Campylobacter 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.
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