Campylobacter

Campylobacter (“curved bacteria”) is a genus of thermophilic, S-shaped, gram-negative bacilli. There are many species of Campylobacter, with C. jejuni and C. coli most commonly implicated in human disease. The mode of transmission is primarily through the consumption of undercooked food contaminated with Campylobacter. Infection is most often associated with self-limiting gastroenteritis and is also a major cause of bloody diarrhea, especially in children. Two associated complications of Campylobacter gastroenteritis are Guillain-Barré syndrome and reactive arthritis.

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General Characteristics

Basic features

General characteristics of Campylobacter species include:

  • Gram-negative
  • Ribbon or S-shaped bacilli
  • Polar flagella
  • Microaerophilic or partially anaerobic
  • Thermophilic:
    • Preferred growth at 37–42°C (98.6–107.6°F)
    • Key factor used to distinguish from Vibrio cholerae, which is also a gram-negative, comma-shaped bacilli
  • Fastidious growth requirements: CO2-enriched environment
  • Oxidase positive
  • Catalase positive: split hydrogen peroxide into water and oxygen

Clinically relevant species

  • C. jejuni
  • C. coli
  • C. upsaliensis
  • C. fetus

Campylobacter bacteria
Scanning electron micrograph depicts an S-shaped organism with a single, polar flagella.

Image: “ARS Campylobacter jejuni” by De Wood, Pooley. License: Public Domain

Epidemiology

  • Campylobacter is the leading cause of acute diarrhea worldwide.
  • Most common in young children and young adults
  • Slight male predominance

Pathogenesis

Reservoirs

  • C. jejuni: intestinal tract of animals, primarily poultry
  • C. coli: intestinal tract of pigs
  • C. upsaliensis: intestinal tract of dogs and cats
  • C. fetus: intestinal tract of cattle and sheep

Trasmission

  • Food contamination (most common):
    • Consumption of raw or undercooked meat
    • Cross-contamination from raw meat
    • Unpasteurized milk
  • Water-borne (contaminated unchlorinated water)
  • Fecal–oral transmission 
  • Direct contact with animals or carcasses: usually associated with occupational exposure (cattle, dogs, and cats)

Pathogenesis factors

  • Bacterial load: higher numbers more likely to produce illness
  • Virulence:
    • Flagella: ability to move through mucus
    • Superficial adhesins, chemotactic factors: mediate attachment to intestinal mucosa
    • High-molecular-weight plasmids: increase invasiveness
  • Host immunity:
    • Primarily humoral (immunoglobulin A (IgA), IgM, IgG, complement)
    • May generate autoimmune response through molecular mimicry

Campylobacter pathogenesis
When pathogens are embedded in the mucosal surfaces, they produce a variety of toxins which include endotoxin, enterotoxins, and cytotoxins. The body reacts by activating the complement cascade which results in the inactivation of organisms. The humoral immune system reacts by creating antibodies, which then target the Campylobacter and cause molecular mimicry to the human neurological and musculoskeletal systems. This results in an autoimmune response.

Image by Lecturio.

Clinical Presentation

Gastroenteritis

  • Abdominal pain/cramping
  • Fever
  • Diarrhea
  • Bloody diarrhea, especially in children
  • Incubation period: 3 days
  • Duration: self-limited, lasts approximately 7 days
  • Treatment: supportive

Complications (autoimmune)

  • Guillain-Barré syndrome:
    • Usually occurs 1–2 weeks after onset of diarrhea
    • Symmetric ascending paralysis due to molecular mimicry of peripheral, Schwann cells
  • Reactive arthritis:
    • Classic triad: conjunctivitis, urethritis, arthritis
    • Usually occurs 1–2 weeks after onset of diarrhea
    • More commonly associated with HLA-B27 phenotype

Prevention

  • Primarily through safe food-handling practices
    • Cooking poultry to proper temperatures
    • Avoiding cross-contamination
  • Hand-washing practices for anyone with diarrheal illnesses or direct contact with farm animals

References

  1. Allos B.M. (2019). Microbiology, pathogenesis, and epidemiology of Campylobacter infection. UpToDate. Retrieved January 2, 2021, from https://www.uptodate.com/contents/microbiology-pathogenesis-and-epidemiology-of-campylobacter-infection?search=campylobacter&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2 
  2. Allos B.M. (2019). Clinical manifestations, diagnosis, and treatment of Campylobacter infection. UpToDate. Retrieved January 2, 2021, from https://www.uptodate.com/contents/clinical-manifestations-diagnosis-and-treatment-of-campylobacter-infection?search=campylobacter&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1

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