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Campylobacter

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Reporting Obligations

Confirmed and suspected cases shall be reported to the local Health Unit.

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Epidemiology

Aetiologic Agent

The bacterium Campylobacter jejuni (C. jejuni) and less commonly Campylobacter coli (C. coli) are the usual causes of campylobacteriosis.

Campylobacter species are motile, comma-shaped, microaerophilic Gram-negative bacilli that cause gastroenteritis.

Clinical Presentation

Symptoms usually occur 2–5 days after exposure and may persist for one to two weeks. Illness is characterized by diarrhea, abdominal pain, malaise, fever, nausea and vomiting. The symptoms can vary from mild to severe, can mimic appendicitis and can also be asymptomatic. Relapses can occur. Blood and mucus may be present in liquid stools. Extraintestinal infection is rare, usually occurring in immunocompromised patients. Post-infectious complications include reactive arthritis, Guillain-Barré syndrome, irritable bowel syndrome, myocarditis and pericarditis.

Modes of Transmission

Ingestion of the organisms in undercooked meat and poultry, contaminated food and water, unpasteurized (raw) dairy products, or from direct contact with infected pets (especially puppies and kittens) and farm animals. Contamination of milk usually occurs from intestinal carrier cattle. Food can become contaminated from food handlers who do not properly wash their hands after touching raw/undercooked poultry; or raw/undercooked poultry can contaminate other foods or surfaces, like cutting boards and knives. The infective dose is often low. Person-to-person transmission appears uncommon.

Incubation Period

Usually 2–5 days, with a range of 1–10 days, depending on dose ingested.

Period of Communicability

Several days to several weeks, individuals without antibiotic treatment may shed Campylobacter bacteria in the feces for 2–7 weeks.

Risk Factors/Susceptibility

Persons with immunocompromised conditions have increased risk of infection, severe or invasive disease, and relapse or recurrence. Decreased stomach acidity is a risk for infection. Immune mechanisms are not well understood, but lasting immunity to serologically related strains follows infection. In developing countries, most people develop immunity in the first two years of life.

Diagnosis and Laboratory Testing

Confirmation of infection with or without clinically compatible signs and symptoms is by isolation of Campylobacter species by culture from an appropriate clinical specimen (e.g. stool, urine, body fluids).

Enteric culture specimens are accepted only from health units at Public Health Lab. If you are a clinician, please use a community laboratory to perform your testing.

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Treatment and Case Management

Treatment recommendations are under the direction of the attending health care provider.

Inform patients that symptomatic cases will be excluded from conducting activities in high-risk settings such as the food industry, healthcare, or daycare until symptom free for 24 hours, or 48 hours after completion of antibiotic or anti-diarrheal medications.

Patient Information

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Additional Resources

Heymann, D.L. Control of Communicable Disease Manual (19th Ed.). Washington, American Public Health Association, 2008.

Public Health Ontario. “Campylobacter”.

References

Ministry of Health and Long-Term Care, Infectious Diseases Protocol, 2019.