflammatory bowel syndrome (IBS), and reactive arthritis (ReA).
6. Pathogenic Species: The most common Campylobacter species associated with campylobacteriosis are C. jejuni, C. coli, C. upsaliensis, C. lari, C. concisus, C. fetus, C. curvus, and C. ureolyticus. Among these, C. jejuni is responsible for about 95% of outbreaks and sporadic illnesses.
7. Global Prevalence: Campylobacteriosis has a significant global prevalence, making its biocontrol methods, transmission routes, and prevention strategies a matter of high concern for public health authorities.

Efforts to prevent campylobacteriosis focus on ensuring food safety, particularly in relation to poultry products, by implementing good hygiene practices during production, processing, and preparation. Public awareness campaigns about safe food handling, proper cooking temperatures, and personal hygiene also play a vital role in reducing the incidence of this bacterial infection.

What is Campylobacter?

Campylobacter is a genus of bacteria that exhibits certain characteristics. Here is some information about Campylobacter:

1. Gram-Negative: Campylobacter bacteria are classified as gram-negative, which means they have a specific cell wall structure that takes up the counterstain during the Gram staining procedure.
2. Non-Spore-Forming: Unlike some other bacterial species, Campylobacter does not produce spores as a means of survival under unfavorable conditions.
3. Curved, Spiral, or S-Shaped Rods: Campylobacter bacteria have a distinctive morphology, appearing as curved, spiral, or S-shaped rods under microscopic examination.
4. Microaerophilic: Campylobacter species are considered microaerophilic, meaning they require low levels of oxygen (around 3 to 5%) for growth.
5. Corkscrew-like Motility: These bacteria exhibit motility characterized by a corkscrew-like or helical motion, which enables them to move through their environment.
6. Optimal Growth Conditions: Campylobacter species thrive at temperatures ranging from 37 to 42°C, reflecting their preference for the human body’s normal internal temperature. They can also tolerate a pH range of 5.5 to 8.
7. Energy Source: Campylobacter bacteria utilize amino acids, organic compounds containing nitrogen, as an energy source for their metabolic processes.
8. Heat and Desiccation Sensitivity: Campylobacter is sensitive to heat and desiccation. It cannot grow above a temperature of 48°C, making proper cooking and heat treatment of food crucial for preventing Campylobacter-related infections.

These characteristics define the fundamental properties of Campylobacter bacteria and contribute to their unique biology and behavior. Understanding these traits is important for identifying and controlling Campylobacter infections and implementing effective prevention strategies.

Sources of transmission of Campylobacter

Campylobacter bacteria can be transmitted through various sources. Here is some information about the sources of Campylobacter transmission:

1. Animals: Animals, particularly poultry (such as chickens and turkeys), birds, cattle, pigs, and domestic pets, serve as the main reservoir for Campylobacter. These animals can carry the bacteria in their intestines without showing any signs of illness.
2. Untreated Water: Campylobacter can be present in untreated water sources such as lakes, rivers, and ponds. Contamination may occur due to fecal matter from infected animals or other environmental sources.
3. Cross-Contamination: Cross-contamination is a common mode of transmission for Campylobacter. It can occur during the handling of raw meat, especially poultry, and the subsequent contamination of cooked meat or other food products. Improper cleaning of kitchen utensils, cutting boards, and surfaces can also contribute to cross-contamination.
4. Consumption of Undercooked Foods: Consuming undercooked or raw foods that are contaminated with Campylobacter poses a risk of infection. This includes undercooked poultry, meats, and eggs. It is important to ensure that these foods are cooked to the appropriate internal temperature to kill the bacteria.
5. Raw or Unpasteurized Milk and Milk Products: Raw or unpasteurized milk and milk products, such as cheese and yogurt, can be a source of Campylobacter infection if they are contaminated with the bacteria. Proper pasteurization of milk and milk products helps eliminate the risk of Campylobacter transmission.
6. Raw Shellfish: Raw shellfish, particularly oysters, can also be a source of Campylobacter infection. These shellfish can filter and concentrate bacteria from contaminated water sources, leading to the risk of transmission if consumed raw or undercooked.

Disease and Complications of Campylobacteriosis

Campylobacteriosis, caused by Campylobacter infection, can result in various diseases and complications. Here is some information about the disease and its associated complications:

1. Gastroenteritis and Diarrhea: The most common manifestation of Campylobacteriosis is gastroenteritis, characterized by symptoms such as watery diarrhea, abdominal cramps, malaise, and fever. Diarrhea is a prominent feature of the infection.
2. Inflammatory Bowel Disease (IBD): In some cases, Campylobacter infection can lead to the development or exacerbation of inflammatory bowel disease, including conditions like Crohn’s disease and ulcerative colitis.
3. Barrett’s Esophagus and Colorectal Cancer: Long-term or chronic Campylobacter infection has been associated with an increased risk of developing Barrett’s esophagus, a condition that may progress to esophageal cancer. Some studies have also suggested a possible link between Campylobacter infection and colorectal cancer.
4. Extragastrointestinal Infections: In severe cases, Campylobacteriosis can result in extragastrointestinal infections. These infections can occur in various organs or systems, including the lungs (lung infections), central nervous system (meningitis, brain abscesses), heart (endocarditis), skin (cellulitis), and bloodstream (bacteremia).
5. Bacteremia: Bacteremia refers to the presence of Campylobacter bacteria in the bloodstream. It can occur, particularly in young children and elderly patients, and can lead to severe complications, including systemic infection and potential mortality.
6. Asymptomatic Carriers: While some individuals may have asymptomatic Campylobacter infection, they can still serve as carriers of the bacteria and spread it through physical contact or contaminated objects.
7. Guillain-Barre Syndrome (GBS): A rare but serious complication associated with Campylobacter infection is Guillain-Barre Syndrome. GBS is an autoimmune disorder that affects the peripheral nervous system, leading to muscle weakness, paralysis, and potential respiratory compromise. It typically occurs several weeks after the initial infection.
8. Reiter’s Syndrome: Reiter’s syndrome, also known as reactive arthritis, is another potential complication of Campylobacteriosis. It primarily affects the joints, particularly the knees and lower back, causing inflammation and pain.

Epidemiology of Campylobacter Infection

Campylobacter infection has a significant impact on public health. Here is some information about the epidemiology of Campylobacter infection:

1. Pathogenic Strain: Among the Campylobacter species, C. jejuni is considered the most pathogenic strain and is commonly isolated from patients with diarrhea and gastrointestinal diseases.
2. Seasonal Variation: Campylobacteriosis cases tend to be higher during the summer months, which may be attributed to increased consumption of poultry and undercooked meat, as well as changes in food handling practices during warmer weather.
3. High-Prevalence Countries: The United States and England are among the countries significantly affected by Campylobacter infection, especially during the summer season. In the US, approximately 845,000 cases of Campylobacter infection and 76 deaths are reported each year.
4. Traveler’s Diarrhea: Campylobacter species, particularly C. jejuni, have been identified as a major cause of traveler’s diarrhea. This condition often occurs when individuals travel to countries with inadequate food safety measures or poor sanitation.
5. European Impact: European countries have also been affected by Campylobacter infection. In 2012, the European Food Safety Authority (EFSA) reported approximately 214,000 cases of Campylobacter infection in Europe.
6. Multinational Study: A surveillance study involving a multinational population of 9,000 children from Bangladesh, Pakistan, and India revealed that Campylobacter, specifically C. jejuni, was a common cause of severe diarrhea in children under 60 months of age.
7. Age Distribution: Campylobacter infections, particularly C. jejuni and C. coli, are more common in children and elderly patients. These populations are more susceptible to severe complications of Campylobacteriosis.
8. Travel-Related Risk: Individuals who frequently travel abroad are at a higher risk of C. coli infection compared to C. jejuni. Factors such as differences in food safety standards and exposure to different strains contribute to this increased risk.
9. Continuous Exposure: Campylobacteriosis continues to be detected each year due to continuous exposure to sources of infection, such as contaminated water and poultry. Continuous monitoring and preventive measures are necessary to reduce the burden of the disease.

Pathogenic Mechanism of Campylobacter

The pathogenic mechanism of Campylobacter involves several steps that enable the bacteria to cause infection. Here is some information about the pathogenic mechanism of Campylobacter:

1. Surviving Stomach Acid: Campylobacter must survive the acidic environment of the stomach (pH 2.3) to cause infection. While the organism cannot survive at low pH, infection occurs through the consumption of contaminated meat, water, and milk.
2. Escaping Stomach Passage: Campylobacter employs virulence factors to escape the stomach passage and reach the gastrointestinal tract. These factors enable the bacteria to resist stomach acid and continue their journey.
3. Epithelial Cell Invasion: Once in the gastrointestinal tract, Campylobacter invades the epithelial cells of the distal ileum and colon. The bacteria secrete proteins that damage the cells and cause inflammation of the intestinal epithelium.
4. Virulence-Associated Factors: Campylobacter virulence-associated factors play a crucial role in the pathogenicity of the bacteria. These factors include chemotaxis, motility facilitated by flagella, cytolethal distending toxin (CDT), adhesion, and invasion factors.
5. Motility and Chemotaxis: Campylobacter’s corkscrew-like motility helps in its colonization, while polar flagella and chemoreceptors assist the bacteria in moving within the mucous lining of the gastrointestinal tract.
6. Cytolethal Distending Toxin (CDT): CDT is a toxin produced by Campylobacter, consisting of three subunits (CdtA, CdtB, and CdtC). CdtB cleaves the DNA of enterocytes, leading to cell wall disruption and eventual cell death. CdtA and CdtC assist CdtB in reaching the enterocytes.
7. Adhesion Proteins: Campylobacter produces adhesion proteins on its cell surface to attach to epithelial cells. Proteins such as Fibronectin domain-containing lipoprotein FlpA, CadF, JlpA, and FlaA aid in the adherence of the bacteria to the host cells.
8. Internalization: C. jejuni synthesizes four proteins (CiaB, CiaC, CiaD, and CiaI) that facilitate the internalization of the bacteria into host cells.
9. Multiplication and Campylobacter-Containing Vacuoles: Once inside the host cell, Campylobacter multiplies within a membrane-bound vacuole called Campylobacter-containing vacuoles.
10. Immune Response and Inflammation: The immune system of the human body responds to Campylobacter infection by triggering the synthesis of interleukin 8 (IL-8), which activates T-cells and B-cells. The immune response leads to local inflammation, and the Cia proteins damage the tight junctions of the intestinal epithelium, resulting in diarrhea.

Diagnostic Methods of Campylobacteriosis

The diagnosis of Campylobacteriosis, the infection caused by Campylobacter bacteria, can be performed using various diagnostic methods. Here is some information about the diagnostic methods of Campylobacteriosis:

1. Culture Method: The culture method involves isolating and identifying the Campylobacter pathogen from clinical samples. Two selective media are typically used: one containing blood and the other containing charcoal. These media help inhibit the growth of other microflora and promote the growth of Campylobacter. Antibiotics specific to Campylobacter are added to the media to further suppress the growth of competing bacteria. Examples of blood-containing media include sheep blood agar with antibiotics like bacitracin, colistin, cephalothin, and actidione. Horse blood agar, also known as Skirrow media, contains antibiotics such as vancomycin, polymyxin B, cephalothin, and trimethoprim. Charcoal-containing media, such as Preston medium, are particularly effective in recovering a maximum number of Campylobacter pathogens.
2. Molecular Typing: Molecular typing techniques, including Polymerase Chain Reaction (PCR), are widely used for detecting Campylobacter genes. PCR is highly sensitive but not species-specific, meaning it can detect the pathogen even in asymptomatic individuals who may shed the bacteria and transmit it to others. Other molecular-based typing methods used for Campylobacteriosis diagnosis include MALDI-TOF MS (Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry), multiplex PCR, Ribotyping, Restriction Fragment Length Polymorphism (RFLP), and Amplified Fragment Length Polymorphism (AFLP).
3. Serotyping: Serotyping methods are employed to identify specific Campylobacter pathogens. Two main serotyping methods are used: heat-labile and heat-stable serotyping. Heat-labile serotyping targets uncharacterized bacterial surface or flagella antigens and is used for detecting C. jejuni, C. coli, and C. lari. Heat-stable serotyping, known as Penner serotyping, detects heat-stable antigens extracted from Campylobacter isolates obtained from capsular lipooligosaccharide (LOS).

Treatment and Control of Campylobacteriosis

The treatment and control of Campylobacteriosis, the infection caused by Campylobacter bacteria, involve several approaches. Here is some information about the treatment and control measures for Campylobacteriosis:

1. Antibiotic Treatment: In most cases, Campylobacteriosis is a self-limiting disease that resolves without the need for antibiotic treatment. However, if the patient has severe symptoms or bloody diarrhea, antibiotics may be prescribed. Erythromycin, azithromycin, gentamicin, carbapenems, and chloramphenicol are commonly used antibiotics for treating C. jejuni and C. coli infections. The choice of antibiotic depends on the severity of the infection and antibiotic susceptibility testing.
2. Symptomatic Treatment: The focus of treatment for Campylobacteriosis is on managing symptoms and providing supportive care. Rehydration therapy, which involves oral or intravenous fluids, helps replace lost fluids and electrolytes during episodes of diarrhea. This helps prevent dehydration and maintains electrolyte balance.
3. Environmental Control: Since Campylobacter species are commonly found in poultry, one of the key control measures is to remove chickens with infections to reduce environmental exposure. This includes implementing biosecurity measures on poultry farms and ensuring proper hygiene and sanitation practices during poultry production and processing.
4. Safe Food Handling: Prevention of Campylobacteriosis involves practicing safe food handling and preparation. It is important to avoid consuming raw or undercooked poultry meats, as well as raw or unpasteurized milk and untreated water, as these can be sources of Campylobacter infection. Thoroughly cooking poultry products and practicing good hygiene during food preparation can help prevent contamination.
5. Personal Hygiene: Maintaining good personal hygiene is crucial in preventing the spread of Campylobacter. This includes proper handwashing with soap and water before handling food, after using the toilet, and after contact with animals. Proper hygiene practices can help reduce the risk of cross-contamination and the spread of Campylobacter bacteria.

FAQ

References

1. Yi, J., & Anderson, E. J. (2018). Campylobacter jejuni and Campylobacter coli. Principles and Practice of Pediatric Infectious Diseases, 899–902.e3.
2. COLVILLE, J. L., & BERRYHILL, D. L. (2007). CAMPYLOBACTERIOSIS (VIBRIOSIS). Handbook of Zoonoses, 44–48. 
3. Kaakoush, N. O., Castaño-Rodríguez, N., Mitchell, H. M., & Man, S. M. (2015). Global Epidemiology of Campylobacter Infection. Clinical Microbiology Reviews, 28(3), 687–720. 
4. Hsieh, Y.-H., & Sulaiman, I. M. (2018). Campylobacteriosis: An Emerging Infectious Foodborne Disease. Foodborne Diseases, 119–155. 
5. Mousavi S, Bereswill S, Heimesaat MM. Novel Clinical Campylobacter jejuni Infection Models Based on Sensitization of Mice to Lipooligosaccharide, a Major Bacterial Factor Triggering Innate Immune Responses in Human Campylobacteriosis. Microorganisms. 2020; 8(4):482. https://doi.org/10.3390/microorganisms8040482.
6. Zautner, A. E., & Masanta, W. O. (2016). Campylobacter: Health Effects and Toxicity. Encyclopedia of Food and Health, 596–601.
7. Facciolà A, Riso R, Avventuroso E, Visalli G, Delia SA, Laganà P. Campylobacter: from microbiology to prevention. J Prev Med Hyg. 2017;58(2):E79-E92.
8. Oyarzabal, O. A., & Carrillo, C. D. (2017). Isolation, identification, and typing of Campylobacter strains from food samples. Campylobacter, 61–83. 
9. Young, K., Davis, L. & DiRita, V. Campylobacter jejuni: molecular biology and pathogenesis. Nat Rev Microbiol 5, 665–679 (2007). https://doi.org/10.1038/nrmicro1718.
10. Haddad N, Marce C, Magras C, Cappelier JM. An overview of methods used to clarify pathogenesis mechanisms of Campylobacter jejuni. J Food Prot. 2010 Apr;73(4):786-802. doi: 10.4315/0362-028x-73.4.786. PMID: 20377972.