Campylobacter Enteritis

Infectious Agent
Infection is caused by gram-negative, spiral-shaped microaerophilic bacteria of the family Campylobacteraceae. Most infections are caused by Campylobacter jejuni; other species, including C. coli, also cause infection. C. jejuni and C. coli are carried normally in the intestinal tracts of many domestic and wild animals.

Mode of Transmission
The major modes of transmission include—
 * Consuming contaminated foods, especially undercooked chicken and foods contaminated by raw chicken
 * Consuming contaminated water or raw (unpasteurized) milk
 * Contact with animals, particularly farm animals such as cattle and poultry, as well as cats and dogs.
 * Occurrence
 * Campylobacter is a leading cause of bacterial diarrheal disease worldwide; within the United States, it is estimated to affect 2.4 million persons every year.
 * Campylobacteriosis is a common cause of travelers’ diarrhea (TD). The percentage of bacteria-caused TD due to Campylobacter ranges from 1% to 2% in Mexico to 28% in Thailand.

Risk for Travelers
The infectious dose is thought to be small, typically fewer than 500 organisms.

The geographic distribution of cases is worldwide; risk for infection is higher in the developing world, especially in areas with poor restaurant hygiene and inadequate sanitation.

Clinical Presentation
Incubation period is typically 2–4 days. Campylobacteriosis is characterized by diarrhea (frequently bloody), abdominal pain, fever, and occasionally, nausea and vomiting. More severe presentations can occur, including bloodstream infection and disease mimicking acute appendicitis or ulcerative colitis.

Diagnosis
Diagnosis is based on isolation of the organism from stools by using selective media and reduced oxygen tension. Most laboratories also combine this with incubation at 42° C (107.6° F).

Visualization of motile and curved, spiral or S-shaped rods by stool phase-contrast or darkfield microscopy can provide rapid presumptive evidence for Campylobacter enteritis.

Treatment
Treatment is generally supportive, including oral rehydration solutions (ORS). The disease is generally self-limited and may last up to a week.

Antibiotic therapy may decrease the duration of symptoms if administered early in the course of disease. Because it is generally not possible to distinguish Campylobacteriosis from other etiologies of TD, the use of empiric antibiotics in travelers should follow the guidelines for TD.

Rates of antibiotic resistance have been on the rise in the past 20 years, in particular for fluoroquinolones; travel abroad has been associated with infection with resistant Campylobacter. Clinicians should have a high degree of suspicion for resistant infection in returning travelers. Documented fluoroquinolone resistance has been highest among travelers to Thailand. When fluoroquinolone resistance is proven or suspected, azithromycin is usually the next choice of treatment.

Campylobacter infection can be a trigger for Guillain–Barré syndrome.

Additional information can be found on the Division of Foodborne, Bacterial and Mycotic Diseases’ website: www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htm.

Preventive Measures for Travelers

 * No vaccine is available.
 * Antibiotic prophylaxis, as used for TD, is likely to be effective, although antibiotic prophylaxis is not routinely recommended.
 * Preventive measures are aimed at avoiding ingestion of foods at high risk for contamination, as well as safe water practices while traveling.