Campylobacteriosis
The Campylobacter enteritis is caused by various species of bacteria of the genus Campylobacter, reportable, inflammatory diarrhea in humans. The infectious disease is also called campylobacteriosis and is the most common disorder of the digestive tract. Campylobacter species are gram-negative, spiral curved rods and belong to the group of zoonotic pathogens that are transmitted from animals to humans and where they can lead to disease. In animals such as cattle or poultry, the disease often goes undetected because the animals often show no symptoms of disease.
Disease mechanism
The pathogens in humans are Campylobacter jejuni, Campylobacter coli, Campylobacter lari, and Campylobacter fetus ssp. fetus. 2010 could be identified as a pathogen in reported cases of campylobacteriosis in 35.7 % C. jejuni, C. coli in 2.3%, 0.22% in C. lari and C. upsaliensis in 0.01%. In most cases ( 51.8 % ) was determined not the kind, but only the genus or kind could not be positively identified.
As part of the Shigella Campylobacter to the pathogens to invade the mucosa of the intestine. To form a heat-resistant toxin ( enterotoxin ), which is believed to be responsible for the diarrhea symptoms.
Campylobacter is enteroinvasiv, that is, it penetrates through the intestinal epithelia and spreads from there. It can thus also into the blood stream ( bacteremia ) and cause sepsis.
Course
From infection to onset of the disease, it takes about 1-7 days. Then it comes to symptoms, which are common in other enteritis. These include abdominal pain, severe, sometimes bloody diarrhea and a strong feeling of illness with fever up to 40 ° C. It often occurs 12-24 hours before the onset of enteric symptoms already at fever (38-40 ° C ), headache, myalgia, arthralgia and fatigue.
After four days to two weeks the symptoms usually disappear spontaneously. Recurrences are rarely observed ( at about 5-10% of non-treated patients). Many infections are asymptomatic. One immunity is not acquired. Patients remain infectious for a period of time, because the pathogens are excreted in the stool. This period is two to four weeks. With Dauerausscheidern is usually not expected. However, in immunocompromised individuals, such as in AIDS patients, there may be a long-term separation. The elimination period can be shortened by antibiotics, if no resistance in the participating Campylobacter species.
According to § 7 of the German Infection Protection Act ( IfSG), a reporting requirement for the positive detection of pathogens by -detecting lab with a roll-call notification of the patient. According to § 6 IfSG the disease as acute infectious gastroenteritis is reportable if an epidemic context, it is likely or is suspected.
Frequency
Campylobacter is now in Germany - as a whole in the European Union - the most common cause of gastrointestinal infection, even before the salmonella. 2010 218.963 confirmed cases of campylobacteriosis were reported from the 27 Member States of the EU, these are more than twice as many cases as with salmonellosis ( 102 323 confirmed cases ). 2010 have been reported in Germany 65 713 cases of campylobacteriosis, in Austria there were 4,404. By comparison, the number of reported salmonellosis cases was 25 306 ( Germany ) or 2179 ( Austria ). The attack rate in the EU is 56.89 cases per 100,000 population, this mean an increase of 4.25 cases per 100,000 population compared to the previous year 2009. In the Czech Republic there was the highest incidence rate of 200.58 per 100,000 followed by the United Kingdom ( UK ) with 113.34 cases per 100,000 population.
The number of campylobacteriosis cases is increasing for years. They usually occur sporadically, but outbreaks are reported regularly. In the year 2010 470 housed with food -related disease outbreaks have been documented, there were over 1700 people affected. The disease occurs mainly in summer (June to August). In the European Union are concerned children aged up to five years to a great extent, the highest attack rate was in boys (aged up to four years ) found with 155.54 cases per 100,000 population.
Infection
Campylobacter jejuni and Campylobacter coli are normally present in the intestines of pigs and poultry and other birds. Main cause of food-borne campylobacteriosis is poultry meat, it is 20-30 % of cases can be traced back. Transmission is primarily by insufficiently cooked poultry meat. Other sources of infection are unpasteurized milk, contaminated, not treated drinking water and raw mince. Infections while bathing in contaminated surface waters ( lakes and other standing waters in summer ) occur. Also the transmission by pets (especially by falling sick puppies and cats ) or contact with their excreta is possible. In unpasteurized milk and beef, the rare Campylobacter fetus ssp. fetus occur.
The amounts made as sources of infection foods are mainly contaminated by excreting animals. Rarely done the direct fecal- oral transmission from person to person. A direct smear infection occurs, especially in children.
Campylobacter can, especially at low ambient temperatures, some time in the environment or in food to survive. However, the pathogen can not be outside of the host organism, eg in food, multiply. Already receiving a rather small amount of Campylobacter is sufficient to cause an infection in children it is possible already at a dose of infection of approximately 500 bacterial cells.
Diagnostics
A proof succeeds usually from the stool culture. The cultivation on selective media are under microaerophilic conditions at 37-42 ° C.
Prevention and treatment
For consumers is the most effective protection against infection in compliance with the Food Hygiene. For example, the contact of the meat with other foods on cooking utensils or hands by washing and disinfection thereof should be avoided.
The Campylobacter enteritis usually heals spontaneously. Because antibiotic treatment usually does not cause shortening of the duration of the disease, an application only if the postoperative vulnerable people (small children, elderly or immunocompromised patients) should be considered.
As with all of diarrhea, it is important above all in the Campylobacter enteritis replacing fluids and electrolytes.
Antibiotic are effective especially macrolides. The drug of first choice is erythromycin represent, alternatively, ciprofloxacin be used. Quinolones are only moderately effective in systemic infections. In septic gradients gentamicin or imipenem are effective. However, some Campylobacter coli strains are resistant to gentamicin.
Complications
While the disease in most people goes without complications, the pathogens remain in some cases in the intestine and can cause a chronic infection. This provides a picture similar to chronic inflammatory bowel disease.
Especially in immunocompromised patients may rarely cause septic gradients. After asymptomatic infection sometimes occur in reactive arthritis and erythema nodosum. There is also evidence that the Guillain -Barré syndrome may be associated with Campylobacter infection.