Campylobacter infection or campylobacteriosis is a contagious gastroenteritis caused by the Campylobacter bacterium and is notifiable in Germany. In industrialized countries, Campylobacter infection is the most common diarrheal disease caused by bacteria, along with Salmonella infection.
What is a Campylobacter infection?
Campylobacter infection is a notifiable infectious gastroenteritis (inflammation of the intestines) that can be attributed to the bacterial pathogen Campylobacter and is accompanied by high fever, watery diarrhea, and a general feeling of illness. The pathogen of a Campylobacter infection is usually transmitted to humans via animal food, contaminated drinking water, through contact with infected farm animals (especially poultry) or domestic animals (especially dogs, cats) or directly from person to person (smear infection). In the case of a Campylobacter infection, the pathogens spread to all areas of the intestine and cause damage to the intestinal mucosa. In many cases, the bacteria produce a toxin (enterotoxin) that is harmful to the human body and contributes to the development of the characteristic symptoms of Campylobacter infection.
Causes
Campylobacter infection is usually caused by direct or indirect transmission of the Campylobacter bacterium from infected animals, which often do not show symptoms of disease, to humans. Campylobacter are Gram-negative, spiral-shaped rod-shaped bacteria, with Campylobacter jejuni, Campylobacter coli, and the rarer subspecies Campylobacter fetus being primarily clinically relevant. In the majority of cases of Campylobacter infection, indirect transmission occurs through contaminated food of animal origin and contaminated drinking water. Campylobacter bacteria are excreted in the feces of affected animals or humans, so that direct or indirect contact with these can also lead to transmission (smear infection). Because the necessary amount of pathogen (500 to 1000 bacteria) for a Campylobacter infection is small, this form of gastroenteritis is considered highly infectious.
Symptoms, complaints, and signs
Infection with Campylobacter bacteria usually follows a very similar course, no matter which genus of Campylobacter bacteria is involved. After an incubation period of two to five days, the first symptoms appear. In the beginning, there are still non-specific symptoms. Patients have a general feeling of illness and complain of fatigue, headache and pain in the limbs, as well as high fever with temperatures up to 40 °C. After this preliminary stage, the typical symptoms of a Campylobacter infection often set in very suddenly due to the inflammation of the intestine. These symptoms are similar to those of a gastrointestinal flu. There is colic-like abdominal pain, i.e. pain that swells and shrinks, and the patients suffer from massive diarrhea. Diarrhea occurs up to 20 times a day, initially mostly watery, later also bloody-mucous diarrhea. The disease lasts between one day and rarely up to two weeks before the symptoms usually disappear spontaneously. In the vast majority of patients, the infection heals without consequences; only in rare cases can complications arise. Very rarely, so-called reactive joint inflammation (arthritis) can occur after healing. There is also a suspected association with Guillain-Barré syndrome, a rarely occurring inflammation of the nervous system.
Diagnosis and course
Campylobacter infection is diagnosed by pathogen detection in a blood or stool sample. In addition, the symptoms characteristic of a Campylobacter infection in the frame provide information about the disease. Thus, after the incubation period (on average 2 to 5 days), headache, high fever, general malaise and vomiting (vomiting) often occur in about 25% of those affected at the beginning of the disease. As Campylobacter infection progresses, spastic contractions (cramp-like pain) in the gastrointestinal tract and watery diarrhea (diarrhea) occur. A Campylobacter infection normally has an uncomplicated course and subsides after an average of 7 days.In isolated cases (10 to 20%, especially in children and immunodeficiency), there is a possibility of recurrence (recurrent Campylobacter infection) or chronic gastroenteritis. Campylobacter infection caused by Campylobacter fetus, on the other hand, has a severe course, as inflammation of other organs may be present in addition to gastroenteritis.
When should you go to the doctor?
With an inflammatory bowel disease and other symptoms that indicate a Campylobacter infection, a doctor should be consulted in any case. If symptoms such as headache, violent vomiting or high fever are added, a serious illness is likely – then immediately visit the doctor’s office and have the causes clarified. At the first signs of inflammation of the brain, inner lining of the heart, joints or veins, there is a medical emergency. The affected person must receive emergency medical treatment before further complications develop. People with weakened immune systems – for example, due to advanced cirrhosis of the liver, a malignant tumor or HIV infection – are particularly susceptible to Campylobacter infection. So are newborns and the elderly. In pregnant women, the disease increases the risk of miscarriage. Anyone to whom these factors apply should seek immediate medical attention with the warning signs of Campylobacter infection. In addition to a general practitioner, a gastroenterologist or infectious disease specialist may be consulted. In severe cases, emergency medical services or the nearest hospital should be contacted.
Complications
Due to Campylobacter infection, the patient usually suffers from symptoms of gastrointestinal illness. Vomiting, fever, and headache occur. Pain also occurs in the abdomen and is often accompanied by diarrhea. In most cases, the patient with Campylobacter infection requires about a week of bed rest and cannot do any physical work during this time. Food intake is also usually restricted due to abdominal pain and diarrhea. Campylobacter infection thus leads to a severe restriction of life, although this is short-lived. In most cases, treatment by the doctor is not necessary and the Campylobacter infection subsides on its own after a few days. If the infection is severe, treatment with antibiotics is necessary. Dehydration, which occurs due to diarrhea, must also be counteracted. Usually, there are no further complications. If the Campylobacter infection is not treated and persists for a long time, in the worst case it can lead to inflammation of the meninges or the inner lining of the heart. However, these complications occur very rarely.
Treatment and therapy
Since Campylobacter infection is a self-limiting disease, therapy depends on the symptoms present. In this regard, treatment is aimed primarily at compensating for the loss of fluids and electrolytes associated with the watery diarrhea. To this end, those affected by Campylobacter infection are advised to increase their fluid intake to compensate. If fluid loss is severe, infusions may be necessary. A low-fiber diet (rusks, tea) and avoidance of stool-stimulating beverages (apple juice) can additionally contribute to relief. In a more severe course of Campylobacter infection, antibiotic therapy with aminoglycosides, erythromycin or ciprofloxacin is recommended. For extraintestinal infections such as Campylobacter infection caused by Campylobacter fetus, antibiotic therapy is part of the treatment plan right from the beginning. In addition, Campylobacter fetus spreads to other areas of the body through the bloodstream system and can lead to endocarditis (inflammation of the inner lining of the heart), meningitis (inflammation of the meninges), phlebitis (inflammation of venous vessels), abscesses, and during pregnancy, miscarriage, among other conditions, so treatment of possible sequelae may be required in addition to prolonged antibiotic therapy.
Outlook and prognosis
Campylobacter infection does cause severe diarrhea and intestinal inflammation. However, it usually heals well without treatment with antibiotics. However, in ten to 20 percent of all those affected, the disease can break out again. This particularly affects children.The course of the infection is violent and leads to a high loss of fluids, which must be compensated. During infection, the disease is highly contagious via smear infection. In some cases, complications may arise. Thus, a mixed infection with other bacteria and viruses is possible, which complicates the course of the disease. Some affected persons develop reactive arthritis (inflammation of the joints) one to two weeks after overcoming the infection, which also usually heals without consequences after a few weeks. In rare cases, however, chronic courses are also observed. Another secondary disease can be Guillain-Barré syndrome. This is an inflammation of spinal nerve roots and peripheral nerves. In two-thirds of patients, there is a complete recovery from this condition as well. However, the disease can also lead to paralysis, including paraplegia, and in about ten percent of cases also to death from heart failure, respiratory paralysis or pulmonary embolism. In immunocompromised patients, an acute Campylobacter infection sometimes ends fatally due to the occurrence of sepsis. Rarely, a chronic course of Campylobacter infection is also possible.
Prevention
Campylobacter infection can be prevented by adequate hygiene. These include frequent hand washing, hygienic handling of potentially contaminated food (poultry), avoidance of raw consumption of these foods and of contaminated drinking water, and avoidance of contact with the stool of potential carriers of the pathogens that cause Campylobacter infections. The infection is notifiable, and in some occupational areas (food industry), the occupation may not be practiced if Campylobacter infection is present.
Follow-up
In most cases, direct follow-up is not necessary for a Campylobacter infection. Ordinary measures of good hygiene should be followed to speed healing and relieve discomfort. Campylobacter infection is treated in most cases with the help of antibiotics, and there are no complications or severe course. In mild cases of the infection, no treatment is necessary. The affected person must take care of his body and rest, taking only light food. Likewise, attention should be paid to the intake of electrolytes to compensate for fluid loss. When taking antibiotics, the affected person should make sure that they are not taken together with alcohol. If the possible reason for the Campylobacter infection is known, the trigger must of course be avoided and a high standard of hygiene must be observed. The light food in this infection should consist of apples, rusks and tea. Only after the symptoms have subsided can the usual diet be resumed. Stress can also have a negative effect on the course of the disease and should be avoided. In most cases, there is a positive course of the disease, and the patient’s life expectancy is also not reduced.
What you can do yourself
To compensate for the loss of water and electrolytes caused by the severe diarrhea, increased fluid intake is extremely important during a Campylobacter infection. Water, lightly sweetened herbal teas or an electrolyte solution, which can be purchased ready-made at the pharmacy or made yourself from water or tea, table salt and dextrose, are well suited for this purpose. Carrot soup is a proven home remedy for diarrhea, a gruel or rice soup also provides the body with necessary fluids and nutrients and additionally soothes the irritated intestinal mucosa. Rusk, grated apple and banana are also well tolerated. Fatty and flatulent foods, alcohol and caffeine should be avoided in campylobacteriosis until the digestive system has completely calmed down. Healing clay dissolved in water binds toxins in the intestines and can help to remove pathogens from the body more quickly. In terms of medicinal herbs, oak bark, cinquefoil and lady’s mantle are particularly useful in cases of severe diarrhea; dried blueberries also have a constipating effect due to their high tannin content. In addition to a sparing diet and an increase in the amount drunk, rest and the avoidance of stress promote healing.Due to the high risk of infection, contact with other people during the Campylobacter infection should be limited to what is necessary and strict hygiene should be observed. If the disease worsens despite self-treatment, a visit to the doctor is strongly advised.
