Campylobacter

5/4/18
 Introduction
• Causes diarrhoea in adults as well as children
• Occasionally causes systemic disease
• They are important veterinary pathogens
 Important Human Species
Campylobacter of medical importance are:
• Causing Diarrhoeal disease: C. Jejuni
C. coli,
C. lari
• Causing Extraintestinal Infection: C. fetus
• Causing abscesses: C. sputorum ,
C. consiscus
• Campylobacter = Curved rod (Greek)
Genus campylobacter includes
• Gram negative bacilli
• Small, thin ,helical (Spiral or curved)
• Typically comma shaped but may appear as
“S” or multispiral; Gull winged appearance
• Non sporing
• Motile – single, unsheathed polar flagellum
at one or both poles
Campylobacter in gram stain
 C Jejuni
• Most important campylobacter species
• Most common cause of bacterial diarrhoea in
developed countries; more common than
salmonellae and shigellae
• In developing countries , C jejuni is endemic and
asymptomatic infection are prevalent in human
as well as domestic animals and birds
• It is part of normal flora of intestine of domestic
animals and birds, is shed in their faeces
• Campylobacter is found most often in food,
particularly in chicken.
• Any raw poultry including milk may contain
Campylobacter, including organic and “free range”
products.
• Food is contaminated when it comes into contact
with animal feces.
• In fact, studies have found Campylobacter
contamination up to 88 % in chicken carcasses.
• Also can be isolated from surface water
• Infection is zoonotic
• Source – Raw milk, chicken
• Infection occurs by ingestion
• Primary sites of colonization – Jejunum and
ileum
• May involve colon and rectum in few cases
• Incubation Period – 1-7 days
 Campylobacter Symptoms
Food poisoning usually occur 2 to 5 days after consuming
contaminated food, but may take up to 10 days to appear.
• Diarrhea: mild to severe and is often bloody
• Fever
• Crampy Abdominal pain
• Nausea
• Vomiting
• Headache
• Muscle pain
Two age groups are most commonly affected by Campylobacter:
children < 5 years and young adults aged 15-29.
 Sequel to Infection
• Guillian-Barre syndrome - Antigenic cross reaction
between oligosaccharides of Campylobacter and
glycosphingolipids on surface of neural tissue,
Antibody against strains can damage neural tissue in
peripheral nervous system.
• Arthropathy – Multiple joints affected;particularly
knee.pain last longer or become chronic
• Bacteremia -Sometimes may involve mesentric LN
and causes bacteremia
 Guillian Barre Syndrome
• GBS is a rapid-onset muscle weakness
• It is caused by the immune system damaging
the peripheral nervous system.
• The initial symptoms are changes in sensation
or pain along with muscle; weakness beginning
in the feet and hands.
• This often spreads to the arms and upper body,
with both sides being involved.
• can be life-threatening, as developing weakness
of the breathing muscles
 Causative agents of GBS
Follows respiratory tract infection or gastroenteritis
• Campylobacter
• Mycoplasma pneumoniae
• Cytomegalovirus
• EBV
• HHV 4
• Varicella zoster virus
• Influenza virus
Sometimes develop following influenza vaccination
 Viability
• Die on exposure to air as oxygen at normal
atmospheric pressure is toxic to them
• Survival time increases when temperature is
lowered to 40 C so survive for 3-5 weeks in milk,
water , feces or urine
• So above material if contaminated may act as
reservoir of infection
• So infection may develop following drinking of
untreated water from rivers , raw or
unpasteuried milk
• May survive well on raw meat,pork,poultry
derived from infected animals – cause infection
if eaten lightly cooked, salted or smoked
• Heat sensitive – killed by temperature achieved
in domestic cooking or milk pasteurization
• Susceptible to drying and acidic conditions
,bactericidal effect of chlorine
 Lab Diagnosis
Sample – Feces ; Rectal swab in few cases
I. Stool Routine examination – Leukocytes and RBCs
II. Direct Microscopic Examination -
1.Phase contrast or dark field microscopy – to
detect the tumbling motility /darting motility of
spiral rods
2.Gram stain - Presence of small curved rods
Direct microscopy is useful for presumptive rapid
diagnosis
 Culture
• Fresh sample should be plated
• Upto 24 hours can be preserved at 40 c
• If delay >24 hours then requset for repeat
fresh sample
• Charcoal based transport media can be used
in rare instances
 III. Culture

Culture Media
• Campy BAP media
• Charcoal based media (Charcoal is effective
substitute to Blood)
• Skirrow’s – Van ,polymyxin and trimethoprim
• Butzler’s
 Campy BAP
• Brucella agar base, 10% sheep red blood
cells, vancomycin, trimethoprim, polymyxin
B, amphotericin B, and cephalothin.
 Cultural Characteristics
• Microaerophilic - 5% oxygen, 10% CO2 and
85% nitrogen
• Provided by various procedures eg disposable
gas generators,
• Candle jar not recommended as oxygen level
(12-17%)
• Thermophilic – Incubate at 420 C
• Colonies appear after 48 hours (2-5 days )
Colony Characteristic:
 0.5-3 mm
 Non hemolytic,
 Grey or colourless
 moist flat or convex
 Look like water droplets (in
fresh cultures)

Coccoid forms in old culture

 Biochemical Reaction
• Catalase – Positive
• Oxidase – Positive
• Don’t ferment sugars
• Low guanine cytosine ratio (29-38%)
(to differentiate from Vibrios (39-51%)
• Nitrate reduction Test – Positive
• Hippurate hydrolysis positive – Help to
distinguish from C. coli ( Negative )
• Sensitive to nalidixic acid ( C lari is resistant)
 Hippurate Hydrolysis
Add 0.5 ml of 5% sodium hippurate to colony
suspension – Incubate in water bath at 370 C for
2 hours – Add ninhydrin – leave for 2 hrs at
room temperature – Development of purple
colour indicates hippurate hydrolysis to glycine
 Antibiotic sensitivity
• Usually not done
As self limiting
Erythromycin is highly sensitive
• Done if specially requested by the clinician or
areas where erythromycin resistant strain are
emerging
 Isolation by filtration method
• C coli and most strains of C upsaliensis – grow
poorly at 420 C & sensitive to antibiotics used
in culture media
• so isolated by filtration technique i.e. passing
the specimen through the membrane before
plating on non selective media
• Many modification were done
 Treatment
• Diarrhoea is often self-limiting, but patients
may be treated with erythromycin or
fluoroquinolones.
• An aminoglycoside may be added for patients
who have septicaemia.
• Disease usually self limited but organism
shedding may continue for weeks after
recovery
 Prevention and control
Prevention of campylobacteriosis depends on
 Good animal husbandry and abattoir practices,
 Good food hygiene in shops, dairies and the
home.
 Prevention
• Make sure the thickest part of any poultry
product reaches 1650 F (740 C)
• Choose the coolest part of the car to
transport meat and poultry home from the
store
• Never leave food out at room temperature
for over two hours
• Use pasteurized milk and eggs
 & Most important Preventive
measure
Wash hands thoroughly after…
• Contact with pets or farm animals
• Preparing food, especially poultry
• Changing diapers
 C. fetus
• Important veterinary pathogen; abortion in cattle
• An opportunistic pathogen
• Predisposing Conditions - liver disease, diabetes
mellitus, chronic alcoholism or malignancies.
• Predilection for endothelial surfaces & secondary
involvement of pulmonary, cardiovascular and
meninges causing bacteremia, sepsis, meningitis
• Grows at 25 & 37 0 c not at 42 0 c
• No hydrolysis of Hippurate
• A microbiologist is reading stool cultures
plates. The campy plate incubated at 42° C
has growth of nonhemolytic, moist colonies
• Gram stain shows tiny gram-negative rods
with some S-shapes and seagull-wing shapes.

What is growing on the plate?

Q. 2 What type of an atmosphere do
campylobacters require for growth?
Q Which organism may play a role in
Guillain-Barré syndrome (GBS)?
Q. What disease manifests in acute cases as a
severe gastroenteritis, accompanied by vomiting
followed by diarrheic stools that are described as
rice water and occur 10 to 30 times a day?
Q. What is the name of the organism that is
strongly associated with gastric, peptic, and
duodenal ulcers, as well as GI carcinoma?