Campylobacter jejuniCampylobacter jejuni

““Bad Bug” PresentationBad Bug” Presentation

by Kim Mihalekby Kim Mihalek

What Is What Is Campylobacter Campylobacter jejunijejuni?? BacteriaBacteria Slender, Rod Slender, Rod

Shaped*Shaped* FlagellateFlagellate MotileMotile Gram negativeGram negative MicroaerophilicMicroaerophilic ThermophilicThermophilic

What is known about What is known about the Genomethe Genome of C. of C. jejuni?jejuni?

First published 2/10/2000 First published 2/10/2000 in Nature by Parkhill, et al.in Nature by Parkhill, et al.

Unusual pointsUnusual points– Almost complete lack of Almost complete lack of

repetitive DNA repetitive DNA sequences.sequences.

– No functional inserted No functional inserted sequences or phage-sequences or phage-related sequences.related sequences.

– Little organization of Little organization of genes into operons or genes into operons or clusters.clusters.

– Broad set of regulatory Broad set of regulatory systems to adapt to systems to adapt to varying environmental varying environmental conditionsconditions

What is What is Campylobacteriosis?Campylobacteriosis? Infectious disease caused by bacteria Infectious disease caused by bacteria

of genus Campylobacter.of genus Campylobacter. 99% C. jejuni, 1% other.99% C. jejuni, 1% other. Affects the small intestine.Affects the small intestine. Not recognized as cause of human Not recognized as cause of human

food borne illness prior to 1975.food borne illness prior to 1975. Most common bacterial cause of Most common bacterial cause of

diarrheal illness in the United States -diarrheal illness in the United States -More cases than Shigella and More cases than Shigella and Salmonella combined.Salmonella combined.

How Prevalent Is This How Prevalent Is This Disease In the United Disease In the United States?States? Most common cause of food borne illness Most common cause of food borne illness

in the United States.in the United States. 15 cases diagnosed/100,000 people 15 cases diagnosed/100,000 people

annually.annually. Approximately 100 people die each year..Approximately 100 people die each year.. Most cases go unreported or undiagnosedMost cases go unreported or undiagnosed

– Estimated 1-4 million cases in U.S. Estimated 1-4 million cases in U.S. yearly.yearly.

How Prevalent Is This How Prevalent Is This Disease Worldwide?Disease Worldwide? Leading cause of food borne illness Leading cause of food borne illness

worldwide.worldwide. Many countries do not have national Many countries do not have national

survey programs for Campylobacteriosis; survey programs for Campylobacteriosis; worldwide incidence numbers do not exist. worldwide incidence numbers do not exist.

Prevalent in developing countries.Prevalent in developing countries. Study by University of Lagos, Nigeria Study by University of Lagos, Nigeria

showed that in developing countries, 40-showed that in developing countries, 40-60% of children under 5 with diarrhea were 60% of children under 5 with diarrhea were positive for Campylobacter spp.positive for Campylobacter spp.

Worldwide, gastroenteritis is second only Worldwide, gastroenteritis is second only to respiratory infections in causing deaths.to respiratory infections in causing deaths.

Who is affected?Who is affected?

All warm-blooded animals can All warm-blooded animals can become affected. Some animals become affected. Some animals carry the disease without exhibiting carry the disease without exhibiting symptoms.symptoms.

Any person can become infected.Any person can become infected. Children under 5 and young adults Children under 5 and young adults

ages 15-29 are most often affected.ages 15-29 are most often affected. Most deaths occur among the Most deaths occur among the

elderly and the immune-suppressed.elderly and the immune-suppressed.

What Are the What Are the Symptoms?Symptoms? DiarrheaDiarrhea

– Usually watery and stickyUsually watery and sticky– Can contain blood and fecal leucocytesCan contain blood and fecal leucocytes

FeverFever Abdominal painAbdominal pain Nausea and vomitingNausea and vomiting HeadacheHeadache Muscle painMuscle pain

Are There Long-Term Are There Long-Term Effects?Effects? Guillain-Barre SyndromeGuillain-Barre Syndrome

– Immune system attacks own nervesImmune system attacks own nerves– 40% caused by C. jejuni infection40% caused by C. jejuni infection

Arthritis, Reiter’s SyndromeArthritis, Reiter’s Syndrome Hemolytic Uremic SyndromeHemolytic Uremic Syndrome SepticemiaSepticemia

– Leading to infection of nearly any organ, Leading to infection of nearly any organ, including appendix, abdominal cavity, including appendix, abdominal cavity, heart, nervous system, etc.heart, nervous system, etc.

How Does Campylobacter How Does Campylobacter affect individual cells in the affect individual cells in the intestines?intestines? Produces a toxin called Cytolethal Produces a toxin called Cytolethal

Distending Toxin (CDT).Distending Toxin (CDT). CDT activity requires activation of CDT activity requires activation of

three genes: cdtA, cdtB, and cdtC.three genes: cdtA, cdtB, and cdtC. CdtB is nuclease that damages DNA CdtB is nuclease that damages DNA

and causes cell cycle arrest.and causes cell cycle arrest. Causes cell death.Causes cell death.

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

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

What are the What are the Diagnostic Tests?Diagnostic Tests? Present in feces of infected Present in feces of infected

individualsindividuals Cultured sample of stool from ill Cultured sample of stool from ill

personperson Isolation requirements:Isolation requirements:

– Special antibiotic containing mediaSpecial antibiotic containing media– Microaerophilic atmosphereMicroaerophilic atmosphere

5% oxygen5% oxygen 2-10 % carbon dioxide2-10 % carbon dioxide

How is the Illness How is the Illness Treated?Treated?– Most cases– Most cases Most infections are usually self-Most infections are usually self-

limited.limited.– > 95% of infections clear up on their > 95% of infections clear up on their

own.own.– Affected persons should drink plenty Affected persons should drink plenty

of fluids to avoid dehydration.of fluids to avoid dehydration.– Antidiarrheal medications such as Antidiarrheal medications such as

loperamide may help symptoms.loperamide may help symptoms.

How is the Illness How is the Illness Treated?Treated?– Severe cases– Severe cases Antibiotics used in severe cases Antibiotics used in severe cases

of gastroenteritis.of gastroenteritis.– Macrolide antibiotics including Macrolide antibiotics including

Erythromycin are effective and may Erythromycin are effective and may shorten course of illness.shorten course of illness.

– Resistance developing to Resistance developing to Fluoroquinolone antibiotics due to Fluoroquinolone antibiotics due to use in poultry feed.use in poultry feed.

How do people get How do people get infected?infected?

Single, sporadic casesSingle, sporadic cases– Eating raw or undercooked poultry Eating raw or undercooked poultry

meatmeat Fact: Even one single drop of juice from Fact: Even one single drop of juice from

raw chicken meat can infect a person.raw chicken meat can infect a person.

– Handling raw poultryHandling raw poultry– Contact with infected fecal matterContact with infected fecal matter

How do people get How do people get infected?infected? OutbreaksOutbreaks

– Unpasteurized or under-pasteurized milkUnpasteurized or under-pasteurized milk Children on class trip drinking unpasteurized Children on class trip drinking unpasteurized

milkmilk Dairy under-processed surplus raw milk for Dairy under-processed surplus raw milk for

schools.schools. Cow-leasing program in Wisconsin.Cow-leasing program in Wisconsin.

– Contaminated water sourceContaminated water source Bennington, VT using non-chlorinated water.Bennington, VT using non-chlorinated water.

How does food or How does food or water become water become contaminated?contaminated? PoultryPoultry

– 63-88% of all chickens carry latent infection.63-88% of all chickens carry latent infection.– Spread through flock through drinking water and Spread through flock through drinking water and

feces.feces.– Spread to meat from intestines during slaughter.Spread to meat from intestines during slaughter.– Present in giblets, especially liver.Present in giblets, especially liver.

MilkMilk– Infected udder.Infected udder.– Contact with manure.Contact with manure.

Surface waterSurface water– Infected manure from cows or wild birds.Infected manure from cows or wild birds.– Enters streams through runoff.Enters streams through runoff.

What can be done to What can be done to prevent Campylobacter prevent Campylobacter infections?infections? Food IndustryFood Industry

– Provide chickens with chlorinated Provide chickens with chlorinated water.water.

– Avoid fecal contamination of udders Avoid fecal contamination of udders or milk.or milk.

– Strictly adhere to pasteurization Strictly adhere to pasteurization time and temperature requirements.time and temperature requirements.

– Avoid fecal and/or intestinal Avoid fecal and/or intestinal contamination in meat processing.contamination in meat processing.

What can be done to What can be done to prevent Campylobacter prevent Campylobacter infections?infections? IndividualsIndividuals

– Avoid drinking unpasteurized Avoid drinking unpasteurized milk or untreated surface water.milk or untreated surface water.

– WASH HANDS!!!WASH HANDS!!!after having contact with pet after having contact with pet

feces.feces.after using the restroom or after using the restroom or

changing a diaper.changing a diaper.

What can be done to What can be done to prevent Campylobacter prevent Campylobacter infections?infections? IndividualsIndividuals

– Use safe food handling practicesUse safe food handling practices Cook all poultry products thoroughlyCook all poultry products thoroughly Wash hands before handling foods.Wash hands before handling foods. Wash hands after handling raw foods Wash hands after handling raw foods

of animal origin.of animal origin. Prevent cross-contamination in the Prevent cross-contamination in the

kitchen.kitchen.

What are the latest What are the latest morbidity and mortality morbidity and mortality reports?reports? CDC Morbidity and Mortality WeeklyCDC Morbidity and Mortality Weekly

– Published April 30, 2004Published April 30, 2004 ““Preliminary FoodNet Data on the Incidence of Preliminary FoodNet Data on the Incidence of

Infection with Pathogens Transmitted Infection with Pathogens Transmitted Commonly Through Food --- Selected Sites, Commonly Through Food --- Selected Sites, United States, 2003 “United States, 2003 “

– Published June 28, 2002Published June 28, 2002 ““Outbreak of Campylobacter jejuni infections Outbreak of Campylobacter jejuni infections

associated with drinking unpasteurized milk associated with drinking unpasteurized milk procured through a cow-leasing program.”procured through a cow-leasing program.” Wisconsin, Nov 10 - Dec 18, 2001.Wisconsin, Nov 10 - Dec 18, 2001.

What is the latest What is the latest research?research? CDC Emerging Infectious DiseasesCDC Emerging Infectious Diseases

– Published March 2002Published March 2002– ““Human Campylobacteriosis in Developing Human Campylobacteriosis in Developing

Countries.”Countries.” Akitoye O. Coker, et al. University Akitoye O. Coker, et al. University of Lagos.of Lagos.

Infection and ImmunityInfection and Immunity– Published July 2001Published July 2001

““CdtA, cdtb, and cdtC form a tripartite complex CdtA, cdtb, and cdtC form a tripartite complex that is required for Cytolethal Distending Toxin that is required for Cytolethal Distending Toxin activity.”activity.” Maria Lara-Tejero and Jorge Galan. Maria Lara-Tejero and Jorge Galan. Yale School of Medicine.Yale School of Medicine.

What were my What were my sources?sources? Bad Bug Book: U.S. Food & Drug Administration Center for Food Safety & Applied Bad Bug Book: U.S. Food & Drug Administration Center for Food Safety & Applied

Nutrition Food borne Pathogenic Microorganisms and Natural Toxins Handbook; Nutrition Food borne Pathogenic Microorganisms and Natural Toxins Handbook; vm.cfsan.fda.gov/~mow/chap4.htmlvm.cfsan.fda.gov/~mow/chap4.html..

CDC Division of Bacterial and Mycotic Diseases, Disease Information; Campylobacter CDC Division of Bacterial and Mycotic Diseases, Disease Information; Campylobacter infections; infections; www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htmwww.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_g.htm..

Campylobacter Facts and Information; Campylobacter Facts and Information; www.foodborneillness.com/ecoli1/campylobacter-overview.htmwww.foodborneillness.com/ecoli1/campylobacter-overview.htm..

Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food --- Selected Sites, United States, 2003; Commonly Through Food --- Selected Sites, United States, 2003; www.cdc.gov/mmwr/preview/mmwrhtml/mm5316a2.htmwww.cdc.gov/mmwr/preview/mmwrhtml/mm5316a2.htm..

Outbreak of Outbreak of Campylobacter jejuniCampylobacter jejuni Infections Associated with Drinking Unpasteurized Infections Associated with Drinking Unpasteurized Milk Procured through a Cow-Leasing Program, Wisconsin, 2001; Milk Procured through a Cow-Leasing Program, Wisconsin, 2001; www.cdc.gov/mmwr/preview/mmwrhtml/mm5125a2.htmwww.cdc.gov/mmwr/preview/mmwrhtml/mm5125a2.htm..

NatureNature 403, 665 - 668 (10 February 2000); The genome sequence of the food-borne 403, 665 - 668 (10 February 2000); The genome sequence of the food-borne pathogen pathogen Campylobacter jejuni Campylobacter jejuni reveals hypervariable sequences; J. PARKHILL, et al.; reveals hypervariable sequences; J. PARKHILL, et al.; www.nature.com/cgitaf/DynaPage.taf?file=/nature/journal/v403/n6770/full/403665a0www.nature.com/cgitaf/DynaPage.taf?file=/nature/journal/v403/n6770/full/403665a0_fs.html_fs.html; ;