Sources and transmission of infection. The single most important route of Campylobacter infections in the United States and other industrialized nations remains the consumption and handling of chicken. Perhaps this should not be surprising in light of the frequency with which poultry products are consumed and the nearly universal contamination of chicken carcasses with Campylobacter [ 23 ]. Indeed, it has been estimated that just 1 drop of chicken juice may contain infectious organisms [ 24 ].
Even with strict attention to good handwashing and cleaning of cutting boards, it is easy to see how simple errors in the handling of food might result in cross-contamination in the kitchen and, therefore, human illness. Because heat kills viable Campylobacter species, thorough cooking of chicken should be emphasized as an important food-safety measure. Other foods and activities also have been implicated as sources of Campylobacter infection.
Although outbreaks of infection account for a small fraction of Campylobacter infections in humans most infections are sporadic , consumption of unpasteurized milk is the most frequently reported cause of outbreaks of infection [ 3 ]. Other sources of sporadic infection include sausages or red meat especially in Scandinavian countries , contaminated water, contact with pets especially birds and cats , and international travel [ 25—27 ].
Outbreaks of Campylobacter infection in day care centers or mental institutions are almost unheard of. Although the reported incidence of Campylobacter infection among homosexual men is almost 40 times greater than in the general population [ 29 ], recent analysis shows the rate is not higher than among heterosexual men of a similar age [ 3 ].
Campylobacter in developing countries. The epidemiology of Campylobacter infections is quite different in developing countries than in the industrialized world. Asymptomatic infections occur commonly in both children and adults, whereas, in developed countries, asymptomatic Campylobacter infections are unusual.
In addition, in developing countries, outbreaks of infection are uncommon and the illness lacks the marked seasonal nature observed in industrialized nations. Nevertheless, in both developed and developing countries, Campylobacter remains one of the most common bacterial causes of diarrhea. Maintenance of hydration and electrolyte balance, not antibiotic treatment, is the cornerstone of treatment for Campylobacter enteritis.
Indeed, most patients with Campylobacter infection have a self-limited illness and do not require antibiotics at all. Nevertheless, there are specific clinical circumstances in which antibiotics should be used. The decision to use antibiotics should be made judiciously. In the United States, the most common cause of bloody diarrhea is not Campylobacter but E.
Recent studies suggest that administration of antibiotics to children with E. Therefore, young children with bloody diarrhea and others who might be at risk of infection with E. Until a few years ago, if antimicrobial therapy was indicated for Campylobacter infection, fluoroquinolones were considered the drugs of choice. This approach was the simplest for physicians and patients alike because the symptoms of Campylobacter enteritis fever, abdominal cramps, and diarrhea are clinically indistinguishable from those of bacterial gastroenteritis caused by other organisms, such as Salmonella or Shigella species.
Because these other pathogens were also generally susceptible to fluoroquinolones, empirical treatment with these drugs could be used without waiting for the results of stool cultures. Fluoroquinolones were especially apt to be used for the treatment of traveler's diarrhea.
However, in the past few years, a rapidly increasing proportion of Campylobacter strains all over the world have been found to be fluoroquinolone-resistant table 2. Primary resistance to quinolone therapy in humans was first noted in the early s in Asia and in European countries such as Sweden, The Netherlands, Finland, and Spain. Not surprisingly, this coincided with initiation of the administration of the fluoroquinolone, enrofloxacin, to food animals in those countries [ 31 ].
A similar increase in rates of resistance to fluoroquinolones in Campylobacter isolates from humans was observed in the United Kingdom after the approval of the use of fluoroquinolones in veterinary animals there as well [ 32 ].
Percentage of Campylobacter isolates from humans with primary resistance to fluoroquinolones. In the United States, the licensure of sarafloxacin in and enrofloxacin in for use in poultry flocks contributed to an increase in the number of domestically acquired fluoroquinolone-resistant Campylobacter infections in Minnesota [ 33 ].
In that state, fluoroquinolone resistance among Campylobacter isolates from humans increased from 1. The impact of the use of fluoroquinolones in food animals upon human health was the subject of a recent World Health Organization meeting [ 34 ].
In addition to more prudent use of these agents in people, international controls on the use of antibiotics in food animals may become necessary to curtail the development of additional resistance among foodborne bacterial pathogens. Erythromycin has once again come to be considered the optimal drug for treatment of Campylobacter infections.
Despite decades of use, the rate of resistance of Campylobacter to erythromycin remains quite low. Other advantages of erythromycin include its low cost, safety, ease of administration, and narrow spectrum of activity. Unlike the fluoroquinolones and tetracyclines, erythromycin may be administered safely to children and pregnant women and is less likely than many agents to exert an inhibitory effect on other fecal flora. Erythromycin stearate is acid-resistant, stable, and incompletely absorbed.
Therefore, in addition to its systemic effects, it may be capable of exerting a contact effect throughout the bowel [ 35 ]. The recommended dosage for adults is mg administered orally 2 times per day for 5 days.
For children, the recommended dosage is 40 mg per kg per day in 2 divided doses for 5 days. The newer macrolides, azithromycin and clarithromycin, are also effective against C. Campylobacter species also are generally susceptible to aminoglycosides, chloramphenicol, clindamycin, nitrofurans, and imipenem. High rates of resistance make tetracycline, amoxicillin, ampicillin, metronidazole, and cephalosporins poor choices for the treatment of infections with C.
All Campylobacter species are inherently resistant to vancomycin, rifampin, and trimethoprim. Because most Campylobacter infections are acquired by consuming or handling poultry, the ideal way to control the number of human infections would be to limit contamination of poultry flocks.
However, the near-universal contamination of poultry with Campylobacter and the heavy bacterial burden in these flocks [ 24 ] make elimination of Campylobacter in chickens impractical, if not impossible. Current mass processing and distribution of chicken may amplify the bacterial load; perhaps future investigations will lead to the creation of a system that will produce chickens that are only lightly colonized with Campylobacter. New strategies will likely include limiting animals' consumption of antibiotics, disinfection of their food and water, treatment of their manure, and isolation of the contagiously ill.
Perhaps the irradiation of foods of animal origin will one day become sufficiently acceptable to the public to make this a feasible method of control of the bacterial contamination of foods. Observing careful food-preparation habits in the kitchen is also important in the prevention of infections.
Chicken should be adequately cooked—not charred on the outside and left pink near the bone. Use of a meat thermometer may help to ensure that temperatures adequate to kill Campylobacter species organisms are achieved. Cutting boards and utensils used in handling uncooked poultry or other meats should be washed with hot soapy water before being used for preparation of salads or other foods that are eaten raw. Although person-to-person transmission of C. Of course, as part of good general hygiene, all persons should wash their hands after using the bathroom, especially if they have diarrhea.
Similarly, all people, but especially those who handle pets or other animals, should wash their hands before eating. Prevention of many outbreaks of C. Persons who travel to developing countries and campers should be cautioned against drinking untreated water. Routine use of antibiotic prophylaxis to prevent Campylobacter infections is not recommended.
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Sign In. Advanced Search. Search Menu. Article Navigation. While there are dozens of species, three represent the main sources of human infection: Campylobacter jejuni , Campylobacter coli , and Campylobacter lari. These characteristics represent adaptations to growth in its normal habitat—the intestines of warm-blooded birds and mammals. Several closely-related bacterial species with similar characteristics, C.
The optimal conditions required for the growth of Campylobacter make it difficult to isolate in the laboratory from fecal specimens without special techniques, including the use of selective culture media. Oct 19, Apr 16, Apr 03, Feb 06, Campylobacter Campylobacteriosis. Section Navigation. Facebook Twitter LinkedIn Syndicate. Minus Related Pages. Get answers to frequently asked questions about Campylobacter.
Campylobacter causes an estimated 1. Antibiotic Resistance.
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