Campylobacter Enteritis

Organism Campylobacter jejuni.

Clinical features An acute diarrhoeal disease with abdominal pain, malaise, fever and vomiting. It is often self-limiting within 47 days, but in severe cases, pus and blood are found in the stools, with a presentation similar to bacillary dysentery. With its association with a food source, it is often thought to be a case of food poisoning until the organism is identified. Campylobacter enteritis is an important cause of traveller's diarrhoea.

Diagnosis The organism can be isolated from the stools using selective media. A preliminary diagnosis can be made by examining a specimen of stool with phase-contrast (dark-ground) microscopy, where an organism similar to a cholera vibrio will be seen. The presence of faecal material and absence of cholera-like symptoms will differentiate it from cholera.

Transmission Domestic animals including poultry, pigs, cattle, sheep, cats and dogs are reservoirs of the organism and their consumption or human's close association with them is responsible for much of the transmission. Most infections are due to faecal contamination by animals or birds, especially of unpasteurized milk and unchlorinated water. Water can be contaminated by bird droppings in which the organism is able to survive for several months at a temperature below 15°C. Many infections are transmitted by pets, especially puppies and person-to-person transmission can occur in a similar way.

Incubation period 1-10 days. The larger the dose of organisms ingested, the shorter the incubation period.

Period of communicability 2-7 weeks, but person-to-person transmission is uncommon.

Occurrence and distribution Children under 2 years of age are most commonly infected in developing countries, immunity developing to further infection in those over this age. There is a worldwide distribution with many of the cases in developing countries not being identified. There has been a progressive increase in Campylobacter for no explainable reason. It is one of the commonest causes of gastroenteritis (Section 8.1).

Control and prevention Proper cooking of foodstuffs and control of pets are the main preventive methods. Wherever possible, water should be chlorinated and milk pasteurized.

Treatment Oral rehydration.

Surveillance and investigation An outbreak of Campylobacter should be investigated in the same way as a food-poisoning outbreak and remedial measures taken around the source.

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