Campylobacter is a genus of bacteria that can cause foodborne illness in humans. The document discusses the history, taxonomy, species, characteristics, habitats, morphology, culture, biochemical reactions, virulence factors, epidemiology, diseases, pathogenesis, clinical symptoms, diagnosis, treatment, and other aspects of Campylobacter. The most common species that causes food poisoning in humans is Campylobacter jejuni, which is often found in the intestines of animals. People typically become infected by eating undercooked contaminated food like poultry. The infection may cause diarrhea, abdominal pain, and fever.

1. CAMPYLOBACTER
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Presented By: Ishwor Shrestha
B.Sc. MLT 3rd Year
MMIHS
Guided By: Dipendra Kumar Mandal
Clinical Microbiologist
Lecturer (MMIHS)

2. CONTENT
⮚History
⮚Introduction
⮚Taxonomy
⮚Campylobacter species
⮚General characteristics
⮚Habitat
⮚Morphology
⮚Cultural characteristics
⮚Biochemical reaction
⮚Virulence factor
⮚Epidemiology
⮚Spectrum of Disease
⮚Pathogenesis
⮚Clinical syndrome
⮚Laboratory diagnosis
⮚Antimicrobial susceptibility and therapy
⮚Others campylobacter
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3. History
●In 1886 Escherich observed organism resembling
Campylobacters in stool sample of children with diarrhoea.
● In 1913, McFaydean and Stockman identified campylobacters
(called related Vibrio) in fetal tissues of aborted sheep
●King in 1957 reported that a thermophilic Vibrio- like
bacterium associated with human acute enteritis.
●In 1973 Campylobacter have been identified as new genus by
Veron & Chatelain
●In 1931, Jones and colleagues discovered C. jejuni from stool of
cattle.
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4. Campylobacter
⮚Introduction
▪ The organisms are currently divided into three genera:
Campylobacter, Arcobacter and Helicobacter.
▪ The genera Campylobacter and Arcobacter are grouped under
the family Campylobacteriaceae.
▪ The genera belonging to this family are Gram-negative, spiral
bacilli with a low DNA guanosine and cytosine base rate.
▪ Most campylobacter are microaerophilic( i.e. they require
oxygen but at lower concentration than present in air) and 5%
oxygen in the environments optimal for growth.
▪ Many pathogenic species are thermophilic( growing well at 42° C
)therefore they do not grow in media incubated at 37°C used for
isolating E. coli and salmonella.
▪ Lack the capacity to oxidize or ferment sugars.
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5. Campylobacter
▪ Campylobacter infection are one of the most common bacterial
infections in humans.
▪ Causes both diarrheal and other systemic diseases
▪ The generic name campylobacter is derived from the Greek
word Kampylos meaning curved rod.
▪ The genus campylobacter resembles the genus Vibrio in being
motile by means of polar flagella and in being curved Gram-
negative bacilli and oxidase positive.
▪ They, however, differ from vibrio:
a) in being microaerophilic,
b) not fermermenting carbohydrates and
c) having a lower guanosine and cytosine content: guanine-
cytosine (G+C) ratio (29-38 mol %) than vibrio's(39-5 1 mol %)
▪ The genus campylobacter consists of 16species and 6
subspecies, of which 11 species are known to cause infections
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6. Taxonomy
●Domain: Bacteria
●Phylum: Proteobacteria
●Class: Epsilonproteobacteria
●Order: Campylobacterales
●Family: Campylobacteraceae
●Genus: Campylobacter
●Species: jejuni subsp.jejuni, jejuni subsp. doylei,
lari, fetus subsp. fetus, sputorum biovar
sputourm, conciscus, rectus, gracilis, upsaliensis,
jejuni subsp. venerealsis
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7. Campylobacter
species
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8. Medically
important
campylobacter
●C. jejuni, C. coli, C. lari, C. upsaliensis- all causing
diarrheal diseases,
●C. fetus responsible for extra intestinal infection
●C. sputorum, C. concisus and C. rectus are associated
with periodontal disease.
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9. General
characteristic
s
●Gram negative, slender(0.2-0.5µm
wide) curved rods
●“S” or “gull-wing” shapes
●Daughter cells which remains joined
have a characteristic gull-winged
appearance and long spirals cells.
●Motile with a single polar flagellum
●Microaerophilic organism grow best
on enriched media in an atmosphere
of increased CO2 and decreased O2
tension.
●Non-fermentative, oxidase positive &
have a variable catalase reaction.
●No spore & no capsule
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10. Habitat
●Campylobacter species are found in the intestinal and genital
tracts of domestic animals and are widely distributed
geographically.
●C.jejuni subsp. jejuni- domestic animals, poultry and birds,
●C. jejuni subsp. doylei- Humans
●C. lari – animals and birds
●C.fetus subsp. fetus – cattle and sheep & C. jejuni subsp.
venerealsis – cattle
●C. sputorum biovar sputourm – Man (mouth), cattle, sheep
●C.conciscus, C. rectus, C. gracilis – Humans
●C. upsaliensis – dogs, cats
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11. Campylobacter
jejuni
●Campylobacter jejuni was discovered by Jones and
colleagues in 1931 from the stool of cattle suffering from
winter dysentery.
●C .jejuni subsp. jejuni is the most important and most
common enteric pathogen causing attacks of diarrhea in
patients worldwide.
●About 90-95% campylobacter infections are caused by C .
jejuni.
●The infection is a zoonotic and the source is food of animal
origin.
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12. Campylobacter
jejuni
Morphology
⮚Small, curved, Gram negative bacilli
⮚0.5-5µm x 0.2-0.9µm in size
⮚Comma, S or “gull- wing” shaped spiral rods
⮚Single polar unsheathed flagellum at one or both ends
⮚Guanine-Cytosine (G+C) content: 29-38%)
⮚Motile, non- sporing
⮚Non – capsulated
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13. Cultural
characteristics
●The organism are microaerophilic, thermophilic (optimum
temperature for growth is 42°C) and capnophilic( requiring
10% CO2 for growth)
●Selective media:
i. Modified Skirrow’s media containing blood agar base &
antibiotics( vancomycin, trimethoprim and polymyxin B
ii. Campy – BAP : Brucella agar base with antibiotics(
trimethoprim, polymyxin B, cephalothin , vancomycin,
amphotericin B) and 10% sheep blood
iii. Modified charcoal cefoperazone deoxycholate agar(CCDA)
iv. Butzler’s selective media
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14. Cultural
characteristics
●On freshly poured solid media, the colonies are flat, moist,
translucent and, when young, are like water droplets, 0.5-3 mm
in diameter and tend to become confluent along the streaks
made by the inoculating wire.
● Incubation period: 42°c for 48 to 72 hours
●May also be dry, round and convex with glistening entire edges.
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15. Biochemica
l reaction
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16. Biochemica
l reaction
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17. Virulence
factor
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18. Epidemiology
●Campylobacter is a zoonotic bacterium (bacteria transmitted to
humans from animals or animal products) as a commensal with a
variety of animal reservoir, such as farm animals, especially
poultry ( chickens and turkeys).
●Dogs and cats are also reported to be source of campylobacters.
●Human infections occur via contaminated water or food.
●The incidence is high in summer and early autumn. Highest
among young children followed by a second peak in young adults
20 to 40 years old.
●Outbreaks are associated with improperly cooked food primarily
poultry products contaminated milk and water.
●In developing countries, C. jejuni infections are hyper endemic,
asymptomatic and widespread in humans as well as animals
including poultry. The highest incidence rate is found among
children less than 2 years old.
●Once a person is infected, the organisms can be transmitted from
person to person by the fecal oral route.
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19. Transmission
●Infection is acquired by ingestion: consumption of
contaminated food, water, unpasteurized milk and
undercooked meat
●Most often carcasses of meat are contaminated by
Campylobacter from feces during slaughtering. In animals,
campylobacter seldom causes disease
⮚ direct contact with infected animals and their products
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21. ❑Risk factors of campylobacteriosis
●HIV infection
●Exposure to poultry, cattle, sheep, or other farm animals
●Eating raw or undercooked meat (especially chicken)
●Recent foreign travel
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22. Spectrum of
Disease
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23. Pathogenesi
s
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24. Pathogenesis
●Human infection follows ingestion of 1000- 10,000 bacteria but the
illness is infrequent with a dose of less than 1000 bacteria.
●Most clinical syndromes occur within 2-4 days(incubation period, 1-7
days) of ingestion of contaminated food, milk or water.
●Three mechanisms have been postulated in the pathogenesis of
intestinal disease caused by C. jejuni.
1. Adherence and production of heat- labile enterotoxins:
❑C. jejuni adheres to the jejunum, ileum and colon.
❑Adherence to epithelial cell or mucus at these sites is possibly
facilitated by flagella.
❑LPS or other outer membrane components are also believed to
contribute to adhesion.
❑PEB1 is a superficial antigen that has been found to be a major
adhesion protein.
❑Furthermore , C . jejuni enterotoxin is a heat labile cholera- like toxin
which is responsible for diarrhea
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25. 2. Invasion and proliferation of bacteria within the intestinal
epithelium:
❑C. jejuni is invasive.
❑The organism multiply in the small intestine, penetrate the gut
epithelium and produces enterotoxins( resembling enterotoxin of V.
cholera)
❑Causes histologic damage in the mucosal surface of the jejunum, ileum
and colon.
❑The organism produces diffuse, bloody, edematous, and exudative
enteritis.
❑Infiltration of lamina propria occurs with neutrophils, mononuclear
cells and eosinophils.
❑Abscesses in epithelial glands and ulceration of the mucosal
epithelium.
❑Precise role of enterotoxin and cytopathic toxins in causation of
intestinal pathology is not known.
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26. 3. Invasion of intestinal mucosa and proliferation:
❑C. jejuni invades intestinal mucosa and multiplies in the
lamina propria and mesenteric lymph nodes.
❑This results in extra-intestinal infections such as
cholecystitis, mesentery adenitis, urinary tract infection and
meningitis.
Host immunity:
❑Acute infection caused by C. jejuni confers immunity with
development of specific IgG, IgM and IgA antibody in the
serum and also IgA antibodies in the intestinal secretions.
❑Both humoral and cell mediated immunity are important in
prevention and termination of C. jejuni infections.
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27. Symptoms
❑Campylobacter infection may cause a variety of symptoms,
including:
▪ Mild to severe diarrhoea
▪ Bloody diarrhoea
▪ Stomach pain
▪ Cramps
▪ Nausea and/or vomiting
▪ Fever
▪ Headache, and
▪ Muscle pain
▪ Persons infected with Campylobacter bacteria may not
exhibit any symptoms. These asymptomatic individuals can
still pass the disease on to others.
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28. Clinical
syndrome
●Campylobacter spp. infection in humans can be broadly classified into
two major groups:
A. Enteric infection
B. Extra- intestinal infections
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❑ Enteric infection:
▪ C. jejuni is the most important species associated with
human enteric infections.
▪ The clinical manifestation of enteric infections caused
by all campylobacters species including C. jejuni are
similar.
▪ Watery diarrhea is the main manifestation
(approximately 10% of children)
▪ The illness lasts for days to several weeks and is usually
self - limiting.
▪ Systemic dissemination is rarely seen.

30. ❑Extra- intestinal infections:
▪ Bacteremia:
✔ the most important manifestation
✔ bacteremia caused by C. jejuni is uncommon
✔Occurs in patients with immunodeficiency , chronic disease and in old
individual.
✔Both stream infection and bacteremia by C. fetus is rare.
▪ Septicemia
▪ Meningitis
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31. Complications
●In immunocompromised persons, there may occur
sustained bacteremia
●Guillain- Barre syndrome
●Septic abortion
●Reactive arthritis
●Hemolytic uremic syndrome
●Thrombotic thrombocytopenic purpura
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32. Guillian – Barre
syndrome(GBS)
▪ Autoimmune disease
▪ Due to molecular mimicry of terminal tetra-saccharide of
LPS of C. jejuni and glycolipid present on the surface of
peripheral nerves.
▪ An acute paralytic disease of the peripheral nervous system.
▪ Approximately 20-40% patients of GBS are infected with C.
jejuni which may appear 1-2 weeks after onset of acute
campylobacter illness.
▪ A rare serotype of C. jejuni called Penner ( LPS type O: 19) is
associated with this condition.
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33. Guillian – Barre
syndrome(GBS)
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34. Laboratory
Diagnosis
Diagnosis is conformed by microscopy and isolation of
campylobacter in cultures.
⮚ Specimen:
▪ Fresh diarrheal or dysenteric stool
▪ Feces
▪ Rectal swabs
▪ Blood, body fluids and tissues (extra intestinal infection)
❖Note : In case of delay(>2 hour), feces or rectal swabs are
transported in Cary Blair transport medium. Campylobacter
spp. survive for 1 – 2 weeks at 4°C in this medium.
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35. ⮚Microscopy
▪ A presumptive diagnosis is made by examination of wet
mount of stool by dark field microscopy or phase contrast
microscopy.
▪ Identified by their characteristic darting motility.
▪ Gram staining: Gram negative, curved, S- shaped or long
spiral forms of the organism
▪ Fecal leukocytes and erythrocytes can also be detected in
Gram stained smear of stool.
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36. Isolation
technique
●Campylobacters can be isolated from fecal specimen
by:
⮚Filtration technique
⮚Selective culture medium
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37. Filtration
technique
●This technique requires the use of a cellulose acetate 0.45
µm porosity, 47 mm diameter membrane filter.
●Procedure :
1) Emulsify about 1 gm of faeces in 10 ml sterile saline. If
available use a vortex mixer. Allow to settle for 2 minutes.
2) Place a filter membrane of 0.45 µm porosity, 47 mm
diameter on a plate of blood agar or chocolate (heated
blood) agar.
3) Add about 10 drops of faecal suspension to the filter,
making sure the suspension does not over run the edge of
the filter.
4) Remove and discard the filter 30-60 minutes after
applying the suspension.
5) Incubate the plate in a microaerophilic environment ,
preferably at 42-43°C for up to 48 h or if this is not
possible at 37°.
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38. Culture
▪ Campylobacter species are strictly microaerophilic,
requiring incubation of reduced O2(7%), CO2 (10%) and
remainder 83% of N2 (inert gas).
▪ C. jejuni, C. coli and C.lari are thermophilic, i.e. they will
grow at 42-43°C and 36-37°C but not at 25°C.
▪ Though they grow at 37°C, incubation at higher
temperature suppresses normal flora.
▪ Rectal swabs or swab of samples of the stool, or 1 or 2
drops of liquid stool specimen are inoculated directly on
the surface of the agar medium.
▪ The inoculated plate is incubated at 42°C for 48-72 hours.
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39. Culture
▪ Selective media:
●Modified Skirrow’s media containing Colombia blood agar
base, 7% horse lysed blood & antibiotics( vancomycin,
trimethoprim and polymyxin B)
⮚Colonies of C. jejuni will appear as small, mucoid, flat or
slightly raised, non-hemolytic translucent and gray.
●Campy – BAP : Brucella agar base with antibiotics(
trimethoprim, polymyxin B, cephalothin , vancomycin,
amphotericin B) and 10% sheep blood
●Modified charcoal cefoperazone deoxycholate
agar(CCDA)
●Butzler’s selective media: containing defibrinated sheep
blood, cefoparazone, rifampicin, colistin, amphotericin B,
Colombia agar base
⮚Two types colonies:
1. Watery and spreading
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41. ▪ Blood agar:
● C. jejuni and C. coli produce non-haemolytic spreading,
droplet-like colonies on blood agar.
▪ Improved Preston blood-free medium:
• C. jejuni produces grey, moist, flat-spreading colonies. Some
strains may have a green hue or a dry appearance with or
without a metallic sheen.
• C. coli usually produces creamy-grey, moist, slightly raised
colonies. A swarming growth may occur.
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42. Serodiagnosis
▪ Latex agglutination test to identify Campylobacter
●A Dryspot Campylobacter latex agglutination test kit (code
DR 0150) is available from Oxoid for the identification of
enteropathogenic Campylobacter species from solid culture
media.
●The latex reagent is dried on reaction cards. The test kit
includes the antigen extraction reagents required to perform
the test. Each test pack contains 50 tests.
▪ Antigen Detection
• Several commercial antigen detection systems are available
for the direct detection of Campylobacter in stool
specimens.
• The enzyme immunoassays (EIA) can be used to detect
antigens in stool samples for several days if stored at 4° C
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43. ▪ ELISA is available for demonstration of specific antibodies in
the serum, and a high titre of antibodies is usually seen after
the symptoms are resolved.
▪ Serology may not be useful for routine diagnosis, but is
useful for epidemiological studies
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44. Molecular
diagnosis
●DNA probes and PCR based amplification of the 16S rRNA
gene
●Direct sequencing of the PCR product
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45. Antimicrobial
Susceptibility
Testing and
Therapy
●Susceptibility tests for campylobacter spp. are not
standardized and therefore testing of isolates is not routinely
performed.
●C. jejuni and C. coli are susceptible to many antimicrobial
agents including: macrolides, tetracyclines, aminoglycosides
and quinolones
●Erythromycin is the drug of choice for patients with severe
gastroenteritis with ciprofloxacin as the alternative
therapeutic option.
●Resistance is being reported from some countries to
ciprofloxacin, tetracyclines, ampicillin and cotrimoxazole.
●Campylobacter infections, however, are often self-limiting
and do not require antimicrobial treatment.
●Parenteral therapy (not taken through alimentary canal but by
an alternate route such as intravenous) is used to treat
systemic infection
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46. Treatment
●Most C. jejuni infections are mild and self-limited. Therefore,
they do not require antibiotic therapy. Supportive treatment
is adequate.
●Treatment is not generally required, except electrolyte
replacement and rehydration
●Treatment with antibiotics is recommended only for
persons:
o with fever, bloody diarrhea,
o with symptoms persisting for more than 7 days, and
o for immunocompromised host.
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47. Prevention
●Potentially contaminated food such as poultry, should be
thoroughly cooked, and milk and milk products should be
pasteurized.
●No vaccines are available for Campylobacter spp.
●Care must be taken during food preparation to prevent
cross- contamination from raw poultry to other food items.
●Wash hands with soap before and after handling raw
foods of animal origin and before touching anything
else.
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48. Other
Campylobacters
▪ C. coli:
✔Closely related to C. jejuni and accounts for 5-10% cases of
enteritis caused by campylobacters in human.
✔C. coli is distinguished from C. jejuni by hippurate
hydrolysis test.
✔C. jejuni hydrolyses hippurate while C. coli does not.
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49. Hippurate
Hydrolysis Test
●The hippurate test is used in the identification of
Campylobacter jejuni, Listeria monocytogenes, Gardnerella
vaginalis and Streptococcus agalactiae
❑Principle:
The test detects the ability of the organism to hydrolyze
sodium huppurate to benzoic acid and glycine by the action of
the enzyme hippuricase
Sodium hippurate hippuricase glycine + benzoic acid
Glycine + Ninhydrin Deep blue color complex
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50. Procedure
A. Prepare hippurate tube:
1) Add 0.2 ml ( 3 or 4 drops) of distilled water at a pH 6.8-7.2 to reconstitute
lyophilized tube test reagent.
2) Add 2 drops of distilled water to empty tube for disk or tablet tests.
3) Defrost one 0.4 ml tube per test for prepared reagent.
A. In the tube, make a heavy suspension ( equivalent to no.3 McFarland
standard) from an 18-24 h culture.
B. For disk or tablet tests, add reagent after inoculation of the tube with the
culture.
C. Incubate the tube for 2 hour at 35-37°C.
D. After the 2 h incubation period, add 2 drops of the Ninhydrin solution to
the hippurate reagent-organism mixture. Add additional 2 drops if test
has 0.4 ml of hippurate.
E. Reincubate at 35-37°C for 30 min. observe the tubes at 10 min intervals
for the appearance of a deep blue color, which is a positive test. The
color change will usually appear within 10-15 min after the Ninhydrin
solution has been added.
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51. Result
●Positive reaction: deep blue color (about the color of crystal
violet) within 30 min.
●Negative reaction: faint purple color or no color change.
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52. ▪ C. lari:
✔Thermophilic, endemic in gulls
✔Infrequently causes enteritis in man, simulating C. jejuni.
Infections
✔Rarely causes bacteraemia especially in
immunocompromised persons
✔Does not hydrolyses hippurate
▪ C. fetus:
✔Theobald Smith isolated the organism in 1918 from
infectious abortion in cattle and named it Vibrio fetus.
✔Veterinary pathogen
✔Human infection- septicemia in debilitated and
immunocompromised individuals.
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53. ✔Does not cause gastroenteritis
✔Non- thermophilic and cannot grow at 42°C (optimum
temperature 37°C.
✔C. fetus subsp. Venerealis – normal flora of genital tract
and has been reported to cause human infection.
▪ Other campylobacter species ( C. sputorum, C. upsaliensis, C.
mucoslais) are occasionally recovered form specimens of
patients with a variety of diseases, but their pathogenic role
has not yet been fully established.
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56. Reference
●A Textbook of Microbiology- P Chakraborty
●Textbook of Microbiology & Immunology, Second Edition-
Subhash Parija
●Bailey Scott’s Diagnostic Microbiology, 13th edition- PDF--
tahir99- VRG
●District Laboratory Practice in Tropical Countries, Second
Edition- Part 2 –Monica Cheesbrough
●Clinical Microbiology Procedure Handbook, Volume
1,Second Edition- Henry D. Isenberg
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57. Thank you !!!
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