Campylobacter jejuni

1. Campylobacter jejuni “Bad Bug” Presentation by Kim Mihalek

2. What Is Campylobacter jejuni? • Bacteria • Slender, Rod Shaped* • Flagellate • Motile • Gram negative • Microaerophilic • Thermophilic

3. What is known about the Genomeof C. jejuni? • First published 2/10/2000 in Nature by Parkhill, et al. • Unusual points • Almost complete lack of repetitive DNA sequences. • No functional inserted sequences or phage-related sequences. • Little organization of genes into operons or clusters. • Broad set of regulatory systems to adapt to varying environmental conditions

4. What is Campylobacteriosis? • Infectious disease caused by bacteria of genus Campylobacter. • 99% C. jejuni, 1% other. • Affects the small intestine. • Not recognized as cause of human food borne illness prior to 1975. • Most common bacterial cause of diarrheal illness in the United States -More cases than Shigella and Salmonella combined.

5. How Prevalent Is This Disease In the United States? • Most common cause of food borne illness in the United States. • 15 cases diagnosed/100,000 people annually. • Approximately 100 people die each year.. • Most cases go unreported or undiagnosed • Estimated 1-4 million cases in U.S. yearly.

6. How Prevalent Is This Disease Worldwide? • Leading cause of food borne illness worldwide. • Many countries do not have national survey programs for Campylobacteriosis; worldwide incidence numbers do not exist. • Prevalent in developing countries. • Study by University of Lagos, Nigeria showed that in developing countries, 40-60% of children under 5 with diarrhea were positive for Campylobacter spp. • Worldwide, gastroenteritis is second only to respiratory infections in causing deaths.

7. Who is affected? • All warm-blooded animals can become affected. Some animals carry the disease without exhibiting symptoms. • Any person can become infected. • Children under 5 and young adults ages 15-29 are most often affected. • Most deaths occur among the elderly and the immune-suppressed.

8. What Are the Symptoms? • Diarrhea • Usually watery and sticky • Can contain blood and fecal leucocytes • Fever • Abdominal pain • Nausea and vomiting • Headache • Muscle pain

9. Are There Long-Term Effects? • Guillain-Barre Syndrome • Immune system attacks own nerves • 40% caused by C. jejuni infection • Arthritis, Reiter’s Syndrome • Hemolytic Uremic Syndrome • Septicemia • Leading to infection of nearly any organ, including appendix, abdominal cavity, heart, nervous system, etc.

10. How Does Campylobacter affect individual cells in the intestines? • Produces a toxin called Cytolethal Distending Toxin (CDT). • CDT activity requires activation of three genes: cdtA, cdtB, and cdtC. • CdtB is nuclease that damages DNA and causes cell cycle arrest. • Causes cell death.

11. How Does Campylobacter Affect Individual Cells In the Intestines?

12. What Is the Incubation Period and How Long Does the Illness Last? • Onset of symptoms 2-10 days after ingestion. • Duration of illness 2-21 days, typically 5-7 days. • Relapses occur in 25% of cases.

13. What are the Diagnostic Tests? • Present in feces of infected individuals • Cultured sample of stool from ill person • Isolation requirements: • Special antibiotic containing media • Microaerophilic atmosphere • 5% oxygen • 2-10 % carbon dioxide

14. How is the Illness Treated?– Most cases • Most infections are usually self-limited. • > 95% of infections clear up on their own. • Affected persons should drink plenty of fluids to avoid dehydration. • Antidiarrheal medications such as loperamide may help symptoms.

15. How is the Illness Treated?– Severe cases • Antibiotics used in severe cases of gastroenteritis. • Macrolide antibiotics including Erythromycin are effective and may shorten course of illness. • Resistance developing to Fluoroquinolone antibiotics due to use in poultry feed.

16. How do people get infected? • Single, sporadic cases • Eating raw or undercooked poultry meat • Fact: Even one single drop of juice from raw chicken meat can infect a person. • Handling raw poultry • Contact with infected fecal matter

17. How do people get infected? • Outbreaks • Unpasteurized or under-pasteurized milk • Children on class trip drinking unpasteurized milk • Dairy under-processed surplus raw milk for schools. • Cow-leasing program in Wisconsin. • Contaminated water source • Bennington, VT using non-chlorinated water.

18. How does food or water become contaminated? • Poultry • 63-88% of all chickens carry latent infection. • Spread through flock through drinking water and feces. • Spread to meat from intestines during slaughter. • Present in giblets, especially liver. • Milk • Infected udder. • Contact with manure. • Surface water • Infected manure from cows or wild birds. • Enters streams through runoff.

19. What can be done to prevent Campylobacter infections? • Food Industry • Provide chickens with chlorinated water. • Avoid fecal contamination of udders or milk. • Strictly adhere to pasteurization time and temperature requirements. • Avoid fecal and/or intestinal contamination in meat processing.

20. What can be done to prevent Campylobacter infections? • Individuals • Avoid drinking unpasteurized milk or untreated surface water. • WASH HANDS!!! • after having contact with pet feces. • after using the restroom or changing a diaper.

21. What can be done to prevent Campylobacter infections? • Individuals • Use safe food handling practices • Cook all poultry products thoroughly • Wash hands before handling foods. • Wash hands after handling raw foods of animal origin. • Prevent cross-contamination in the kitchen.

22. What are the latest morbidity and mortality reports? • CDC Morbidity and Mortality Weekly • Published April 30, 2004 • “Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food --- Selected Sites, United States, 2003 “ • Published June 28, 2002 • “Outbreak of Campylobacter jejuni infections associated with drinking unpasteurized milk procured through a cow-leasing program.” Wisconsin, Nov 10 - Dec 18, 2001.

23. What is the latest research? • CDC Emerging Infectious Diseases • Published March 2002 • “Human Campylobacteriosis in Developing Countries.” Akitoye O. Coker, et al. University of Lagos. • Infection and Immunity • Published July 2001 • “CdtA, cdtb, and cdtC form a tripartite complex that is required for Cytolethal Distending Toxin activity.” Maria Lara-Tejero and Jorge Galan. Yale School of Medicine.

24. What were my sources? • Bad Bug Book: U.S. Food & Drug Administration Center for Food Safety & Applied Nutrition Food borne Pathogenic Microorganisms and Natural Toxins Handbook; vm.cfsan.fda.gov/~mow/chap4.html. • CDC Division of Bacterial and Mycotic Diseases, Disease Information; Campylobacter infections; www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htm. • Campylobacter Facts and Information; www.foodborneillness.com/ecoli1/campylobacter-overview.htm. • Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food --- Selected Sites, United States, 2003; www.cdc.gov/mmwr/preview/mmwrhtml/mm5316a2.htm. • Outbreak of Campylobacter jejuni Infections Associated with Drinking Unpasteurized Milk Procured through a Cow-Leasing Program, Wisconsin, 2001; www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a2.htm. • Nature 403, 665 - 668 (10 February 2000); The genome sequence of the food-borne pathogen Campylobacter jejuni reveals hypervariable sequences; J. PARKHILL, et al.; www.nature.com/cgitaf/DynaPage.taf?file=/nature/journal/v403/n6770/full/403665a0_fs.html;