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C. jejuni Identification, Transmission, Pathogenesis & Treatment (39
- 2. Objectives •To identify the classification, structure, epidemiology and risk factors of C. jejuni. •To know the transmission, pathogenesis and clinical manifestations if C. jejuni. •To determine the diagnosis, prevention and treatment of diseases caused C. jejuni
- 3. Introduction
- 4. Introduction
- 5. Epidemiology •Infections are zoonotic and are extremely common in low to middle income countries. •Incidence in high income countries: 4.4-9.3 per 1000 population •Rarely causes mortality
- 6. Risk Factors •travelling •undercooked poultry or meat •unpasteurized dairy products •contact with infected domestic animals •acid reflux medications (proton pump inhibitors)
- 7. Transmission •Transmitted via: consumption of contaminated food or water Direct contact with infected animals or person Fecal-oral route
- 8. Pathophysiology • Infective dose is < 10,000 organisms. • The organism penetrates the gastrointestinal mucus with its high motility and spiral shape. • It adheres to the enterocytes and releases enterotoxins cytotoxins causing cellular apoptosis. • These toxins induce diarrhea. • Ig A is the primary immunoglobulin
- 9. Virulence Factors •Adhesion and invasion of epithelial cells •Motility •Serum resistance •Resistance to bile salts
- 10. Clinical manifestations • Clinical manifestations lasts 5 to 7 days in healthy individuals. • Includes: Enteritis Diarrhea Fever Severe abdominal pain
- 11. Clinical manifestations • Clinical manifestations lasts 5 to 7 days in healthy individuals. • Includes: Enteritis Diarrhea Fever Severe abdominal pain
- 14. Diagnosis • Gram staining and microscopy •Oxidase Test •Immunoassay Test •Culture Arrow shows C. jejuni
- 15. Diagnosis • Microscopic: •A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. •characteristic thin, “S-shaped” organisms will be seen. •Results wouldn’t be available until 2 weeks Arrow shows C. jejuni Charcoal Agar
- 16. Diagnosis • Gram staining and microscopy •Oxidase Test •Immunoassay Test •Culture Arrow shows C. jejuni
- 17. Diagnosis • All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. • Immunoassay (ELISA) • It has a sensitivity of 80% to 90% and a specificity of greater than 95%. • Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin • PCR is another test that can be done.
- 18. Diagnosis • Gram staining and microscopy •Oxidase Test •Immunoassay Test •Culture Oxidase positive
- 19. Diagnosis • Gram staining and microscopy •Oxidase Test •Immunoassay Test •Culture Arrow shows C. jejuni Hippurate positive
- 20. Diagnosis • Culture: • The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. • The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. • The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. • It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. • Produces two types of colonies: • One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. • The other colony type is flat, mucoid, translucent, grayish and has an irregular edge • DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- 21. Diagnosis • Gram staining and microscopy •Oxidase Test •Immunoassay Test •Culture Arrow shows C. jejuni Charcoal Agar
- 22. Diagnosis • Gram staining and microscopy •Oxidase Test •Immunoassay Test •Culture Arrow shows C. jejuni Charcoal Agar Blood Agar
- 23. Treatment and Prevention • Replacement of fluids and electrolytes • Antibiotic therapy: azithromycin or erythromycin- treats enteritis • Good hygienic slaughtering practices, Good food hygiene, bactericidal treatment of food, washing hands with soap and water can be considered to prevent infection
- 24. Summary Characteristics • Spiral shaped • Gram-negative • Motile by means of a polar flagellum at one or both ends. • Microaerophiles. Laboratory identification • enriched media and moist microaerophilic environment for growth. • Incubation at 42°C for 24–72 h. • Colonies resemble water drops. • Full identification by biochemical tests and characteristic antibiotic susceptibility pattern. Diseases Diarrhoea. Can invade to give septicaemia. Guillain–Barré syndrome infrequently associated with Campylobacter disease
- 25. Summary Transmission • Animal reservoir. • Organisms acquired from contaminated food and milk (but do not multiply in these vehicles). • Person-to-person spread is rare.. Pathogenesis • Little known, but cytotoxin implicated. • Also invasion and local destruction of gut mucosa. Treatment and prevention • No specific treatment necessary for diarrhoea. • First-line agent : erythromycin or azithromycin. • Prevention depends upon good food hygiene. • No vaccine.
- 28. Reference •Lehman D, Cha H, Shi L. Campylobacter jejuni - microbewiki [Internet]. Microbewiki.kenyon.edu. 2015 [cited 20 May 2020]. Available from: https://microbewiki.kenyon.edu/index.php/Campylobacte r_jejuni •Wallis M. The Pathogenesis of Campylobacter Jejuni [Internet]. PubMed. 1994 [cited 20 May 2020]. Available from: https://pubmed.ncbi.nlm.nih.gov/7841837/
- 29. Reference •Javid M. Campylobacter Infections: Background, Pathophysiology, Epidemiology [Internet]. Emedicine.medscape.com. 2019 [cited 21 May 2020]. Available from: https://emedicine.medscape.com/article/213720-overview •Liu L. Campylobacter jejuni - Microbiology - Medbullets Step 1 [Internet]. Step1.medbullets.com. 2018 [cited 21 May 2020]. Available from: https://step1.medbullets.com/microbiology/104061/campy lobacter-jejuni?expandLeftMenu=true
- 30. Reference •Campylobacter [Internet]. Who.int. 2020 [cited 21 May 2020]. Available from: https://www.who.int/news- room/fact-sheets/detail/campylobacter •Altekruse S, Stern N, Fields P, Swerdlow D. Campylobacter jejuni—An Emerging Foodborne Pathogen [Internet]. Center for Disease Control and Prevention. 1999 [cited 21 May 2020]. Available from: https://wwwnc.cdc.gov/eid/article/5/1/99-0104_article
- 31. Reference • Mims C, Goering R, Dockrell H, Zuckerman M, Chiodini P. Mims' medical microbiology. 6th ed. New York: Elsevier; 2019. • Murray P, Rosenthal K, Pfaller M. Medical microbiology. 7th ed. Philadelphia: Elsevier; 2013. • Stef L, Cean A, Vasile A, Julean C, Drinceanu D, Corcionivoschi N. Virulence characteristics of five new Campylobacter jejuni chicken isolates [Internet]. Gut pathogens. PubMed Central; 2013 [cited 2020May22]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3866932/#B8
Editor's Notes
- Campylobacter derives from the Greek kampylos (curved) and baktron (rod). The most common organism involved in gastroenteritis infection for this genus is C. jejuni (named jejuni as it is found primarily in the jejunum of the infected organism) It is A spiral-shaped, oxidase-positive, microaerophilic, gram-negative, non spore forming rod with polar flagella which gives it a darting motility(microaerophilic means it requires environments containing lower levels of oxygen than that which is present in the atmosphere, and as a result it is very sensitive to stress in the environment.) about 0.2 to 0.5 µm in diameter It belongs to the Epsilon class of Proteobacteria (the phylum; all proteobacteria is gram negative. This particular class inhabits the Digestive track of higher order animals and can serve as a symbiote or a pathogen) in humans, C. jejuni often invades intestinal epithelial cells and causes acute bacterial gastroenteritis It grows at 42°C It is most commonly found in animal feces
- Campylobacter derives from the Greek kampylos (curved) and baktron (rod). The most common organism involved in gastroenteritis infection for this genus is C. jejuni (named jejuni as it is found primarily in the jejunum of the infected organism) It is A spiral-shaped, oxidase-positive, microaerophilic, gram-negative, non spore forming rod with polar flagella which gives it a darting motility(microaerophilic means it requires environments containing lower levels of oxygen than that which is present in the atmosphere, and as a result it is very sensitive to stress in the environment.) about 0.2 to 0.5 µm in diameter It belongs to the Epsilon class of Proteobacteria (the phylum; all proteobacteria is gram negative. This particular class inhabits the Digestive track of higher order animals and can serve as a symbiote or a pathogen) in humans, C. jejuni often invades intestinal epithelial cells and causes acute bacterial gastroenteritis It grows at 42°C It is most commonly found in animal feces
- infections are zoonotic. Animal resovoirs include Poultry, cattle, sheep Exact figures of infection rate are not available, however it is believed to be extremely common in low to middle income countries. In high income countries the incidence ranges from 4.4-9.3 per 1000 population It is self limiting (basically it limits its own growth since it may release waste which is ultimately toxic to the colony once it exceeds a certain population.) As a result it rarely causes mortality. However in in elderly or immunocompromised (such as cancer, AIDS and hypogammaglobinemia patients) persons it can be deadly.
- Travelling to regions where this bacteria is prevelant eg places where there is little to no distilled water or no proper food handling guideline Pasteurisation eliminates the bacteria as it heats the milk pass 42°C Acid reflux medication: as HCl found in the stomach is known to kill the bacteria and these drugs decrease production
- Consumption of contaminated food, such as undercooked meat and meat products, as well as raw or contaminated milk, water or ice is said to be the main route of transmission (chicken consumption accounting for 50-70%). Carcasses or meat are contaminated by Campylobacter from faeces during slaughtering. Fecal-oral transmission from person-toperson contact may also occur, but it is uncommon for the disease to be transmitted by food handlers
- Infective dose is as low as 800 some sources say five but it is <10000 the primary site of Campylobacter infection seems to be the ileum and jejunum and to a lesser extent it can occur in the colon. The organisms are killed when exposed to gastric acids, so conditions that decrease or neutralize gastric acid secretion favor disease. It is resistant to bile salts Initiation of infection happens when the organism must penetrate the gastrointestinal mucus, which it does by using its high motility and spiral shape (like a drill). The bacteria must then adhere to the gut enterocytes and once adhered can then induce diarrhoea by toxin release. the flagellum has been shown to secrete Campylobacter invasive antigens (Cia) and cytolethal distending toxins (CdtA,B,C) responsible in host cell apoptosis. In addition strains lacking enterotoxin activity are still fully virulent Factors that regulate adhesion, motility, and invasion into intestinal mucosa as well as cytopathic toxins, enterotoxins, and endotoxic activity are poorly defined. Some strains of C jejuni produce a heat-labile, cholera like enterotoxin, which is important in the watery diarrhea observed in infections. The major antigen of the genus is the lipopolysaccharide of the outer membrane. During infection, levels of all immunoglobulin classes rise. Of these, IgA is the most important as it can cross the gut wall. IgA immobilises organisms, causing them to aggregate and activate complement, and also gives short-term immunity against the infecting strain of organism. Since the other Igs (M and G) cannot cross the gut wall they act in the blood stream, preventing bacteremia. C. jejuni can also stimulate T cell immune response, but this seems to play only a small role in preventing infection.
- Adhesion and invasion of epithelial cells+ Motility- allows the organism to burrow into intestinal wall and release toxins Serum resistance-allows it to enter blood and cause bacteremia Resistance to bile salts- prevents the lipids found in the outer membrane as well as in the cell from being digested
- Campylobacteriosis refers to the disease which Campylobacter species (this includes C. jejuni) cause. onset of disease symptoms usually occurs 2 to 5 days after infection and usually lasts 5 to 7 days, and most of these cases will disappear without treatment. The disease is generally self-limited However, 25% of these patients are likely to have a relapse. recurrence occurs in children and adults with immunoglobulin deficiencies. Acute C jejuni infection confers short-term immunity. Infection with the organism produces diffuse, bloody, edematous, and exudative enteritis (important virulence factors include: adhesion and invasion of epithelial cells, motility, serum resistance and resistance to bile salts) diarrhea- 10 or more bowel movements per day during the peak of disease, and stools may be bloody on gross examination. severe abdominal pain mimicking acute appendicitis Colitis Bacteremia (rare cases) Crypt abscesses may develop in the epithelial glands, and ulceration of the mucosal epithelium occurs, the inflammatory infiltrate consists of neutrophils, mononuclear cells, and eosinophils. Also on a Physical exam there will be noted weight loss and signs of dehydration
- Campylobacteriosis refers to the disease which Campylobacter species (this includes C. jejuni) cause. onset of disease symptoms usually occurs 2 to 5 days after infection and usually lasts 5 to 7 days, and most of these cases will disappear without treatment. The disease is generally self-limited However, 25% of these patients are likely to have a relapse. recurrence occurs in children and adults with immunoglobulin deficiencies. Acute C jejuni infection confers short-term immunity. Infection with the organism produces diffuse, bloody, edematous, and exudative enteritis (important virulence factors include: adhesion and invasion of epithelial cells, motility, serum resistance and resistance to bile salts) diarrhea- 10 or more bowel movements per day during the peak of disease, and stools may be bloody on gross examination. severe abdominal pain mimicking acute appendicitis Colitis Bacteremia (rare cases) Crypt abscesses may develop in the epithelial glands, and ulceration of the mucosal epithelium occurs, the inflammatory infiltrate consists of neutrophils, mononuclear cells, and eosinophils. Also on a Physical exam there will be noted weight loss and signs of dehydration
- GBS is an autoimmune disorder of the peripheral nervous system characterized by development of symmetric weakness over several days and recovery requiring months or longer Associated with C. jejuni serotype O:19 This may be due to antigenic cross-reactivity between the surface lipopolysaccharides of some strains of Campylobacter and peripheral nerve gangliosides
- Reactive arthritis (formerly known as reiter syndrome) classic triad of conjunctivitis, urethritis, and arthritis characterisied by joint pain and swelling involving the hands, ankles, and knees and persisting from 1 week to several months.
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- Microscopic: A Gram stain of stool samples for characteristic curved rods is specific, with a sensitivity of 50-75%. characteristic thin, “S-shaped” organisms will be seen. Results wouldn’t be available until 2 weeks All Campylobacter organisms are oxidase positive (ie it produces cytochrome C oxidase) but C jejuni is the only one that hydrolyses hippurate. Immunoassay (ELISA) It has a sensitivity of 80% to 90% and a specificity of greater than 95%. Susceptibility to nalidixic acid and cephalotin is an important differential trait among species since C.jejuni is susceptible to nalidixic acid but resistant to cephalotin PCR is another test that can be done. Culture: The stool sample can be filtered in a ~ pore diameter of 25 nm to 0.45 µm to separate the Campylobacteria bacteria from flora found in the guts. The sample must be then placed in a microaerophilic atmosphere which is about 85% N2, 10% CO2, and 5% O2 and at a temperature of 42° C. The selective media must contain blood or charcoal to remove toxic oxygen radicals, and antibiotics are added to inhibit the growth of contaminating organisms. It is slow-growing and usually requiring incubation for 48 to 72 hours or longer. Produces two types of colonies: One is small, raised, grayish-brown, smooth and glistening with an entire translucent edge. The other colony type is flat, mucoid, translucent, grayish and has an irregular edge DDx: includes Salmonella, Shigella andEnteroinvasive Escherichia coli (EIEC) infection but distinguishing factor clinically very similar but presents more frequently with bloody diarrhedistinguish based on culture or polymerase chain reaction
- rehydration with oral glucose-electrolyte solutions are mainstay therapy. Failure to achieve hydration with oral intake may require intravenous fluids. Antibiotic therapy may be used in patients with severe infections or septicemia. These include: macrolides (i.e., erythromycin, azithromycin and clarithromycin) tetracyclines Aminoglycosides Chloramphenicol fluoroquinolones Clindamycin amoxicillin/ clavulanic acid (augmentin) imipenem azithromycin or erythromycin antibiotic of choice to treat enteritis, however, tetracycline or fluoroquinolones used as secondary antibiotics. In adults Augmentin can be used in place of tetracycline (contraindicted in children) Note it is resistant to penicillins, cephalosporins, and sulfonamide Systemic infections are treated with an aminoglycoside, chloramphenicol, or imipenem Good hygienic slaughtering practices, thoroughly cooking meat, bactericidal treatment of food (eg pasteurization), adequate sewage disposal systemscan be considered to prevent infection