Recurrent Campylobacter Infection: Causes And Management Strategies

  • Sungbeen Lee BSc Neuroscience and Physiology, University of Toronto

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Introduction

Nowadays the bacteria, Campylobacter, is one of the most recurrent causes of diarrhoea globally. Campylobacter are gram-negative bacteria and non-spore-forming spiral rods that belong to the Campylobacteraceae family.1 The C.jejuni, C.coli, C. fetus, and C. lari. are examples of Campylobacter species. 

Campylobacter spp. is a recurrent pathogen that causes infection to enterocolitis. The infection in humans is documented to be caused by C.jejuni as self-limiting enterocolitis. However, recurrent campylobacter infections occur in individuals who have human immunodeficiency virus (HIV), immunocompromised patients and hypogammaglobulinemia and it was reported that patients have severe, prolonged and recurrent infections.2

Overview of campylobacter bacteria

The consumption of raw milk, undercooked poultry and contaminated water is usually associated with campylobacter infection. Also, only 5 to 7 days of infected individuals experience acute-onset diarrhea. People who are immunocompromised and of old age are at risk of prolonged illness as well as morbidity and mortality. The CDC reported that there are 1.3 million cases of Campylobacter infection each year in the US only. Despite effective treatment, the number of cases keeps increasing in some regions of the world.3

The Campylobacter species are considered pathogens to humans and cause illness to humans with other species. Travelers' diarrhoea is usually caused by Campylobacter typically in Thailand and regions of Southeast Asia.3        

Food product consumption and infected animals are how Campylobacter is transmitted to humans. Chicken is one of the foods that 50% to 70% of the infection occurs in humans. To illustrate, puppies are widely associated with Campylobacter outbreaks, leading to infection in humans through contact. Additionally, Campylobacter is present in shellfish.3

The transmission of Campylobacter to humans is via animals, contact with infected individuals and consuming contaminated food and drinks.3  

What causes campylobacter infection?

 The following may lead to Campylobacter infection:4

  • Eating raw or uncooked poultry
  • Drinking unpasteurized milk
  • Drinking contaminated water
  • Touching contaminated pets or livestock (farm animals)
  • Being in contact with an infected individual

There is a higher chance for you to get back the Campylobacter infection if you are:4 

  • Older adult or young child
  • Compromised immune system
  • Malnutrition

Symptoms of campylobacter infection

The Campylobacter infection symptoms may include the following conditions. Furthermore, an individual infected by the bacteria may notice the symptoms 2 to 5 days after they are exposed and they may last around a week.5

  • Fever
  • Nausea
  • Vomiting 
  • Stomach cramping
  • Diarrhoea will have blood (only babies)

Campylobacter is a stomach bug that can lead to dehydration. Signs to observe dehydration in adults and youngsters are:5

  • Feeling thirsty often
  • Warm skin when touched
  • Rarely peeing

In babies, signs of dehydration vary from adults and older children. These include:5

  • Sleeping a lot
  • Little to no tears when crying
  • Less pee
  • Not interested in playing

Complications of campylobacter infection

  • Guillain-Barre syndrome
  • Reactive arthritis
  • Irritable bowel syndrome (IBS)
  • Bloodstream infection for individuals who have weakened immune systems which  could lead to sepsis

Diagnosis of campylobacter infection

To detect a Campylobacter infection a doctor will require the following laboratory test depending on the situation.6 

  • Stool test
  • Blood test
  • Polymerase chain reaction (PCR) testing
  • Enzyme immunoassay (EIA)

Management strategies against campylobacter infection 

Treatment for campylobacter infection

Antibiotics are not prescribed by a doctor to treat Campylobacter infection,as it usually takes a few days to notice recovery.7

The elderly and immunocompromised individuals should be considered for antibiotics. Individuals who are suffering from bloody stools, fever and severe illness also can take antibiotics. In addition, patients who are immunocompromised will need multiple antibiotics, and if the infection is found to be Campylobacter, it is best to be treated using macrolide antibiotics.3   

These are some recommendations to treat gastroenteritis:7

  • Consume as many fluids as you can. Oral rehydration solution should be given to kids with moderate dehydration
  • Avoid drinking fizzy or carbonated drinks, especially for kids
  • Don’t give medication to kids who are vomiting and having diarrhoea by yourself unless a doctor prescribes it for them
  • Don’t change the diet of the kids
  • Don’t consume food high in sugar and fat and when eating take small portions

Prevention methods against campylobacter

The methods provided are used to avoid getting infected by Campylobacter:8

  • Good hygiene should be practised to reduce contamination
  • Control measures of all stages of the food chain, from agricultural production on farms to processing, manufacturing and preparation of foods should be controlled commercially and domestically to prevent infection
  • The training of farm workers and raw meat producers about hygienic food is vital to reduce contamination to a minimum
  • Hygienic standards should be maintained when slaughtering animals to reduce contamination via faeces of carcasses
  • To eliminate Campylobacter food and drinks should be cooked or pasteurized only
  • To prevent foodborne disease prevention methods against infection should be followed in the home kitchen

Summary

Campylobacter is the bacteria that cause foodborne diseases worldwide, whereas C. jejuni is the species that is responsible for human infections. This robust bacterium can survive in various environments, and even a small number can cause infection. Those at higher risk include international travellers, livestock handlers, and consumers of untreated water or unpasteurized milk. Clinically, the infection usually manifests as diarrhoea, sometimes bloody, peaking 1 to 2 days after onset and typically resolving within 7 days. To confirm Campylobacter is present in the body stool culture, PCR, or EIA is used to diagnose. Most cases are self-limiting, needing only fluid and electrolyte support, but when antibiotics are necessary, macrolides like azithromycin are preferred. A notable complication of recurrent Campylobacter infection affects individuals who are immunocompromised, old age, hypogammaglobulinemia and HIV.

FAQs

When should campylobacter-infected individuals resume school or work?

When the diarrhoea is gone and the poop is solid then it is safe to resume your school or work. However, it is better if your doctor confirms that you can resume your school or work. Individuals who handle food or work in the medical field are required to stay at home until the symptoms are gone to avoid the spread of infection to others.

Campylobacter is contagious?

Yes, it is contagious as it spreads infections to animals and humans. Campylobacter will survive in the poop of humans or animals and can travel from there to someone who touches it. The transmission doesn’t occur frequently in humans only via drinking contaminated water or uncooked foods. Wash your hands thoroughly after going to the bathroom to avoid being infected by campylobacter.

References

  1. Gharamti AA, Moukalled N, Taher A, Kanafani ZA. Recurrent campylobacter bacteremia as the first manifestation of hypogammaglobulinemia: a case report and literature review. Infect Chemother [Internet]. 2020 Sep [cited 2024 Jun 13];52(3):415–20. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533215/
  2. Kim Y, Shin JA, Han SB, Cho B, Jeong DC, Kang JH. Recurrent Campylobacter jejuni bacteremia in a patient with hypogammaglobulinemia. Medicine (Baltimore) [Internet]. 2017 Jun 23 [cited 2024 Jun 13];96(25):e7238. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5484231/
  3. Fischer GH, Hashmi MF, Paterek E. Campylobacter infection. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 [cited 2024 Jun 13]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK537033/
  4. Australia H. Campylobacter infection [Internet]. 2023 [cited 2024 Jun 13]. Available from: https://www.healthdirect.gov.au/campylobacter-infection
  5. Cleveland Clinic [Internet]. [cited 2024 Jun 13]. Is campylobacter to blame for your diarrhea? Available from: https://my.clevelandclinic.org/health/diseases/15251-campylobacter-infection
  6. MSD Manual Consumer Version [Internet]. [cited 2024 Jun 13]. Campylobacter infections - infections. Available from: https://www.msdmanuals.com/home/infections/bacterial-infections-gram-negative-bacteria/campylobacter-infections
  7. scheme=AGLSTERMS. AglsAgent; corporateName=Department for Health and Wellbeing; address=11 Hindmarsh Square A. Campylobacter infection - including symptoms, treatment and prevention [Internet]. [cited 2024 Jun 13]. Available from: https://www.sahealth.sa.gov.au/wps/wcm/connect/Public+Content/SA+Health+Internet/Conditions/Infectious+diseases/Campylobacter+infection/Campylobacter+infection+-+including+symptoms+treatment+and+prevention
  8. Campylobacter [Internet]. [cited 2024 Jun 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/campylobacter

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