Campylobacteriosis
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2008-06-21T22:31:31Z
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{{DiseaseDisorder infobox |
Name = Campylobacter |
ICD10 = {{ICD10|A|04|5|a|00}} |
ICD9 = {{ICD9|008.43}} |
Image = |
Caption = |
DiseasesDB = 1914 |
ICDO = |
OMIM = |
MedlinePlus = 000224 |
eMedicineSubj = ped |
eMedicineTopic = 2697 |
eMedicine_mult = {{eMedicine2|med|263}} |
MeshName = Campylobacter |
MeshNumber = B03.440.180 |
}}
'''Campylobacteriosis''' is an [[infection]] by the [[campylobacter]] [[bacterium]] <ref>[http://www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htm cdc.gov] </ref>, most commonly [[C. jejuni]]. It is among the most common [[List of infectious diseases|bacterial infections]] of [[human]]s, often a [[foodborne illness]]. It produces an inflammatory, sometimes bloody, [[diarrhea]] or [[dysentery]] syndrome, mostly including cramps, fever and pain.
== Cause ==
[[Image:Campylobacter.jpg|thumb|Campylobacter bacteria are the number-one cause of food-related [[gastrointestinal]] illness in the United States. To learn more about this [[pathogen]], [[Agricultural Research Service|ARS]] scientists are sequencing multiple Campylobacter genomes. This scanning electron microscope image shows the characteristic spiral, or corkscrew, shape of ''[[Campylobacter_jejuni|C. jejuni]]'' cells and related structures.
|left|250px]] {{Main|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 ''[[Campylobacter coli|C. coli]]'' (also found in cattle, swine, and birds) ''[[Campylobacter upsaliensis|C. upsaliensis]]'' (found in cats and dogs) and ''[[Campylobacter lari|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 (anatomy)|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. <ref name=Saenz_2000>{{cite journal | author=Saenz Y, Zarazaga M, Lantero M, Gastanares MJ, Baquero F, Torres C | title=Antibiotic resistance in ''Campylobacter'' strains isolated from animals, foods, and humans in Spain in 1997-1998 | journal=Antimicrob Agents Chemother | year=2000 | pages=267–71 | volume=44 | issue=2 | pmid=10639348 [http://aac.asm.org/cgi/content/full/44/2/267 fulltext] | doi=10.1128/AAC.44.2.267-271.2000}}</ref>.
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]] <ref>Moore, 2005</ref>. For instance, an estimated 2 million cases of ''[[Campylobacter]]'' [[enteritis]] occur annually in the [[United States|U.S.]], accounting for 5-7% of cases of [[gastroenteritis]]. Furthermore, in the [[United Kingdom]] during [[2000]] [[campylobacter jejuni]] was involved in 77.3% <ref> [http://www.food.gov.uk/science/sciencetopics/microbiology/58736 Food Standards Agency] </ref> 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 [[chicken]]s, [[turkey]]s, and waterfowl, having asymptomatic infections in their intestinal tracts. An infected [[chicken]] may contain up to 10<sup>9</sup> 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 (anatomy)|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 of dirty brown 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 (tests)|specificity]] and a [[sensitivity (tests)|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#Nutritional_significance|electrolyte replacement]] is enough in human infections. <ref>Sherris</ref>
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.<ref>{{cite journal | author=Ternhag A, Asikainen T, Giesecke J, Ekdahl K | title=A meta-analysis on the effects of antibiotic treatment on duration of symptoms caused by infection with Campylobacter species | journal=Clin Infect Dis | year=2007 | volume=44 | pages=696–700 | doi=10.1086/509924}}</ref>
[[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. <ref name=McDermott_2002>{{cite journal |author=McDermott P, Bodeis S, English L, White D, Walker R, Zhao S, Simjee S, Wagner D |title=Ciprofloxacin resistance in Campylobacter jejuni evolves rapidly in chickens treated with fluoroquinolones |journal=J Infect Dis |volume=185 |issue=6 |pages=837–40 |year=2002 |pmid=11920303 |doi=10.1086/339195}}</ref>
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. This occurs only with infection of C. jejuni and C. upsaliensis. <ref>Medical microbiology,Murray, P.R. and others. 2002 Mosby St. Louis</ref>
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.
A mysterious paralysis can attack people who just had mild symptoms of campylobacteriosis years earlier.<ref>[http://news.yahoo.com/s/ap/20080121/ap_on_he_me/healthbeat_food_poisoning;_ylt=AuyiUYsrFfwyU.9UatM3AXPVJRIF ''Food poisoning can be long-term problem'' by Lauran Neergaard, accessed 21 January 2008]</ref>
==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]]
==Notes==
{{reflist}}
[[Category:Gastroenterology]]
[[Category:Bacterial diseases]]
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