Campylobacter

Worldwide, Campylobacter species are the most common cause of bacterial gastroenteritis, with 400-500 million cases of diarrhea each year.¹ Infants in developing countries are at even greater risk, as are travelers to those countries.² Campylobacter–associated gastroenteritis is estimated to affect nearly one million people a year in the U.S.³ In approximately 1 of 1000 cases, Campylobacter jejuni is closely linked to the subsequent development of Guillian-Barre Syndrome, an acute auto-immune paralysis.⁴ C. jejuni infection has also been associated with reactive arthritis in both children and adults.^4,5 When individuals with severe symptoms of gastroenteritis seek medical help, the clinician is faced with multiple possible causes that can present with similar clinical features (e.g., diarrhea, nausea, vomiting, fever, abdominal pain) but that require very different, often conflicting, types of treatment.⁴

For Campylobacter, the current standard for identification is bacterial culture followed by microscopic examination of the organisms.⁶ Although this traditional method is straightforward, it has two major limitations. First, pathogenic species of Campylobacter are microaerophilic or strictly anaerobic, so that exposure of culture or feces to environmental oxygen leads to death or inactivation of the bacteria.^7,8 Thus, during transport or storage of specimens under aerobic conditions, the number of viable organisms can decrease, leading to potentially inaccurate culture results.⁹ Second, Campylobacter species are slow-growing, requiring from 48-72 hours before reaching a point where the culture can safely be reported as negative. Such delays can leave the clinician in a quandary and the patient with non-specific, ineffective, or even inappropriate treatment.

References

1. Ruiz-Palacios, G. M. 2007. The health burden of Campylobacter infection and the impact of antimicrobial resistance: playing chicken. Clin Infect Dis 44:701-703.
2. Kendall, M. E., S. Crim, K. Fullerton, P. V. Han, A. B. Cronquist, B. Shiferaw, L. A. Ingram, J. Rounds, E. D. Mintz, and B. E. Mahon. 2012. Travel-Associated Enteric Infections Diagnosed After Return to the United States, Foodborne Diseases Active Surveillance Network (FoodNet), 2004-2009. Clinical Infectious Diseases 54:S480-S487.
3. Friedman, C. R., R. M. Hoekstra, M. Samuel, R. Marcus, J. Bender, B. Shiferaw, S. Reddy, S. D. Ahuja, D. L. Helfrick, F. Hardnett, M. Carter, B. Anderson, R. V. Tauxe, and E. I. P. F. W. Group. 2004. Risk factors for sporadic Campylobacter infection in the United States: A case-control study in FoodNet sites. Clin Infect Dis 38:S285-96.
4. Guerrant, R. L., T. Van Gilder, T. S. Steiner, N. M. Thielman, L. Slutsker, R. V. Tauxe, T. Hennessy, P. M. Griffin, H. DuPont, R. Bradley Sack, P. Tarr, M. Neill, I. Nachamkin, L. B. Reller, M. T. Osterholm, M. L. Bennish, and L. K. Pickering. 2001. Practice Guidelines for the Management of Infectious Diarrhea. Clinical Infectious Diseases 32:331-351. Young, K. T., L. M. Davis, and V. J. Dirita. 2007. Campylobacter jejuni: molecular biology and pathogenesis. Nature Reviews Microbiology 5:665-679.
5. Hurd, S., M. Patrick, J. Hatch, P. Clogher, K. Wymore, A. B. Cronquist, S. Segler, T. Robinson, S. Hanna, G. Smith, and C. Fitzgerald. 2012. Clinical Laboratory Practices for the Isolation and Identification of Campylobacter in Foodborne Diseases Active Surveillance Network (FoodNet) Sites: Baseline Information for Understanding Changes in Surveillance Data. Clinical Infectious Diseases 54:S440-S445.
6. Bessede, E., A. Delcamp, E. Sifre, A. Buissonniere, and F. Megraud. 2011. New Methods for Detection of Campylobacters in Stool Samples in Comparison to Culture. Journal of Clinical Microbiology 49:941-944.
7. Lastovica, A. J., and E. le Roux. 2000. Efficient Isolation of Campylobacteria from Stools. Journal of Clinical Microbiology 38:2798-2799.
8. Couturier, B. A., M. R. Couturier, K. J. Kalp, and M. A. Fisher. 2013. Detection of non-jejuni and -coli Campylobacter Species from Stool Specimens with an Immunochromatographic Antigen Detection Assay. Journal of Clinical Microbiology 51:1935-1937.
9. Couturier, B. A., M. R. Couturier, K. J. Kalp, and M. A. Fisher. 2013. Detection of non-jejuni and -coli Campylobacter Species from Stool Specimens with an Immunochromatographic Antigen Detection Assay. Journal of Clinical Microbiology 51:1935-1937.