What is Campylobacter Infection?
The bacteria known as Campylobacter is one of the most frequent causes of diarrhea-related sickness around the world. The Centers for Disease Control (CDC) reports that approximately 1.3 million people in the United States alone get infected by Campylobacter every year. This results in an economic impact ranging from $1.3 to $6.8 billion annually in the U.S.
People usually catch a Campylobacter infection by consuming raw milk, undercooked poultry, or contaminated water. Those affected typically suffer from diarrhea for around 5 to 7 days. Those with weaker immune systems and older individuals are at the highest risk of severe and prolonged sickness. Even though there are effective treatments and ways to eliminate the bacteria in animals, the number of Campylobacter cases has noticeably risen around the world.
Different types of Campylobacter, including C. jejuni, C. coli, C. fetus, and C. lari, can make people sick. These bacteria species can get in the bloodstream and cause illness throughout the body. For instance, C. jejuni infection can cause severe conditions in patients with AIDS. Most other diseases when bacteria get into the bloodstream (known as bacteremia) are from C. fetus infection. Other types of Campylobacter can cause occasional bacteremia in those with weak immune systems and can cause diarrhea as well.
Campylobacter can also cause “traveler’s diarrhea,” especially in Thailand and other regions of Southeast Asia. In a study done on U.S. military personnel stationed in Thailand, over half of those who had diarrhea had a Campylobacter infection.
C. lari, a type of Campylobacter often found in healthy seagulls, can cause mild, recurring diarrhea in children.
What Causes Campylobacter Infection?
There is a type of bacteria called Campylobacter which is small in size and has a spiral, or corkscrew, shape. This bacterium can be found in many species, and is often present in various types of animals we use for food, like cows, chickens, pigs, ostriches, sheep, and even pets like cats and dogs.
People can catch this bacteria usually through eating food or drinking water that has been contaminated by it. In most cases, infection happens when we consume foods that have not been cooked properly and are still carrying the bacteria. Chicken is often a significant source of such infections in humans, causing about 50% to 70% of all cases.
Besides eating or drinking contaminated food and water, you can also get this infection from contact with animals or even from being in direct contact with an infected person. Some types of shellfish have also been found to carry this bacteria. Another interesting point is that people who have contact with pets, especially puppies, can have a higher risk of catching the infection.
What makes Campylobacter particularly concerning is how quickly it can cause infection. Studies have shown that it can cause symptoms in humans even when they are exposed to very small doses – as few as 800 colonies-forming units of the bacteria. This makes it extremely important for people who handle poultry, work with unprocessed milk, or use contaminated water sources to maintain high levels of cleanliness to avoid infection.
Risk Factors and Frequency for Campylobacter Infection
It’s important to understand that Campylobacter, a bacteria, is a leading cause of diarrhea worldwide and is becoming increasingly common. In 2013, the CDC reported that cases of a particular strain, C. jejuni, in the United States had risen by 14%. Each year, one percent of people in Europe are affected by an illness caused by the bacteria, known as campylobacteriosis. In less developed countries, out of the illnesses rooted in food, 5% to 20% are due to Campylobacter.
While campylobacteriosis affects people of all ages, it is predominantly seen in children in less economically developed countries. In developed countries, the majority of cases (90%) happen in the summer. This may be due to undercooked meat at outdoor activities. Most affected are children under four and individuals aged 15 to 44.
This disease is prevalent worldwide, showing that Campylobacter can survive in many different environments. As international travel for both humans and livestock is more common, controlling the spread of Campylobacter becomes challenging. To help combat this, the CDC is trying to educate people about the disease, its symptoms, and how to prevent it. This includes:
- Practicing good hand hygiene
- Separating raw meats from other foods during meal preparation
- Ensuring food is cooked thoroughly
- Avoiding raw dairy products and untreated water, especially when traveling to high-risk countries
Signs and Symptoms of Campylobacter Infection
Infection from a bacteria called Campylobacter often results in a type of inflammation in the intestines called enteritis, which causes heavy diarrhea. Some people may have a set of early symptoms like high fever, shivering, dizziness, and body aches for 1 to 3 days. These early symptoms usually signal a more severe illness. Around 24 to 72 hours after swallowing the bacteria, people start to feel sick, though it can take a bit longer for those who took in fewer bacteria. The worst part of the illness usually lasts for 24 to 48 hours.
People with Campylobacter enteritis might experience serious diarrhea for about a week. Sometimes abdominal pain can continue even after the diarrhea stops, lasting for days to weeks. It’s worth noting that even after patients start to feel better, they may still have the bacteria in their feces for a few weeks. However, those who had antimicrobial therapy are less likely to continue having the bacteria in their feces after getting better.
- Severe intestinal inflammation causing heavy diarrhea
- Early symptoms include high fever, shivering, dizziness, body aches
- Symptoms start around 24 to 72 hours after swallowing the bacteria
- Worst part of the illness usually lasts for 24 to 48 hours
- Diarrhea may last for about a week
- Abdominal pain might continue even after the diarrhea stops
- Bacteria may still be present in feces even after patient recovers
- Antimicrobial therapy reduces the chance of bacteria remaining in feces
During the most intense phase of the illness, it’s common to experience abdominal cramps and multiple episodes of diarrhea, eventually leading to more than 10 bowel movements per day. The stools look bloody and mucus-filled due to the bacteria invading and damaging the intestines’ inner lining. The abdominal pain may feel similar to appendicitis. Although we still don’t fully understand it, there seems to be a connection between a certain type of the bacteria and more serious illnesses and bloody diarrhea.
People with a Campylobacter infection often look very sick. The doctor might feel tenderness in various parts of your abdomen, especially on the right and left lower sides.
Testing for Campylobacter Infection
If your doctor suspects a Campylobacter infection, which is a type of bacterial infection, they might use a variety of tests to confirm this. One such test is a stool culture, where a sample of your stool is grown in a lab to see if it contains colonies of the Campylobacter species, specifically C. jejuni and C. coli. These bacteria prefer to grow at a temperature of 42 °C (around 107.6 °F) and in environments with 5% to 10% oxygen.
Another test that may be used is the Enzyme Immunoassay (EIA) or the Polymerase Chain Reaction (PCR), both of which are considered to be more sensitive than a stool culture meaning they may be better able to detect the Campylobacter bacteria. There are also recent advances in PCR testing that allow for even more sensitive tests to screen for potentially infected food sources. Real-time PCR can quickly and accurately detect C. jejuni in stool.
There are also new techniques being used, such as immunoenzymatic and molecular biology. These are considered more sensitive than traditional cultures.
Alternatively, there are also rapid tests that can detect antigens in stool. Antigens are substances that trigger an immune response, and their presence may indicate a Campylobacter infection. However, the usefulness of these rapid tests on their own is currently unclear.
Treatment Options for Campylobacter Infection
If you catch a Campylobacter infection, you’ll typically notice that it goes away on its own and the symptoms are mild. Doctors usually focus on making sure patients drink plenty of fluids and replenish their electrolytes which are minerals that help your body perform essential functions. If the sickness is severe and causes a lot of dehydration, or loss of water, doctors might give fluids through an IV.
It’s generally not a good idea to take medications that slow down your bowel movements, as these can actually prolong the infection. While antibiotics, which are drugs that fight bacteria, aren’t commonly used to treat Campylobacter in healthy individuals, doctors might prescribe them for people at high risk. This includes individuals who have weaker immune systems, older people or those who are very sick with symptoms like high fever, bloody poop, or severe belly pain. Those with weaker immune systems may need more than one course of antibiotics.
If antibiotics are needed, macrolide antibiotics, a specific type of antibiotics which includes drugs like erythromycin and azithromycin, work best against Campylobacter infections.
It’s important to be aware that some Campylobacter bacteria have become resistant, or less sensitive, to certain antibiotics. Studies suggest that this resistance comes from using antibiotics too much in farm animals. In fact, in Canada, a type of Campylobacter that was resistant to tetracycline antibiotics rose from 8.6% in 1981 to a whopping 56% in more recent studies. Meanwhile, in the early 1990s, these bacteria were hardly ever resistant to a group of antibiotics called fluoroquinolones, but recent studies from Pennsylvania showed a 40% resistance rate.
Thankfully, resistance to macrolide antibiotics remains low at 1 to 3% in the United States. However, health experts are concerned about future resistance to these antibiotics. Patients who don’t get better with antibiotics may need a test done to help figure out which drugs will work for their infection. Studies suggest that cutting down on antibiotic use in farming could help control this antibiotic resistance problem.
What else can Campylobacter Infection be?
When doctors are trying to diagnose a Campylobacter infection, they have to consider other conditions that might have similar symptoms. These could include:
- Other types of bacteria that can cause diarrhea, such as Salmonella, Shigella, Escherichia coli, Listeria, Clostridium difficile, and Yersinia Enterocolitica.
- Viral stomach bugs, like norovirus.
- Food poisoning caused by toxins.
- Different kinds of stomach parasites, including Giardia lamblia, Cryptosporidium parvum, and Entamoeba histolytica. These especially might cause long-lasting diarrhea in travelers and people with weak immune systems, looking like a Campylobacter infection.
The stomach pain from a Campylobacter infection might also look like appendicitis. The doctor might have to use advanced imagining techniques such as ultrasound, CT scan, or MRI to tell these conditions apart. Conditions that cause inflammation in the bowels, like Crohn’s disease and ulcerative colitis, might also give the same symptoms, including stomach pain and bloody stools. Doctors can confirm these chronic conditions with a stool culture, diagnostic imaging, biopsy, and colonoscopy.
What to expect with Campylobacter Infection
In general, a Campylobacter infection has a very good chance of recovery. It almost always improves on its own, whether you receive specific treatment or not. Out of 10,000 cases confirmed by lab tests, there are around 24 deaths. For healthy people, the infection usually gets better on its own with very good outcomes. Treatment often involves supportive care like rehydration and restoring electrolytes, which are substances in your body vital for normal functioning.
Antibiotics, which are drugs that kill or slow the growth of bacteria, might be needed for patients with weakened immune systems or those experiencing symptoms such as fever, bloody diarrhea, frequent bowel movements, or worsening symptoms.
Around 10.8% of people with the infection need to be hospitalized, making it the third most common reason for hospitalization due to gastroenteritis, an inflammation of the digestive tract. Those with weakened immune systems and older people are more likely to have a longer and potentially deadly illness. But most people typically recover without any complications.
Less than 1% of patients experience transient bacteremia, a condition where bacteria is present in the bloodstream during the acute infection. This condition is associated with a mortality rate between 2.5% and 12.5%. People with weakened immune systems and older individuals are more likely to experience this condition.
For individuals with HIV/AIDS, they have a higher chance of getting infected with Campylobacter and their infection tends to be more severe. They might need more doses of antibiotics to treat the infection. They are more likely to experience symptoms that affect parts of the body outside the intestines and a higher death rate.
Possible Complications When Diagnosed with Campylobacter Infection
Campylobacter infection can lead to several complications. Not only does this infection harm the digestive tract, but it can also affect the nervous, heart, lungs, and immune systems, often resulting in more serious conditions than the initial infection.
Back in 1859, French scientist Jean-Baptiste Octave Landry first discovered a disease now known as Guillain-Barre syndrome (GBS). This autoimmune disease weakens muscles due to damage to the nerves. In the 1900s, researchers found a strong link between GBS and Campylobacter. These days, it’s believed that around 30% of all GBS cases are provoked by Campylobacter, particularly C. jejuni. Around 1 in 1,000 people infected with Campylobacter may develop this syndrome about 1 to 3 weeks later. Some people who suffer from GBS may require a long period of intensive care and the disease has a death rate between 3% to 7%.
There have also been instances of heart inflammation, known as myocarditis, and inflammation surrounding the heart, or pericarditis, linked to Campylobacter. Symptoms may vary from mild chest pain to severe pain similar to a heart attack. Some tests may show elevated levels of particular proteins, which could indicate a worse prognosis. In serious cases, life-threatening irregular heartbeats and cardiovascular failure may occur.
Problems:
- Guillain-Barre syndrome
- Myocarditis and pericarditis
- Life-threatening irregular heartbeats
- Cardiovascular failure
Moreover, approximately 1% to 5% of patients may suffer acute reactive arthritis, a joint inflammation condition that typically occurs in younger adults. The symptoms may appear within 4 weeks after the initial infection, ranging from mild joint pain to debilitating multi-joint inflammation. Some patients could also witness eye, skin, and urinary symptoms, and symptoms could last from a few months to a year.
Also, Campylobacter has been related to gastrointestinal issues such as esophageal and colorectal diseases. Severe infections may cause colitis, making surgery necessary occasionally. A rare but severe complication of Campylobacter colitis is toxic megacolon, which can cause serious health problems and may even result in death.
Other linked conditions include gastroesophageal reflux disease, Barrett esophagus, esophageal cancer, irritable bowel disease, and colorectal carcinoma. Antibiotic treatment targeting Campylobacter has also shown positive effects on a certain form of lymphoma known as immunoproliferative small intestinal disease.
Preventing Campylobacter Infection
Most cases of Campylobacter infections, a type of food poisoning, are commonly linked to eating under-cooked poultry in developed countries, whereas in developing countries, it’s often from drinking contaminated water. To lower your chance of getting this infection, make sure chicken and other meats are cooked at a temperature of 70 degrees Celsius or higher before you eat them.
The Centers for Disease Control and Prevention (CDC), a U.S. health agency, advises washing things like dishes and utensils that have touched raw poultry. They also suggest using different cutting boards for raw meat to avoid cross-contamination and also washing your utensils and hands after they’ve touched raw meat.
It’s also best to stay away from unpasteurized milk and cheese, as these can harbor dangerous bacteria. You should not drink water that hasn’t been treated, as it may contain harmful germs. Washing your hands properly and regularly can also help reduce your risk of getting this foodborne infection.
