Campylobacter - Technical Information

Clinical Features

Diarrhea (often bloody), abdominal cramps, and fever. Illness typically lasts about one week.

Etiologic Agent

Campylobacter, a gram-negative, microaerophilic bacterium. Most human illness is caused by one species, Campylobacter jejuni.

Incidence

Campylobacter is the most common bacterial cause of diarrheal illness. In 2012, the Foodborne Diseases Active Surveillance Network (FoodNet) estimated the incidence to be 14.3 cases per 100,000 population. An estimated 1.3 million persons are affected each year.

Sequelae

An estimated 76 fatal cases each year. Can cause life-threatening bloodstream infection in persons with compromised immune systems. Approximately 1 in 1000 diagnosed infections lead to Guillain-Barré syndrome, a paralysis that lasts several weeks and usually requires intensive medical care.

Transmission

Contaminated food (particularly poultry), water, or contact with infected animals (particularly kittens and puppies).

Risk Groups

All age groups. Infants and young adults are particularly likely to be infected.

Surveillance

Although campylobacteriosis is not a nationally notifiable condition, confirmed and probable cases can be reported by states to the National Notifiable Diseases Surveillance System (NNDSS). Active laboratory- and population-based surveillance is conducted in FoodNet sites. Surveillance for resistance to antimicrobials is conducted through the National Antimicrobial Resistance Monitoring System (NARMS). PulseNet is a national network whose participants perform standardized molecular subtyping (or “fingerprinting”) of foodborne disease-causing bacteria by pulsed-field gel electrophoresis (PFGE). PFGE can be used to distinguish strains of organisms including Campylobacter at the DNA level. DNA “fingerprints,” or patterns, are submitted electronically to a dynamic database at the CDC. These databases are available on-demand to participants—this allows for rapid comparison of the patterns.

Trends

Most cases are isolated, sporadic events, not part of outbreaks. The incidence of infection in FoodNet sites has increased 14% since 2006-2008, reaching 14.3 per 100,000 persons in 2012. In 1995, fluoroquinolone antibiotics were approved for use in poultry flocks. In 2001 and 2005, FDA withdrew these approvals because the use of fluoroquinolones in poultry led to increases in fluoroquinolone resistance in human Campylobacter infections. Comparing 1997 and 2011, the percent of human Campylobacter isolates tested through NARMS that were resistant to ciprofloxacin, an important fluoroquinolone, increased from 12% to 24%.

Challenges

Decreasing the contamination of poultry meat. Reducing the development of resistant strains. Preventing consumption of raw milk. Detecting outbreaks. Determining the proportion of cases related to poultry. Determining the proportion of infections due to consumption of well water. Consumer education. Identifying sources and syndromes associated with campylobacters other than C. jejuni. Understanding the impact of culture-independent diagnostic tests on surveillance for human Campylobacter infection.

Opportunities

Improving detection of dispersed outbreaks through molecular subtyping. Determining risk factors for sporadic illness, for Guillain-Barré syndrome, and for resistant infections.

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