Header graphic for print
Marler Blog Providing Commentary on Food Poisoning Outbreaks & Litigation

Campylobacter

Campylobacter1.jpgCampylobacter is the second most common cause of bacterial foodborne illness in the United States after Salmonella. Over 3,000 cases were reported to the Centers for Disease Control and Prevention in 2003, or 12.6 cases for each 100,000 persons in the population. Many more cases go undiagnosed and unreported, with estimates as high as 2 to 4 million cases per year.  It is estimated that each case costs $920 on average due to medical and productivity (lost wages) expenses with an annual total cost of $1.2 billion.

Chicken is the most common food implicated.  Any raw poultry—chicken, turkey, duck, goose, game fowl—meat and its juices may contain Campylobacter including organic and “free-range” products.  Other foods include unpasteurized milk, undercooked meats such as beef, pork, lamb, and livestock offal, and occasionally shellfish, fresh produce, and eggs.

Most cases of Campylobacter infection occur as isolated, sporadic events, and are not usually part of large outbreaks. But, very large outbreaks (>1,000 illnesses) of campylobacteriosis have been documented, most often from consumption of contaminated milk or unchlorinated water supplies.

Other sources of Campylobacter that have been reported include children prior to toilet-training, especially in child care settings, and intimate contact with other infected individuals. Campylobacter jejuni is commonly present in the gastrointestinal tract of healthy cattle, pigs, chickens, turkeys, ducks, and geese. Direct exposure to feces from animals carrying Campylobacter can lead to infection. People have become ill from contact with infected dogs and cats. Pets that may carry Campylobacter include birds, cats, dogs, hamsters, and turtles. The organism is also found in streams, lakes, ponds, and dairy wastewater.

Symptoms of Campylobacter Infection

The incubation period for Campylobacteriosis (the time between exposure to the bacteria and onset of the first symptom) is typically two to five days, but onset may occur in as few as two days or as long as 10 days after ingestion of the bacteria. The illness usually lasts no more than one week but severe cases may persist for up to three weeks, and about 25% of individuals experience relapses of symptoms.

Diarrhea is the most consistent and prominent manifestation of Campylobacter infection and is often bloody. Typical symptoms also include fever, nausea, vomiting, abdominal pain, headache, and muscle pain.  A majority of cases are mild, do not require hospitalization, and are self-limited.  However, Campylobacter jejuni infection can be severe and life-threatening.  It may cause appendicitis or infect other organs as well as the blood stream. It is estimated that about one in 1,000 cases of Campylobacter infection results in death. Death is more common when other diseases (for example, cancer, liver disease, and immune deficiency diseases) are present.

Diagnosis of Campylobacter Infection

Health care providers can look for bacterial causes of diarrhea by asking a laboratory to culture a stool sample from an ill person. Campylobacter is usually a self-limited illness; the affected person should drink plenty of fluids as long as the diarrhea lasts in order to maintain hydration. Antidiarrheal medications such as loperamide may allay some symptoms. Specific treatment with antibiotics is sometimes indicated, particularly in severe cases, and may shorten the course of the illness. Macrolide antibiotics (erythromycin, clarithromycin, or azithromycin) are the most effective agents. Fluoroquinolone antibiotics (ciprofloxacin, levofloxacin, gatifloxacin, or moxifloxacin) can also be used, but resistance to this class of drugs has been rising, at least in part due to their use in poultry feed. Consultation with a health care provider is recommended prior to taking anti-diarrheal medications or antibiotics.

Complications of Campylobacter Infection

Long-term consequences and complications can sometimes result from a Campylobacter infection. Some people may develop a rare disease that affects the nerves of the body following infection. This disease is called Guillain-Barre syndrome (GBS). It begins several weeks after the diarrheal illness, may last for weeks to months, and often requires intensive care. Full recovery is common but some affected individuals may be left with mild to severe neurological damage. Two therapies, intravenous immunoglobulin infusions and plasma exchange, may improve the rate of recovery in patients with GBS.

Miller Fisher Syndrome (MFS) is a related neurological syndrome that can occur with a Campylobacter infection. In MFS, the nerves of the head are affected more than the nerves of the body. Another chronic condition that may be associated with Campylobacter infection is a form of reactive arthritis called Reiter’s syndrome (RS). RS typically affects large weight-bearing joints such as the knees and the lower back. It is a complication that is strongly associated with a particular genetic make-up; persons who have the human lymphocyte antigen B27 (HLA-B27) are most susceptible.

Preventing Campylobacter Infection

The single most important and reliable step to preventing Campylobacter infection is to adequately cook all poultry products. Make sure that the thickest part of the bird (the center of the breast) reaches 180F or higher. It is recommended that the temperature reaches at least 165F for stuffing and 170F for ground poultry products, and that thighs and wings be cooked until juices run clear. Do not cook stuffing inside the bird.

If you are served undercooked poultry in a restaurant, send it back for further cooking. 

Consider using irradiated foods.  Irradiation within approved dosages has been shown to destroy at least 99.9% of common foodborne pathogens including Campylobacter, which are associated with meat, poultry, and secondary contamination of fresh produce.

Transport meat and poultry home from the market in the coolest part of the vehicle (generally the trunk in winter and cab in summer). Defrost meat and poultry in the refrigerator. Place the item on a low shelf, on a wide pan, lined with paper towel; ensure that drippings do not land on foods below. If there is not enough time to defrost in the refrigerator, use the microwave.

Make sure that other foods, such as fruits or vegetables, do not come into contact with cutting boards or knives that have been used with raw meat or poultry. To avoid cross-contamination, carefully clean all cutting boards, countertops, and utensils with soap and hot water after preparing raw meat or poultry.

Rapidly cool leftovers. Never leave food out at room temperature (either during preparation or after cooking) for more than 2 hours.

Avoid raw milk products and untreated (not chlorinated or boiled) surface water.

Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.

Wash hands thoroughly using soap and water, concentrate on fingertips and nail creases, and dry completely with a disposable paper towel after contact with pets, especially puppies, or farm animals; before and after preparing food, especially poultry; and after changing diapers or having contact with an individual with an intestinal infection. Children should wash their hands on arrival home from school or daycare.

References

Ang CW; De Klerk MA; Endtz HP; Jacobs BC; Laman JD; van der Meche FG; van Doorn PA. (2001). Guillain-Barre syndrome and Miller Fisher syndrome-associated Campylobacter jejuni lipopolysaccharides induce anti-GM1 and anti-GQ1b antibodies in rabbits. Infect Immun. Apr;69(4):2462-9.

Angulo FJ, Baker NL, Olsen SJ, Anderson A, Barrett TJ. (2004). Antimicrobal Use in Agriculture: Controlling the Transfer of Antimicrobal Resistance to Humans. Seminars in Pediatric Infectious Diseases. 15(2):78-85.

Angulo FJ, Nargund VN, and Chiller TC. (2004). Evidence of an Association Between Use of Anti-microbial Agents in Food Animals and Anti-microbial Resistance Among Bacteria Isolated from Humans and the Human Health Consequences of Such Resistance. J. Vet. Med. B Infect. Dis. Vet. Public Health. 51 (8-9):374-9.

CDC. (2005, October 6). Campylobacter: Technical Fact Sheet. Retrieved October 29, 2007 from Centers for Disease Control and Prevention Web site: http://www.cdc.gov/ncidod/dbmd/diseaseinfo/campylobacter_t.htm.

CDC. (2007). Salmonella Surveillance: Annual Summary, 2005. Atlanta, Georgia: US Department of Health and Human Services.

Center for Food Safety and Applied Nutrition (CFSAN). (1996). Temperature – Tips on Cooking and Storing Your Food. Retrieved October 29, 2007, from US Food and Drug Administration Web site: http://vm.cfsan.fda.gov/~ear/temperat.html..

Consumers Union. (1998). Chicken: What you don’t know can hurt you. Consumer Reports 63(3):12–18.

Council for Agriculture, Science and Technology (CAST) (1994). Foodbome pathogens: risks and consequences. Task Force Report No.122. CAST, Ames, 87 pp.

Fang G, Araujo V, Guerrant RL. (1991). Enteric infections associated with exposure to animals or animal products. Infect Dis Clin North Am. 5:681-701.

Fey PD, Safranek TJ, Rupp ME, Dunne EF, Ribot E, Iwen PC, Bradford PA, Angulo FJ, Hinrichs SH. (2000). Ceftriaxone-resistant Salmonella infection acquired by a child from cattle. N Engl J Med 342:1242–1249.

Food Safety and Inspection Service (FSIS). (1996). Nationwide broiler chicken microbiologic baseline data collection program, 1994-1995. Washington, DC: United States Department of Agriculture.

Glynn MK, Bopp C, Dewitt W, Dabney P, Mokhtar M, Angulo FJ. (1998). Emergence of multidrug-resistant Salmonella enterica serotype typhimurium DT104 infections in the United States. N Engl J Med 338:1333–1338.

Goossens H, Giesendorf AJ, Vandamme P, et al. (1995). Investigation of an outbreak of Campylobacter upsaliensis in day care centers in Brussels: analysis of relationships among isolates by phenotypic and genotypic typing methods. J Infect Dis. 172:1298-305.

MMWR Weekly. (2000, March 17). Preliminary FoodNet data on the incidence of foodborne illnesses – Selected sites, United States, 1999. 49:201-203. Atlanta, GA: Centers for Disease Control and Prevention.

MMWR Weekly. (2007, April 13). Preliminary FoodNet Data on the Incidence of Infection with Pathogens Transmitted Commonly Through Food—- 10 States, 2006. 56(14);336-339. Atlanta, GA: Centers for Disease Control and Prevention.

MMWR Surveillance Summaries. (2000, March 17). Guidelines for confirmation of foodborne-disease outbreaks. 49(SS01);54-62. Atlanta, GA: Centers for Disease Control and Prevention.

Rees JH, Soudain SE, Gregson NA, and Hughes RAC. (1995). Campylobacter jejuni infection and Guillain-Barré syndrome. N Engl J Med; 333:1374-1379.

Scott E and Sockett P. (1998). How to Prevent Rood Poisoning. New York: John Wiley & Sons.

Smith KE, Besser JM, Hedberg CW, Leano FT, Bender JB, Wicklund JH, Johnson BP, Moore KA, and Osterholm MT. (1999, May 20). Quinolone-resistant Campylobacter jejuni infections in Minnesota, 1992-1998. N Engl J Med. 340:1525-1532.

Stevenson JE, White D, Torpey III DJ, Craig AS, Smith KE, Park MM, Pascucilla MA, Anderson AD, and the NARMS Working Group. (2002, March). Enhanced Surveillance for Antimicrobial Resistance Among Enteric Bacteria: NARMS Retail Food Study. Atlanta, GA: International Conference on Emerging Infectious Diseases.

Tauxe RV. (1992). Epidemiology of Campylobacter jejuni infections in the United States and other industrial nations. In: I Nachamkin, MJ Blaser, and LS Tompkins, (Ed.). Campylobacter jejuni: current and future trends (pp 9-12). Washington: American Society for Microbiology.

Wallinga, D. (2002, October). Antimicrobial Use in Animal Feed: an Ecological and Public Health Problem. Minnesota Medicine. 85. Retrieved January 16, 2008, from http://www.mmaonline.net/publications/MNMed2002/October/Wallinga.html.

  • mark mcafee

    campylobacter was not considered a pathogen by the CDC prior to 1975…
    Sounds like we have sterilized our immune systems and now we have an entire industry based on chasing the who-done-it of food producers.
    Campylobacter is also something that does not reoccur in those that have been infected. You become immune to it. As a preventative nutrition, it would be very smart to drink raw milk. Those that do on a continuous basis have an immunity to campylobacter.
    So in other words….it is not a pathogen except to to those that buy into the sterilized food and western medical idea that sterilized is better. Sterilized foods and depressed immune function aslo brings on lactose intolerance, heart disease, cancers and the list goes on….and on.
    Living foods bring on improved immunity. That is why the NIH just announced a huge push towards probiotics and even something they call “ancient milk”. someday the government will get the guts to say raw milk.
    All the best as you rethink what health really means.
    Mark
    S

  • brandon

    how do you get it

  • Corey

    I thought Norovirus was the number 1 cause of foodborne illness? Is Salmonella the number 1 cause of foodborne bacterial illness? Is that how this is working? Just wanted to know and make sure I have my facts right.

  • http://www.draxe.com/is-milk-hurting-or-helping-your-bones/ Dr. Josh Axe

    Are you suggesting people drink pasteurized milk? Far better to drink raw milk or coconut milk instead. http://www.draxe.com/is-milk-hurting-or-helping-your-bones/

  • Corey

    What? Pasteurized milk is way safer than raw milk, as well as being nutritionally comparable. Raw milk, even under the best circumstances is extremely risky, especially for the YOPI populations (Young, Old, Pregnant, Immunocompromized). At the very least, if you want a ‘closer to raw milk’ milk, choose milk that has been vat-pasteurized. It is held at a lower temperature for a longer amount of time to achieve the right amount of thermal lethality.