Campylobacter is a type of bacteria that can cause a diarrhea disease in people. Its name means "curved bacteria", as the germ typically appears in a comma or "s" shape. According to its scientific classification, it is a genus of Gram-negative bacteria that are motile.[a]
The germ is common in nature and in domestic animals. It is frequently found in raw food of vegetable and animal origin. Its numbers can be very high in some foods, like raw poultry. Due to their diverse natural reservoir, some Campylobacter can also be detected in the air, although not in an epidemiological significance. The disease that some of the species of the bacteria can cause is called campylobacteriosis.[b]
At least a dozen species of Campylobacter have been implicated in human disease, with C. jejuni (80–90%) and C. coli (5-10%) being the most common. C. jejuni is recognized as one of the main causes of bacterial foodborne disease in many developed countries. It is the number one cause of bacterial gastroenteritis in Europe, with over 246,000 cases confirmed annually. C. jejuni infection can also cause bacteremia in immunocompromised people, while C. lari is a known cause of recurrent diarrhea in children. C. fetus can cause spontaneous abortions in cattle and sheep, and is an opportunistic pathogen in humans.
Morphology and Phenotype
Campylobacter spp. generally appear as curved or comma-shaped rods, and are able to move via unipolar or bipolar flagella. They grow best between 37–42 °C in a microaerophilic environment. When exposed to atmospheric oxygen, C. jejuni is able to change into a coccus form. Most species of Campylobacter are positive by the oxidase test and catalase test and are able to reduce nitrate. The number of known quinolone-resistant Campylobacter strains is growing. It is suggested that this is caused by the overuse of quinolone antibiotics in animal agriculture.
Theodor Escherich was the first to describe in 1886 what are known today as Campylobacters in the stool samples of infants, who perished from a disease he named "cholera infantum". In the following years until the end of the century, a number of publications appeared, describing the occurrence of such "spirilla" in cases of "cholera-like" and "dysenteric" disease. These organisms were mainly found in the colon or associated with mucous in diarrhoeal stool specimens. Vibrio-like bacteria were also described by Sir John McFadyean and Stockman in 1913 in fetal tissues of aborted sheep. For several years Campylobacters were continuously referred to as ‘‘Vibrio-like organisms’’, until 1963 when Sebald and Veron gave the name "Campylobacter" to the genus based on their shape and microaerophilic growth requirement and after showing significant biological differences with Vibrio species.
The genomes of several Campylobacter species have been sequenced, beginning with C. jejuni in 2000. These genome studies have identified molecular markers specific to members of Campylobacter. Campylobacter ssp. genomes are rather small compared to those of other gastrointestinal pathogens, with sizes ranging between 1.60 and 1.90 Mbp. A characteristic of most Campylobacter genomes is the presence of hypervariable regions, which can differ greatly between different strains.
Studies have investigated the genes responsible for motility in Campylobacter species. Some Campylobacter species contain two flagellin genes in tandem for motility, flaA and flaB. These genes undergo intergenic recombination, further contributing to their virulence. A single Type VI secretion system (T6SS) cluster was also predicted in approximately one-third of Campylobacter species, grouping into three distinct organisations and harbouring up to five vgrG genes.
The confusing taxonomy of Campylobacter over the past decades makes identifying the earliest reports of Campylobacter bacteriophages difficult. Bacteriophages specific to the species now known as C. coli and C. fetus (previously Vibrio coli and V. fetus), were first isolated from cattle and pigs during the 1960s, and Campylobacter bacteriophage therapy is an ongoing area of research in the age of bacterial antibiotic resistance.
Campylobacter can cause a gastrointestinal infection, campylobacteriosis. The incubation period is 24–72 hours after infection. This is characterized by an inflammatory, sometimes bloody diarrhea or dysentery syndrome, mostly including cramps, fever, and pain. The most common routes of transmission are fecal-oral, ingestion of contaminated food or water, and the eating of raw meat. Foods implicated in campylobacteriosis include raw or under-cooked poultry, raw dairy products, and contaminated produce. Campylobacter is sensitive to the stomach's normal production of hydrochloric acid: as a result, the infectious dose is relatively high, and the bacteria rarely cause illness when a person is exposed to less than 10,000 organisms. Nevertheless, people taking antacid medication (e. g. people with gastritis or stomach ulcers) are at higher risk of contracting disease from a smaller number of organisms, since this type of medication neutralizes normal gastric acid.
In humans, the sites of tissue injury include the jejunum, the ileum, and the colon. Most strains of C. jejuni produce cytolethal distending toxin, which inhibits cell division and impedes activation of the immune system. This helps the bacteria to evade the immune system and survive for a limited time inside intestinal cells. Campylobacter has, on rare occasions, been suggested to cause hemolytic uremic syndrome and thrombotic thrombocytopenic purpura, though no unequivocal case reports exist. Campylobacter infection is the most common trigger of Guillain–Barré syndrome. Gastrointestinal perforation is a rare complication of ileal infection.
Campylobacter testing needs to be done to manage the risk of foodborne Campylobacter and reducing the level of foodborne Campoboteriosis, to protect people and to determine if a person is infected with Campylobacter.
Usually, detection of Campylobacter in humans is done by laboratory culturing a stool sample or swab of the rectum collected by a healthcare provider. Results take about 48–72 hours for preliminary results. Confirmation test and testing to determine the species of Campylobacter or drug sensitivities of the organism require additional time.
Usually, detection of Campylobacter in livestock is done by laboratory culturing a faecal sample. Results take about 48–72 hours.
Usually, detection of Campylobacter in meat is done by laboratory culturing a homogenised sample. Results takes about 48–72 hours.
The infection is usually self-limiting and, in most cases, symptomatic treatment by liquid and electrolyte replacement is sufficient to treat human infections. Symptoms typically last 5–7 days. Treatment with antibiotics has only a minor effect on the typical duration of the infection in non-complex cases, and is discouraged except in high-risk patients. Diagnosis of campylobacteriosis is made by testing a fecal specimen. Standard treatment in high-risk cases is azithromycin, a macrolide antibiotic, especially for Campylobacter infections in children, although other antibiotics, such as quinolones, tetracycline and other macrolides are sometimes used to treat gastrointestinal Campylobacter infections in adults. In case of systemic infection, other bactericidal antibiotics are used, such as ampicillin, amoxicillin/clavulanic acid, or aminoglycosides. Fluoroquinolone antibiotics, such as ciprofloxacin or levofloxacin, may no longer be effective in some cases, due to resistance. In addition to antibiotics, dehydrated children may require intravenous fluid treatment in a hospital.
In January 2013, the UK's Food Standards Agency (FSA) warned that two-thirds of all raw chicken bought from UK shops was contaminated with Campylobacter, affecting an estimated half a million people annually and killing about 100 of them. In June 2014, the FSA started a campaign against washing raw chicken, as washing can spread germs onto clean surfaces by splashing. In May 2015, cumulative results for samples taken from fresh chickens between February 2014 and February 2015 were published by the FSA and showed 73% of chickens tested positive for the presence of Campylobacter.
Campylobacter infections increased 14% in the United States in 2012 compared to the rate from 2006 to 2008. This represents the highest reported number of infections since calendar year 2000.
High prevalence of Campylobacter (40% or more) has been reported in raw chicken meat in regional retail stores in the US, which remained steady from 2005 through 2011. The last USDA quarterly progress report on Salmonella and Campylobacter testing of meat and poultry, for July–September 2014, showed a low prevalence of Campylobacter spp. in ground chicken meat, but a larger prevalence (20%) in mechanically separated chicken meat (which is sold only for further processing).
FoodNet Canada has reported that Campylobacter was the most common pathogen found on packaged chicken breast, with nearly half of all samples testing positive. Additionally, Campylobacter and Salmonella were the most common causes of gastrointestinal illness in Canada.
In August 2016, an estimated 8,000+ residents of Havelock North, a town with around 13,000 residents, had gastric illness after the water supply was thought to be contaminated by Campylobacter.
In June 2019, an estimated 2,000 residents of Askøy municipality got sick due to the presence of C. jejuni in the water supply. Two deaths were connected to the outbreak, and it was the largest outbreak of Campylobacter in Norway. The suspected source of the contamination was thought to be horse faeces, which leaked into a drinking water pool. A C. jejuni water isolate thought to be the cause of the outbreak was examined with human isolates, and showed the highest pathogenic potential in vitro, transcriptomic and genomic investigations. This could suggest why the isolate was able to cause an outbreak.
During the period of August 2016 to June 2017 there was a large outbreak of C. jejuni in Sweden. It was the largest outbreak that has been reported so far. 5000 more cases than would be expected during this period were reported to the authorities. The source of the outbreak was contaminated chicken meat that came from the same producer. The reason for the increased incidence and elevated levels of Campylobacter was reported to be an improperly installed washing plant, where dirty water was accidentally used to wash transport cages.
- Motile means that it can move of its own.
- It is usually self-limiting and antimicrobial treatment is often not required, except in severe cases or immunocompromised patients.
- Blaser, Martin J. (December 1997). "Epidemiologic and Clinical Features of Campylobacter jejuni Infections". The Journal of Infectious Diseases. 176 (s2): S103–S105. doi:10.1086/513780. PMID 9396691.
- Garrity, George M.; Bell, Julia A.; Lilburn, Timothy (2005). "Class V. Epsilonproteobacteria class. Nov.". Bergey's Manual® of Systematic Bacteriology. pp. 1145–1194. doi:10.1007/0-387-29298-5_4. ISBN 978-0-387-24145-6.
- Humphrey T, O'Brien S, Madsen M (July 2007). "Campylobacters as zoonotic pathogens: a food production perspective". International Journal of Food Microbiology. 117 (3): 237–57. doi:10.1016/j.ijfoodmicro.2007.01.006. PMID 17368847.
- Olsen, K.; Lund, M.; Skov, J. "Detection of Campylobacter Bacteria in Air Samples for Continuous Real-Time Monitoring of Campylobacter Colonization in Broiler Flocks". National Library of Medicine. Retrieved 28 Sep 2023.
- Skarp CP, Hänninen ML, Rautelin HI (February 2016). "Campylobacteriosis: the role of poultry meat". Clinical Microbiology and Infection. 22 (2): 103–109. doi:10.1016/j.cmi.2015.11.019. PMID 26686808.
- Ryan KJ, Ray CG, eds. (2004). Sherris Medical Microbiology: An Introduction to Infectious Diseases (4th ed.). McGraw Hill. pp. 378–80. ISBN 978-0-8385-8529-0.
- Moore, John E.; Corcoran, Deborah; Dooley, James S.G.; Fanning, Séamus; Lucey, Brigid; Matsuda, Motoo; McDowell, David A.; Mégraud, Francis; Cherie Millar, B.; O'Mahony, Rebecca; O?Riordan, Lisa; O'Rourke, Michele; Rao, Juluri R.; Rooney, Paul J.; Sails, Andrew; Whyte, Paul (May 2005). "Campylobacter". Veterinary Research. 36 (3): 351–382. doi:10.1051/vetres:2005012. PMID 15845230.
- "Campylobacter". European Food Safety Authority. Retrieved 2020-11-02.
- Campylobacter Infections at eMedicine
- Sauerwein RW, Bisseling J, Horrevorts AM (1993). "Septic abortion associated with Campylobacter fetus subspecies fetus infection: case report and review of the literature". Infection. 21 (5): 331–3. doi:10.1007/BF01712458. PMID 8300253. S2CID 28539930.
- "Information for Health Professionals | Campylobacter | CDC". www.cdc.gov. 2019-12-23. Retrieved 2020-11-02.
- Crushell E, Harty S, Sharif F, Bourke B (January 2004). "Enteric campylobacter: purging its secrets?". Pediatric Research. 55 (1): 3–12. doi:10.1203/01.PDR.0000099794.06260.71. PMID 14605259.
- Samie A, Obi CL, Barrett LJ, Powell SM, Guerrant RL (June 2007). "Prevalence of Campylobacter species, Helicobacter pylori and Arcobacter species in stool samples from the Venda region, Limpopo, South Africa: studies using molecular diagnostic methods". The Journal of Infection. 54 (6): 558–66. doi:10.1016/j.jinf.2006.10.047. PMID 17145081.
- Altekruse SF, Stern NJ, Fields PI, Swerdlow DL (1999). "Campylobacter jejuni--an emerging foodborne pathogen". Emerging Infectious Diseases. 5 (1): 28–35. doi:10.3201/eid0501.990104. OCLC 677425436. PMC 2627687. PMID 10081669.
- Fouts DE, Mongodin EF, Mandrell RE, Miller WG, Rasko DA, Ravel J, et al. (January 2005). "Major structural differences and novel potential virulence mechanisms from the genomes of multiple campylobacter species". PLOS Biology. 3 (1): e15. doi:10.1371/journal.pbio.0030015. PMC 539331. PMID 15660156.
- Parkhill J, Wren BW, Mungall K, Ketley JM, Churcher C, Basham D, et al. (February 2000). "The genome sequence of the food-borne pathogen Campylobacter jejuni reveals hypervariable sequences". Nature. 403 (6770): 665–8. Bibcode:2000Natur.403..665P. doi:10.1038/35001088. PMID 10688204.
- Parkhill J, Wren BW, Mungall K, Ketley JM, Churcher C, Basham D, et al. (February 2000). "The genome sequence of the food-borne pathogen Campylobacter jejuni reveals hypervariable sequences". Nature. 403 (6770): 665–8. Bibcode:2000Natur.403..665P. doi:10.1038/35001088. PMID 10688204. S2CID 205004234.
- Grant CC, Konkel ME, Cieplak W, Tompkins LS (May 1993). "Role of flagella in adherence, internalization, and translocation of Campylobacter jejuni in nonpolarized and polarized epithelial cell cultures". Infection and Immunity. 61 (5): 1764–71. doi:10.1128/IAI.61.5.1764-1771.1993. PMC 280763. PMID 8478066.
- Robinson, L; Liaw, J; Omole, Z; Corcionivoschi, N; Hachani, A; Gundogdu, O (October 2022). "In silico investigation of the genus Campylobacter type VI secretion system reveals genetic diversity in organization and putative effectors". Microbial Genomics. 8 (10): 000898. doi:10.1099/mgen.0.000898. ISSN 2057-5858. PMC 9676060. PMID 36314601.
- Firehammer BD, Border M (November 1968). "Isolation of temperate bacteriophages from Vibrio fetus". American Journal of Veterinary Research. 29 (11): 2229–35. PMID 5693467.
- Fletcher RD (1965). "Activity and morphology of Vibrio coli phage". American Journal of Veterinary Research. 26 (111): 361–4.
- Fletcher RD, Bertschinger HU (2010). "A Method of Isolation ofVibrio colifrom Swine Fecal Material by Selective Filtration". Zentralblatt für Veterinärmedizin Reihe B. 11 (6): 469–74. doi:10.1111/j.1439-0450.1964.tb01075.x.
- Connerton PL, Timms AR, Connerton IF (August 2011). "Campylobacter bacteriophages and bacteriophage therapy". Journal of Applied Microbiology. 111 (2): 255–65. doi:10.1111/j.1365-2672.2011.05012.x. PMID 21447013. S2CID 46270047.
- Zilbauer M, Dorrell N, Wren BW, Bajaj-Elliott M (February 2008). "Campylobacter jejuni-mediated disease pathogenesis: an update". Transactions of the Royal Society of Tropical Medicine and Hygiene. 102 (2): 123–9. doi:10.1016/j.trstmh.2007.09.019. PMID 18023831.
- "Infections from some foodborne germs increased, while others remained unchanged in 2012" (Press release). CDC. April 18, 2013. Retrieved October 22, 2015.
- "Infections from some foodborne germs increased, while others remained unchanged in 2012". Centers for Disease Control. April 18, 2013. Retrieved April 19, 2013.
- Keithlin, Jessica; Sargeant, Jan; Thomas, M. Kate; Fazil, Aamir (2014-11-22). "Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae". BMC Public Health. 14: 1203. doi:10.1186/1471-2458-14-1203. ISSN 1471-2458. PMC 4391665. PMID 25416162.
- Morton, A. R.; Yu, R.; Waldek, S.; Holmes, A. M.; Craig, A.; Mundy, K. (1985-11-16). "Campylobacter induced thrombotic thrombocytopenic purpura". Lancet. 2 (8464): 1133–1134. doi:10.1016/s0140-6736(85)90729-9. ISSN 0140-6736. PMID 2865609. S2CID 44823836.
- Finsterer, Josef (2022-11-17). "Triggers of Guillain-Barré Syndrome: Campylobacter jejuni Predominates". International Journal of Molecular Sciences. 23 (22): 14222. doi:10.3390/ijms232214222. ISSN 1422-0067. PMC 9696744. PMID 36430700.
- Jassim SS, Malik A, Aldridge A (2011). "Small bowel perforation: an unusual cause". Grand Rounds. 11 (1): 17–9. doi:10.1102/1470-5206.2011.0006.
- Buss JE, Cresse M, Doyle S, Buchan BW, Craft DW, Young S (June 2019). "Campylobacter culture fails to correctly detect Campylobacter in 30% of positive patient stool specimens compared to non-cultural methods". European Journal of Clinical Microbiology & Infectious Diseases. 38 (6): 1087–1093. doi:10.1007/s10096-019-03499-x. PMC 6520473. PMID 30783889.
- Hong Y, Berrang ME, Liu T, Hofacre CL, Sanchez S, Wang L, Maurer JJ (June 2003). "Rapid detection of Campylobacter coli, C. jejuni, and Salmonella enterica on poultry carcasses by using PCR-enzyme-linked immunosorbent assay". Applied and Environmental Microbiology. 69 (6): 3492–9. Bibcode:2003ApEnM..69.3492H. doi:10.1128/AEM.69.6.3492-3499.2003. PMC 161512. PMID 12788755.
- Ternhag A, Asikainen T, Giesecke J, Ekdahl K (March 2007). "A meta-analysis on the effects of antibiotic treatment on duration of symptoms caused by infection with Campylobacter species". Clinical Infectious Diseases. 44 (5): 696–700. doi:10.1086/509924. PMID 17278062.
- Vukelic D, Trkulja V, Salkovic-Petrisic M (April 2010). "Single oral dose of azithromycin versus 5 days of oral erythromycin or no antibiotic in treatment of campylobacter enterocolitis in children: a prospective randomized assessor-blind study". Journal of Pediatric Gastroenterology and Nutrition. 50 (4): 404–10. doi:10.1097/MPG.0b013e3181a87104. PMID 19881393. S2CID 22460970.
- Gendrel, D.; Cohen, R.; European Society for Pediatric Infectious Diseases; European Society for Gastroenterology, Hepatology and Nutrition (October 2008). "Diarrhées bactériennes et antibiotiques : les recommandations européennes" [Bacterial diarrheas and antibiotics: European recommendations]. Archives de Pédiatrie (in French). 15: S93–S96. doi:10.1016/S0929-693X(08)74223-4. PMID 19000862.
- Lehtopolku M, Nakari UM, Kotilainen P, Huovinen P, Siitonen A, Hakanen AJ (March 2010). "Antimicrobial susceptibilities of multidrug-resistant Campylobacter jejuni and C. coli strains: in vitro activities of 20 antimicrobial agents". Antimicrobial Agents and Chemotherapy. 54 (3): 1232–6. doi:10.1128/AAC.00898-09. PMC 2825995. PMID 20038624.
- "FSA warns that chicken bacteria could be next meat scandal". The Telegraph. January 23, 2013.
- "Don't wash raw chicken". Food Standards Agency.
- "Campylobacter survey: cumulative results from the full 12 months (Q1 – Q4)" (Press release). Food Standards Agency. May 28, 2015. Retrieved October 23, 2015.
- Williams A, Oyarzabal OA (August 2012). "Prevalence of Campylobacter spp. in skinless, boneless retail broiler meat from 2005 through 2011 in Alabama, USA". BMC Microbiology. 12: 184. doi:10.1186/1471-2180-12-184. PMC 3490988. PMID 22920043.
- "Quarterly Progress Report on Salmonella and Campylobacter". Testing of Selected Raw Meat and Poultry Products: Preliminary Results, July 2014 to September 2014. Food Safety and Inspection Service. United States Department of Agriculture. 2015-04-24.
- "FoodNet Canada 2014 Short Report". Public Health Agency of Canada, FoodNet Canada. 2016-01-12. Retrieved 3 October 2016.
- "Woman died in Havelock North gastro outbreak". Stuff. 19 August 2016.
- "Govt rejects call for Hawke's Bay water emergency declaration". Radio New Zealand. 19 August 2016.
- Gilpin BJ, Walker T, Paine S, Sherwood J, Mackereth G, Wood T, et al. (September 2020). "A large scale waterborne Campylobacteriosis outbreak, Havelock North, New Zealand". The Journal of Infection. 81 (3): 390–395. doi:10.1016/j.jinf.2020.06.065. PMID 32610108. S2CID 220306856.
- "Fant samme bakterie i drikkevannet som hos sykehuspasienter fra Askøy". NRK. 11 June 2019.
- Paruch L, Paruch AM, Sørheim R (March 2020). "DNA-based faecal source tracking of contaminated drinking water causing a large Campylobacter outbreak in Norway 2019". International Journal of Hygiene and Environmental Health. 224: 113420. doi:10.1016/j.ijheh.2019.113420. PMID 31748129.
- Davies E, Ebbesen M, Johansson C, Kaden R, Rautelin H (2020). "Genomic and Phenotypic Characterisation of Campylobacter jejuni Isolates From a Waterborne Outbreak". Frontiers in Cellular and Infection Microbiology. 10: 594856. doi:10.3389/fcimb.2020.594856. PMC 7658296. PMID 33194843.
- "Utbrott av anmälningspliktiga sjukdomar i Sverige 2017". Folkhälsomyndigheten. 2018-05-09. Retrieved 27 May 2020.