Overview

Are you a frequent traveller and would like to know more about how to have a safe trip? Are you or someone you know a traveller suffering from diarrhoea? Are you curious about what the cause is and how to treat it? One of the causes can be linked to campylobacter.¹ So, what is campylobacter? It is a bacteria that can cause diarrhoea.¹ It is spread from animals to humans and contracted from contaminated foods or untreated water.¹ It is important to understand campylobacter while travelling as we are more susceptible to it whilst abroad.¹ Almost anyone can get this infection and there are multiple ways we can approach the situation to either prevent it or decrease its prevalence. So, in this article, we will tackle this topic and shed more light on this area.

Basics of campylobacter

So, as mentioned previously, campylobacter is a bacterium that can infect humans and cause diarrhoea.¹ Around 1.5 million people get sick from campylobacter yearly in the US alone, and around 16% of foodborne illnesses worldwide are due to this bacteria.^1,2 It is a zoonotic disease that can come from pets, farm animals, wild birds and poultry.³ Most cases involve Campylobacter jejuni, and Campylobacter coli (however, less frequently).⁴ Other known species that can contribute to the disease include Campylobacter lari and Campylobacter upsaliensis, although less commonly.⁵

Campylobacter are gram-negative bacteria that can be shaped as rods, spirals, “S” shapes or curves and has 17 species.^{5, 6} They have a high mutation rate and are capable of living in different environments; they have mechanisms that can protect them against different stressors such as temperature changes, and living in the gut.⁷ Additionally, this bacterium is capable of resisting intestinal expulsion, meaning that it can remain in its reservoir.⁷ Furthermore, campylobacter is capable of resisting bile, allowing it to survive in the intestines and exhibit antibiotic resistance.⁷

Campylobacter can reside in multiple animals such as pets (e.g. cats and dogs), pigs, sheep, poultry and even ostriches.⁸ The animals act as a reservoir for the bacterium and it can reach humans through:

• Consumption of raw or undercooked food like poultry, meat, or seafood¹
• Preparing salads and raw foods (e.g. fruits and vegetables) using utensils and tools that touched contaminated raw meat or poultry¹
• Contact with animals or items that were touched by the infected animal; for example, cages, bowls, toys etc¹
• Drinking untreated and contaminated water, or contaminated milk^1,5

It is worth noting that animals can carry the bacteria without showing any symptoms or being sick, hence making it harder to know which animals are infected and which aren’t.⁵ The most common way for raw meat/poultry to get contaminated is through the faeces or carcass of an infected animal during slaughter.⁵ Additionally, these infections tend to occur more in the summer than in the winter months.⁵

So why is campylobacter important? It is considered as one of the 4 global causes of diarrhoeal illnesses and can affect many people, including children; around 220 million kids (< 5 years old) get infected yearly.⁵ With its high frequency, some complications can occur which makes it significant from a socio-economic perspective; for example, it is frequently seen in children below the age of 2 and sometimes can lead to death.⁵

So, what are the stages of the disease, known as campylobacteriosis? Once the infection occurs, the symptoms will appear after 2-5 days but can be delayed to 10 days post-infection.⁵ Once symptoms develop, they can last between 3 to 6 days.⁵

Symptoms

The symptoms of campylobacter include:

• Diarrhoea, often bloody (sometimes, more than 10 stools a day can occur) ⁸
• Fever⁵
• Headache⁵
• Abdominal pains/cramps⁵
• Nausea and vomiting⁵

Death from campylobacter is possible, although it is rare and is limited to certain patients that are high risk such as babies, young kids, the elderly, international travellers and immunocompromised individuals.^1,5 Also, complications can occur from campylobacteriosis such as:

• Bacteraemia (presence of bacteria in the blood)⁵
• Hepatitis⁵ 
• Pancreatitis⁵ 
• Miscarriages (variable frequencies)⁵ 
• Reactive arthritis⁵ 
• Neurological conditions like Guillain-Barré syndrome, which is a paralysis (similar to polio) that can cause respiratory and very significant neurological issues (although this is rare)⁵ 
• Myocarditis and pericarditis with most cases reported in younger males (assigned at birth) that have had a history of diarrhoea linked to travelling⁸
• Severe infections can result in colitis,w hich can lead to marked morbidity and may require surgical intervention⁸
• Gastrointestinal illnesses can arise due to the association with campylobacter, like Barrett oesophagus, gastroesophageal reflux disease (GORD), and oesophageal adenocarcinoma⁸

Diagnosis

So, once symptoms appear and a person would like a diagnosis, there are multiple of choices a healthcare professional can take:

• Stool analysis and culture: where the different species are grown using selective agars at selected temperatures (42 °C)⁸
• Enzyme immunoassay and PCR, which are more sensitive to a stool culture⁸
• Real-time PCR can be a useful tool to screen foods that are suspected to be infected⁸
• Differential diagnosis from other infections that can cause diarrhoea like salmonella, Shigella or E. coli etc⁸

Once campylobacteriosis is confirmed, treatment can commence. This includes rest, supportive care like rehydration, and in some cases (ie more severe symptoms like bloody stools) treatment with antibiotics can be an option in high-risk individuals.8 Although the resistance rate of this bacteria is low, it is always important to consider the prevalence of future resistant strains.⁸

The prognosis of this infection is encouraging, with the infection often self-limiting in healthy individuals.⁸ However, high-risk individuals may face a more severe reaction that is longer in duration and may be fatal.⁸

Risks to consider by travellers

When travelling there are multiple things that we need to consider, and one of the most essential things is our safety. So, when travelling it is important to consider the destination; some countries may have poor sanitation compared to other places and this can lead to infections (one of them being campylobacter).¹⁰ It is also wise to look at the incidence of infections; for example, looking at the statistics and cases of campylobacter between different regions.⁹ Additionally, there are some actions that we, as travellers, can take that make us more at risk than others; for example, eating street food that was contaminated o, swimming in contaminated or untreated water (e.g. pools, rivers, lakes), or interacting with animals that may be carriers of the bacterium (like puppies in the pet store).^1,10,11

Precautions to take before travelling

Before travelling, it is important to prepare and research the country you would like to visit; this includes their customs, culture, foods, and understanding local health risks. Getting the appropriate medications with you while travelling is essential to avoid more severe symptoms; for example, painkillers and diarrhoea medications if required. Currently, there is no vaccination available for campylobacter.¹²

It is also good to have a hand sanitiser/gel or wipes to regularly clean your hands when travelling.¹³ Additionally, having portable water filters or iodine tablets to have clean water can be a choice to avoid the consumption of contaminated water.¹⁴

Preventative actions to consider during travel

While travelling, there are multiple actions that we can take to avoid infections, such as:

• Choosing restaurants with good hygiene and adherence to food safety
• Eating well-cooked foods and avoiding undercooked/raw meat, seafood or poultry and cold/reheated meats¹³
• Avoiding raw eggs and unpasteurised milk/cheeses¹³
• Drinking bottled or purified water¹⁴
• Avoid ice prepared from contaminated or untreated water¹³
• Maintain a good personal hygiene through regular and thorough washing of hands before eating and after using the restroom or touching animals¹³
• Using hand sanitiser or wipes to clean hands in case soap is unavailable¹³
• Avoid touching your face with unclean hands as this can cause the bacteria to transfer and increase risk of infection¹⁵ 

What to do in a case of suspected campylobacter infection

If you are travelling and suspect that you caught an infection, it is important to recognise the symptoms and watch for the early signs. Seeking medical help and attention early on is the first step in reaching a diagnosis for your case and helping prevent any complications from occurring.

While campylobacter is self-limiting and can be treated with rest and rehydration, it is important to remember that complications can occur in some individuals, and it is better to address the problem before it worsens. Hence, finding local healthcare clinics and facilities in the country you are visiting is crucial for your safety.

Summary

Campylobacter is one of 4 global diseases of diarrhoea. It can infect anyone and is transmitted through contaminated food, water or animals. While it is an infection that resolves on its own, it can still lead to complications in some people. While travelling, it is important to stay aware of possible risks and be prepared and vigilant regarding our health. Travelling safely and responsibly can help us avoid many unpleasantries including infections such as campylobacter.