Campylobacter Jejuni

00:01 Campylobacter Jejuni, a bacteria.

00:04 Campylobacter are gram-negative, motile rods meaning, that they swarm or move on the culture plate and they are characteristic in their seagull-shape with a single flagellum.

00:17 In fact, if you can remember one thing about Campylobacter, it is that they appear like the seagull wings on staining.

00:25 They have very fastidious growth requirements as well and in fact, require elevated temperatures, 42 degrees Celsius in a carbon dioxide enriched environment.

00:35 So, to isolate Campylobacter as we’ll talk about in just a little bit, one requires a specific culture plate and a specific culture environment.

00:45 In addition Campylobacter are both oxidase and catalase positive.

00:49 How do the Campylobacter cause their disease? First and foremost like many other infections in the gut, the Campylobacter Jejuni must invade the mucosal surfaces throughout the intestine.

01:04 When embedded in the mucosal surfaces, they’re able to create and produce toxins, endo, entero, and cytotoxins, pretty much a full smorgasbord of toxins being produced into the gut and affecting other gut lining cells.

01:22 Now, the body of course is very anti-Campylobacter and does whatever it can to remove that bacteria as well as many others which are not supposed to normally be in the intestine.

01:35 And so, the immune response to Campylobacter includes complement cascade as well as development of antibodies.

01:44 And so, we’ll see in just a little bit, this immunologic cascade has downstream effects and sometimes allowing autoimmune type diseases to occur.

01:53 However, gastric juices when present are also a wonderful way to get rid of Campylobacter but hypersecretion of gastric juices of course, can allow for additional damage including erosive lesions to the intestines downstream.

02:10 Finally, the antibody mediated killing which the immune system, the humoral immune system would precipitate against any foreign invader many times creates a cross-linked reaction to parts of the Campylobacter cell wall which develops molecular mimicry to other parts of the human neurologic system and musculoskeletal system.

02:35 As I just mentioned, these then can create an auto-immune process allowing further disease to occur, not just gastrointestinal disease.

02:45 But the major problem from Campylobacter is indeed that.

02:49 Acute gastroenteritis, typically transmitted through fecal-oral transmission.

02:55 Yes, that’s poop to mouth and it does happen and it many times happens with person to person contact as well.

03:02 As a brief reminder, washing your hands, good idea especially after going to the toilet.

03:08 Ingesting undercooked poultry as well as undercooked meats and unpasteurized milk are other frequent sources of Campylobacter and in fact, one can sometimes see point source outbreaks in communities associated with contamination of their water supply with Campylobacter.

03:26 Also, contact with infected animals especially sharing kisses, those lovely kisses with cats, dogs, puppies, and pigs, can all contribute to causing Campylobacter disease.

03:38 What are the risk factors for developing Campylobacter because of course, this organism is somewhat ubiquitous? Pretty much having a lack of gastric acids or those who are immunocompromised, l acking either a humoral response, an antibody or immunoglobulin response or those rare individuals who are complement deficient.

04:00 Acute gastroenteritis caused by Campylobacter is unpleasant of course.

04:05 It’s perhaps not the most severe gastroenteritis in the world, certainly not when compared to Salmonella or Shigella but it is all by itself plenty unpleasant.

04:16 Typical patients will have a watery, scantily bloody diarrhea along with vomiting and fever is certainly along with malaise which may last up to one week.

04:27 Along with the gastrointestinal complaints, there is crampy abdominal pain all over and there may even be purulent material or pus in the stool.

04:38 Here is the mention of the autoimmune diseases that I had briefly discussed before.

04:44 Molecular mimicry to structures of the Campylobacter cell wall will trigger antibody production which in some patients may precipitate Guillain-Barre syndrome, excuse me, an ascending paralysis as well as reactive arthritis, typically in patients who are HLA-B27 positive.

05:05 Now, the risk for developing Guillain-Barre or post-infectious reactive arthritis is not equal going both ways.

05:14 While many patients with Guillain-Barre syndrome for example have had Campylobacter infection preceding the onset of their disease, it is not true that many Campylobacter infected patients will develop Guillain-Barre.

05:29 In fact, the overall or relative risk for developing Guillain-Barre syndrome or post-infectious reactive arthritis if one develops Campylobacter infection is quite low.

05:40 Prevention, treatment, and also, diagnosis.

05:45 So, as I mentioned before, Campylobacter has very specific growth requirements and if one is ordering stool cultures to look for Campylobacter, one has to specifically request the so called campy plate, a Campylobacter plate which will tell the lab to grow that particular agar or culture source at 42 degrees Celsius and in a carbon dioxide enriched environment.

06:09 Treatment for Campylobacter is most often accomplished with a macrolide antibiotic such as erythromycin or azithromycin or secondarily, a fluoroquinolone.

06:21 Now, for those of you who have taken erythromycin for treatment of an infection, you may realize that sometimes the treatment is worse than the disease.

06:31 Macrolides frequently are associated with their own gastrointestinal upset, perhaps, making the patient far more miserable than they were before.

06:39 Most patients do not require antibiotic treatment for Campylobacter as it does resolve spontaneously.

06:46 The principal effect of treatment needs to be to maintain hydration and replace any loss of nutrients or electrolytes.

06:56 So, Campylobacter, remember, seagull-shaped, special growth requirements in a carbon dioxide enriched environment and warm, and potentially, a risk factor for developing Guillain-Barre syndrome or post-infectious reactive arthritis, and that my friends is Campylobacter.