Researchers at the University of Veterinary Medicine, Vienna have now solved the puzzle, showing that Campylobacter can survive ambient oxygen levels thanks to the presence of other bacteria, species of Pseudomonas. The interaction between the different species seems to be a mechanism for Campylobacter to remain viable on chicken meat and thus to infect humans. Campylobacter (yellow) and Pseudomonas (red).

Although Campylobacter infections are rarely life-threatening they are extremely debilitating and have been linked with the development of Guillain-Barré syndrome, one of the leading causes of non-trauma-induced paralysis worldwide.

Friederike Hilbert, Manuela Scherwitzel, Peter Paulsen and Michael P. Szostak. Survival of Campylobacter jejuni under Conditions of Atmospheric Oxygen Tension with the Support of Pseudomonas spp.. Applied and Environmental Microbiology, 2010; 76 (17): 5911 DOI: 10.1128/AEM.01532-10

A prospective cohort study was set up in Walkerton, Ontario, Canada to investigate any long-term health problems following contamination of the town’s water supply in May 2000 with E. coli O157:H7 and Campylobacter.

Researchers recruited 1977 adult participants of whom almost all (99%) said they had drunk the contaminated water. Of these, 1067 (54%) had had acute gastroenteritis, and 378 sought medical attention.

Participants were followed up annually, with physical examination and laboratory assessment. This included height, weight, blood pressure, serum creatinine concentration, random (spot) urine analysis for albumin: creatinine ratio; in some years fasting serum glucose measurement, oral glucose tolerance testing and 24-hour urine collection were also done.

People who had had acute gastroenteritis during the E. coli outbreak were 1.3 times more likely to develop hypertension, 3.4 times more likely to develop renal impairment and 2.1 times more likely to have a cardiovascular event such as a heart attack or stroke, compared with people who had not been ill or only mildly ill. We have certainlly seen these risks for people who develop Hemolytic Uremic Syndrome (HUS), but not for more mild illnesses.

“Our findings underline the need for following up individual cases of food or water poisoning by E. coli O157:H7 to prevent or reduce silent progressive vascular injury.” They suggest that annual monitoring of blood pressure and periodic monitoring of renal function may be warranted. They add: “These long term consequences emphasize the importance of ensuring safe food and water supply as a cornerstone of public health.”

Authors

Arnon Broides1, Raffi Lev-Tzion1, Eugene Leibovitz2

1Department of Pediatric Emergency Medicine, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
2Pediatric Infectious Disease Unit, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel

Abstract

We present a case of a child with generalized convulsions and dysentery caused by Campylobacter jejunii and review the pediatric literature published on this topic. Our case, as well as previous reports, suggests that in a child with convulsions and dysentery, the differential diagnosis should include shigellosis and also Campylobacter spp. infection. Because azithromycin provides appropriate coverage for both etiologies and in light of the present case, we suggest that it be considered in addition to parenteral ceftriaxone in severe cases of dysentery with or without convulsions.

Although acute cases are an emergency, most people recover completely, according to the Mayo Clinic.

Q: What are its symptoms?

A: While its first symptoms are usually weakness and numbness in the extremities, it can eventually paralyze the entire body, according to the Merck Manual of Medical Information. Symptoms are often worst in the first two or three weeks.

In 5% to 10% of cases, the muscles that control breathing become so weak that patients need to be put on a ventilator. In another 10% of cases, muscles that control swallowing are so weakened that patients need to be fed through a tube into the stomach.

Q: How is it treated?

A: Doctors may cleanse the blood, removing harmful antibodies, or give patients a treatment called immune globulin, with protective antibodies with donors, according to the Mayo Clinic.

Q: Do people recover?

A: Most patients improve slowly over several months, even without treatment, according to the Merck Manual. Early treatment can speed up recovery, allowing patients to improve within days or weeks. Although there's no known cure, treatment can ease recovery, according to the Mayo Clinic.

About 30% of adults still suffer from some muscle weakness three years later, however. Fewer than 5% of patients die in the early stages of the disease.

Q: How common is it?

A: Guillain-Barre affects one or two out of every 100,000 people.

Q: What causes it?

A: Doctors don't know the exact cause of Guillain-Barre, and some cases appear without any clear trigger, according to the Mayo Clinic. One of the most common triggers is campylobacter, a type of bacteria often found in undercooked chicken or other food. Guillain-Barre has also been triggered by surgery; the Epstein-Barr virus; Hodgkin's disease; mononucleosis; HIV, the virus that causes AIDS; and rabies.

In an infamous outbreak in 1976, hundreds of people who received a swine flu vaccine developed Guillain-Barre, although scientists question whether the shots were really the cause. The Centers for Disease Control and Prevention has not seen any increase in Guillain-Barre related to vaccination against the H1N1 virus.

Q: How is the immune system involved?

A: The disease occurs when the immune system — which typically protects the body from illness by attacking viruses and other foreign invaders — instead attacks the myelin sheath, a coating that protects the nerves. Damage to this critical coating, which acts like insulation, interferes with the way that nerves send signals between the body and brain, according to the Mayo Clinic.

Campylobacter bacteria are the most common cause of gastroenteritis in the developed world. They are frequently shed by beef cattle in manure and although the impact on human health is undetermined there appears to be a link in areas such as Alberta, Canada where cases of human campylobacteriosis are extremely common and the cattle density is high.

Composting is described as a process in which organic matter in manure is stabilized through water loss, nutrient transmission, alteration of physical structure, elimination of weed seeds, and the inactivation of coliform bacteria, protozoan cysts and oocysts and viruses. Government agencies in both the United States and Canada recommend composting to reduce pathogen levels in manure.

In the study researchers examined the persistence of naturally occurring campylobacter bacteria in compost derived from manure of beef cattle that were administered antibiotics (AS700) and a control group that were not. Bacterial populations were the same in both groups, however, the temperature of the AS700 compost was more viable and not as high as that of the control group. Water content, total carbon, total nitrogen and electrical conductivity varied significantly between groups. Results showed that no reductions in the quantities of Campylobacter jejuni DNA were observed throughout the 10-month composting period. Further testing suggests that Campylobacter DNA examined from compost was extracted from viable cells.

"The findings of this study indicate that campylobacteria excreted in cattle feces persist for long periods in compost and call into question the common belief that these bacteria do not persist in manure," say the researchers.

Despite the tradition involved, a food-safety specialist in Penn State's College of Agricultural Sciences says some practices are worth reconsidering, especially since Mom may not have fully appreciated the risk of foodborne illness.

"Cooking a stuffed turkey is riskier than cooking an unstuffed one, because it takes longer for the stuffing to reach the proper internal temperature of 165 degrees F when it is placed into the cavity of the bird," said Martin Bucknavage, food safety specialist in the department of food science. "While people concern themselves about cooking the bird to 165 degrees F, they must ensure that stuffing also achieves that temperature."

Bucknavage noted that often the turkey ends up overcooked in getting the stuffing to the proper temperature, or the stuffing ends up undercooked because the turkey is removed from the oven when the bird is at the right temperature, but the stuffing is not.

"It is the undercooked stuffing that poses the real risk," he said. "Bacterial pathogens such as Salmonella may be present in the cavity of the bird and can contaminate the stuffing. If the stuffing is not cooked thoroughly, Salmonella can survive and may infect those who consume it."

If you want a properly cooked, stuffed bird with less chance of foodborne illness, Bucknavage said, just cook your stuffing separately. To preserve a family tradition, stuff your fully cooked bird with the cooked stuffing before serving. If you simply must stuff your bird before cooking, take extra care to ensure the internal temperature of both the bird and the stuffing exceeds 165 degrees F before serving.

Another common practice that Bucknavage discourages is washing the outside surface of your store-purchased bird.

"The problem with this practice is that pathogenic bacteria often are embedded in the surface of the skin," he said. "When faucet water hits bacterial pathogens, they become aerosolized and land all over your kitchen counter, the faucet and you.

"The U.S. Food and Drug Administration says Campylobacter is one of the most common causes of diarrheal illness in the country, and undoubtedly, many of these cases are a result of cross-contamination in the kitchen. So there is no need to wash the outside of your bird -- the cooking process easily will kill these bacteria. But you still need to clean and sanitize your counter and any kitchen equipment that touches the raw bird."

Lastly, although Mom may have thawed that frozen bird on the counter overnight, this method has been shown to help increase the amount of pathogenic bacteria that might be present on the raw turkey. Rather, you can use one of three methods:

--Thaw in the refrigerator. "You should allow about 24 hours for every five pounds of turkey in a refrigerator set at 40 degrees F or below," he said. "Be sure to place the frozen turkey, breast side down, in the original wrapper in a container to prevent raw fluids from dripping on other foods. A 16-pound turkey will require three and a half days of refrigerated thaw time."

--Thaw under cold water. Submerge the wrapped turkey in cold tap water in a leak-proof plastic bag to prevent cross-contamination and to prevent excess pick-up of moisture. Allow 30 minutes per pound, and change the water every 30 minutes until the turkey is thawed.

--Thaw in your microwave. "You can do this if your microwave is large enough," Bucknavage said. "Follow the manufacturer's instructions, and be sure to cook the bird immediately once you've thawed it this way.

"Mother won't mind if you change a thing or two if it means keeping this generation's food safe," Bucknavage said.

According to Steve Pretanik, director of science and technology for the National Chicken Council, the USDA survey shows that the industry is doing an excellent job of reducing the presence of potentially disease-causing bacteria on raw chicken. Pretanik emphasized that the investments made by the industry in improved technology and bacteria-fighting interventions have paid off in terms of a safer product for consumers. He noted that any remaining bacteria are destroyed by the heat of normal cooking.

USDA conducted the study from July 2007 to June 2008 at 182 broiler slaughter plants. The agency collected a total of 6,550 samples, divided equally between samples taken at the re-hang station and after the chiller. Raw chickens were processed under the available antimicrobial measures of each plant, which typically include the use of chlorinated water in processing and in the chiller.

The survey showed that campylobacter was present in 65% of the samples of chicken tested. Salmonella was in 6% of samples, 0.5% of these samples contained S. enteritidis and S. typhimurium.

Andrew Wadge, Director of Food Safety at the Food Standards Agency, said: "The continuing low levels of salmonella are encouraging, but it is disappointing that the levels of campylobacter remain high. It is obvious more needs to be done to get these levels down and we need to continue working with poultry producers and retailers to make this happen. Other countries like New Zealand and Denmark have managed to do so; we need to emulate that progress in the UK."

As part of the Agency’s work to reduce levels of campylobacter in UK-produced chicken an international conference on campylobacter is being organised for 2010, where a range of options for tackling the bug will be discussed.

Campylobacter is the most common bacterial cause of food poisoning. It is responsible for around 55,000 cases of illness in the UK every year, and is therefore one of the key organisms the Agency is tackling in order to reduce levels of foodborne illness. Campylobacter can be found on meat, unpasteurised milk, and untreated water; however there is strong evidence that chicken is the most common cause of illness.

The FSA emphasises that while campylobacter is still present in a significant proportion of fresh chicken sold in the UK, cooking chicken properly all the way through will kill the bug, so consumers can avoid the risk of illness.

The UK-wide survey of fresh chicken at retail was carried out between May 2007 and September 2008. During the course of the survey, 3,274 samples were tested for the presence of campylobacter and salmonella.

 drinking unpasteurised milk is risky because it hasn’t been heat treated to kill any harmful bacteria that might be in the raw product, such as Salmonella, E. coli, Campylobacter and Listeria monocytogenes.

NZFSA also explains why "raw" milk is so risky.

It is very easy for harmful bacteria to get into raw milk during the milking process. They can cross into milk while it is still in the udder (via unrecognised mastitis) or milk can be contaminated from the dairy farm environment during milking. Once contaminated, raw milk is not subjected to any step between collection and consumption that will rid milk of the harmful bacteria; unlike pasteurised milk, which receives a heat treatment that kills them.

Campylobacter jejuni is also a common illness in the U.S. In rare cases, it can lead to the development of Guillain Barre Syndrome (GBS). GBS is a very serious illness that causes nerve paralysis.

According to the Post:

The vaccine candidate against the pathogen Campylobacter jejuni, developed by Guerry, her colleagues at the U.S. Naval Medical Research Center in Silver Spring and Canadian scientist Mario Monteiro, successfully protected against infection in monkeys during testing last year and is slated for human clinical trials.

If the vaccine becomes a reality, it would be significant step forward in reducing foodborne illness in the U.S. and internationally.

While it does not receive the notoriety of foodborne pathogens like E. coli O157:H7 and Salmonella, it is very common and can be quite dangerous.  In rare cases, Campylobacter infection can lead to Guillain-Barré (ghee-yan bah-ray) syndrome (GBS).   GBS is a disorder in which the body’s immune system attacks part of the peripheral nervous system.     Although this syndrome is rare (affecting about one to two persons in 100,000) it is the most common cause of acute neuromuscular paralysis in the world.

Payne provides four primary tips on avoiding Campylobacter infection:

• Limiting poultry exposure - especially exposure to raw poultry.   The public lacks sufficient appreciation of the risks of exposure to raw foods, especially poultry, in the preparation process.  According to FDA testing, Campylobacter has been found in nearly 50% of raw chicken breasts.  Good kitchen hygiene, including handwashing, is important.
• Proper hygiene with pets.   Payne reports that new animal owners (including dog owners)  are more likely to get Campylobacter infections.   Long time owners may build some resistance to infection.   Once again, washing hands is a good idea.
• Travel Abroad-  the water supply in some countries can pose a threat.
• Limit Antacids- Payne reports that antacids neutralize the stomach acids that help protect our bodies from bacteria.

Like many others in our family, the "Culligan Man" spent time as an expectant father at St. Joseph's Hospital in Sioux City, Iowa one January day in 1921.  Walking the halls, he found his way down in the boiler room, where he was perplexed about two large cylindrical tanks.  The boiler tender told him the tanks were used to "soften" the water to prevent scales in the boilers and make soap in the hospital laundry go furthers.

As the story goes, cousin Emmett was so interested in how St. Joe's made soft water that the boiler man gave him a coffee can full of the "Zeolites," the greenish black stuff that removed the hardness from water like magic.

It took Emmett another 15 years or so to put it all together, but as we all know, soft water systems installed by calling "Hey Culligan Man" became more common than not in hard water areas like those around Sioux land.

And now that could be solve a new problem.  

Writing for the United States Department of Agriculture (USDA), Sharon Durham reports that water hardness plays a role in removing bacteria from chicken skin.  She reports:

Reducing water hardness may increase its ability to remove bacteria from broiler chicken skin, according to Agricultural Research Service (ARS) scientists in Athens, Ga.  Water hardness varies in different geographical locations, but most water tested in the United States has some degree of hardness. 

“Hard” water has higher concentrations of dissolved minerals, such as calcium and magnesium.  Water is softened by removing these minerals, either mechanically or chemically. 

Microbiologist Arthur Hinton, Jr., and chemist Ronald Holser of the ARS Richard B. Russell Research Center in Athens conducted studies comparing the ability of very hard, moderately hard, and “soft” water to rinse away bacteria like Campylobacter,Staphylococcus and Pseudomonas from the skin of broiler chicken carcasses.

Very hard water was prepared by dissolving calcium chloride and magnesium chloride in distilled water, and moderately hard water was prepared by diluting one part very hard water with one part soft water.  Potassium citrate was used to reduce water hardness.

After five rinses in each water type, soft water removed up to 37 percent more bacteria from the chicken skin than did the other two water types.

Campylobacter bacteria are found in the intestinal tract of birds and can contaminate the bird’s carcass during processing. Staphylococcus is normally found on the skin of the birds, and Pseudomonas is a type of spoilage bacteria that can be found in processing water.

There is more at the ARS site.

In the High Temperature/Short Time process, which is typically used in milk pasteurization, the milk is forced between metal plates or through pipes heated on the outside by hot water, and is heated to 161 degrees F for 15 to 20 seconds, followed by quick cooling to about 39 degrees.

This process does not add any ingredient to the milk and it certainly does not add formaldehyde, which is considered to be carcinogenic.

This process is designed to achieve a 5-log reduction, killing 99.999 percent of the viable microorganisms in milk.

Mr. Stromberg writes, "I would suggest that before anyone makes a decision to consume raw milk, they should thoroughly research this issue and make a rational decision on a scientific basis and not on an unfounded emotional basis." 

Consuming raw milk and other unpasteurized dairy products made from raw milk is an established risk factor for infection with pathogenic bacteria such as E. coli O157:H7, Salmonella, and Campylobacter.  E. coli and other pathogens are shed in the feces of livestock such as cows and goats and can contaminate milk during the milking process. Although practicing standard hygiene such as washing hands and keeping equipment clean can lower the potential for contamination, pasteurization is seen as the most effective treatment for reducing the number of E. coli and other contaminants found in milk.

Licensing or certifying dairies to sell raw milk does not guarantee that a safe product will be produced. Laws regulating the sale of raw milk were passed in the early 20th century, and in what proved to be a major public health success in the United States, the percentage of all food and water-borne outbreaks attributable to milk products dropped from 25 percent in 1938 to about 1 percent by 2005. Today, it is a violation of federal law to sell raw milk packaged for consumer use across state lines (interstate commerce), but each state regulates the sale of raw milk within its own state lines (intrastate).

In Washington, all raw milk product packaging must include the following warning:  “WARNING: This product has not been pasteurized and may contain harmful bacteria. Pregnant women, children, the elderly and persons with lowered resistance to disease have the highest risk of harm from use of this product.”  Rules for producing raw milk products in Washington are online, courtesy of the Washington Department of Agriculture.

Campylobacter bacteria is one of the common causes of diarrhea and food-borne illness in the U.S, where about 20 million stool culture tests are done every year to diagnose Campylobacteriosis.

Meridian said that ImmunoCard STAT! CAMPY, by means of a simple procedure, could provide results in 20 minutes. The testing technique is also free from the problems associated with the presently used method of culture testing.

For more, check this out.

"Our findings indicate that chilling process has a limited effect in the final products Campylobacter contamination because poultry enter the slaughter processing with high counts of contamination. This may represent a health risk to consumers, if proper cooking practices are not employed. The levels and frequencies of Campylobacter found during the processing of Chilean poultry appear to be similar to those reported elsewhere in the world," BMC Microbiology quoted the researchers as saying.

A copy of the provisional report can be found here.

Didn't think so.  Well, the good folks at British Poultry are giving that a lot of thought.

The European Union wants to cut the amount of Campylobacter in chickens. That has British Poultry looking hard at the issue.

Research data shows that chicks are campylobacter free for the first two or three weeks of their life. Professor Diane Newell says one option for UK's poultry industry would be to move forward the time of slaughter for chickens, which is the current practice in Scandinavia.

Professor Newell has also found that a 30 percent reduction in the risk to the consumer can be achieved with only a small reduction in the numbers of campylobacter on chicken carcasses.

UK 's poultry and meat sector is tackling campylobacter with a target of halving it by 2010 in British retail chicken.  For more on how the UK broiler industry is dealing with the future EU targets, go here.

The writer is Jo-Ann Heslin, the dietitian and the author of the nutrition counter series for Pocket Books with 12 current titles and sales in excess of 7 million books.  Her words are found on HealthNewsDigest.com where she responds to the question: Is Raw Milk Safe To Drink?

Ms. Heslin does not mince words, answering: "In a word, no."   Go here and read it all.

According to the company, there is a significant need for the Premier Campy test because it provides a solution to several concerns associated with culture testing, currently the most commonly practiced lab technique for detecting the campylobacter bacteria.

Premier Campy dramatically reduces these concerns with a consistent enzyme immunoassay method that measures the antigen instead of the fragile bacteria in an environment that is less inhibitory than current culturing procedures, the company claimed.

For more from Meridian, go here. 

FWI quotes the Council's Ted Wright as saying: "Foodborne illness caused by campylobacter infection is still a problem. We know it is a widespread bacterium and that the chicken's gut provides an ideal environment for it to multiply. We are keen to work further to reduce campylobacter on poultrymeat."

"While indoor rearing can help reduce the incidence, greater scientific understanding is needed of how the organism gets into flocks. There have been several joint research projects between FSA and industry over many years, but we need to distil these findings into interventions that work.

"As Andrew Wadge of the FSA said recently, we need to look at what cost-effective measures we can put in place between the farm and the fork, which will intervene to eliminate camplylobacter," said Mr Wright  

"Therefore, we want to set-up a joint technical group to pull these together. There's a lot to do in this area, but we can hope that one day we will have campylobacter under control, at least in the poultry sector, in the same way that we now control salmonella."

So it was only a matter of time before grocery stores began offering cart-washing services to their customer services. As the Wall Street Journal put it this week:

Though hardly Public Enemy No. 1, shopping carts are gaining a reputation as one of the dirtiest public places, with some found to harbor such microbial villains as the diarrhea-causing Campylobacter and the potentially deadly Salmonella.

Check out what's happening at the Chevy Chase Supermarket here.  It will be coming to a store near you soon enough!