|
Foodborne Pathogenic Microorganisms
and Natural Toxins Handbook |
1. Name of the Organism: Campylobacter jejuni (formerly known as Campylobacter fetus subsp. jejuni) |
Campylobacter jejuni is a
Gram-negative
slender, curved, and
motile rod. It is a microaerophilic organism, which means
it has a requirement for reduced levels of oxygen. It is
relatively fragile, and sensitive to environmental stresses
(e.g., 21% oxygen, drying, heating, disinfectants, acidic
conditions). Because of its microaerophilic characteristics
the organism requires 3 to 5% oxygen and 2 to 10% carbon
dioxide for optimal growth conditions. This bacterium is
now recognized as an important enteric pathogen. Before
1972, when methods were developed for its isolation from
feces, it was believed to be primarily an animal pathogen
causing abortion and enteritis in sheep and cattle.
Surveys have shown that C. jejuni is the leading cause of
bacterial diarrheal illness in the United States. It causes
more disease than
Shigella spp. and
Salmonella spp.
combined.
Although C. jejuni is not carried by healthy individuals in the United States or Europe, it is often isolated from healthy cattle, chickens, birds and even flies. It is sometimes present in non-chlorinated water sources such as streams and ponds. Because the pathogenic mechanisms of C. jejuni are still being studied, it is difficult to differentiate pathogenic from nonpathogenic strains. However, it appears that many of the chicken isolates are pathogens. |
2. Name of Disease: | Campylobacteriosis is the name of the illness caused by C. jejuni. It is also often known as campylobacter enteritis or gastroenteritis. |
3. Major Symptoms: |
C. jejuni infection causes diarrhea, which may be watery or
sticky and can contain blood (usually occult) and fecal
leukocytes (white cells). Other symptoms often present are
fever, abdominal pain, nausea, headache and muscle pain.
The illness usually occurs 2-5 days after ingestion of the
contaminated food or water. Illness generally lasts 7-10
days, but relapses are not uncommon (about 25% of cases).
Most infections are self-limiting and are not treated with
antibiotics. However, treatment with
erythromycin does
reduce the length of time that infected individuals shed the
bacteria in their feces.
The infective dose of C. jejuni is considered to be small. Human feeding studies suggest that about 400-500 bacteria may cause illness in some individuals, while in others, greater numbers are required. A conducted volunteer human feeding study suggests that host susceptibility also dictates infectious dose to some degree. The pathogenic mechanisms of C. jejuni are still not completely understood, but it does produce a heat-labile toxin that may cause diarrhea. C. jejuni may also be an invasive organism. |
4. Isolation Procedures: | C. jejuni is usually present in high numbers in the diarrheal stools of individuals, but isolation requires special antibiotic-containing media and a special microaerophilic atmosphere (5% oxygen). However, most clinical laboratories are equipped to isolate Campylobacter spp. if requested. |
5. Associated Foods: | C. jejuni frequently contaminates raw chicken. Surveys show that 20 to 100% of retail chickens are contaminated. This is not overly surprising since many healthy chickens carry these bacteria in their intestinal tracts. Raw milk is also a source of infections. The bacteria are often carried by healthy cattle and by flies on farms. Non-chlorinated water may also be a source of infections. However, properly cooking chicken, pasteurizing milk, and chlorinating drinking water will kill the bacteria. |
6. Frequency of the Disease: | C. jejuni is the leading cause of bacterial diarrhea in the U.S. There are probably numbers of cases in excess of the estimated cases of salmonellosis (2- to 4,000,000/year). |
7. Complications: |
Complications are relatively rare, but infections have been
associated with
reactive arthritis,
hemolytic uremic syndrome, and following
septicemia, infections of nearly any
organ. The estimated case/fatality ratio for all C. jejuni
infections is 0.1, meaning one death per 1,000 cases.
Fatalities are rare in healthy individuals and usually occur
in cancer patients or in the otherwise debilitated. Only 20
reported cases of septic abortion induced by C. jejuni have
been recorded in the literature.
Meningitis, recurrent colitis, acute cholecystitis and Guillain-Barre syndrome are very rare complications. |
8. Target Populations: | Although anyone can have a C. jejuni infection, children under 5 years and young adults (15-29) are more frequently afflicted than other age groups. Reactive arthritis, a rare complication of these infections, is strongly associated with people who have the human lymphocyte antigen B27 (HLA-B27). |
9. Recovery from Foods: | Isolation of C. jejuni from food is difficult because the bacteria are usually present in very low numbers (unlike the case of diarrheal stools in which 10/6 bacteria/gram is not unusual). The methods require an enrichment broth containing antibiotics, special antibiotic-containing plates and a microaerophilic atmosphere generally a microaerophilic atmosphere with 5% oxygen and an elevated concentration of carbon dioxide (10%). Isolation can take several days to a week. |
10. Selected Outbreaks: | For information on recent outbreaks see the Morbidity and Mortality Weekly Reports from CDC. |
11. Education: | The Food Safety Inspection Service of the U.S. Department of Agriculture has produced a background document on Campylobacter. |
12. Other Resources: | A Loci index for genome Campylobacter jejuni is available from GenBank. |