There is no way of knowing for sure just how many species of bacteria exist in the world but the number is believed to be anywhere between 10 million and 1 billion. Only a small portion of these affect humans. It can cause a range of diseases from a sore throat, to diarrheal illness, bladder infections, brain infections and even spread throughout the body to cause death. One of these bacterial species is known as Campylobacter which is among the most common bacterial infections in humans.
What is Campylobacter diarrhea?
Campylobacter diarrhea is frequent bowel movements of usually watery stool that is caused by an infection of the bowels by the Campylobacter species of bacteria. It is a type of bacterial gastroenteritis. Although gastroenteritis is usually caused by viruses, Campylobacter enteritis accounts for about 7% of all cases of gastroenteritis. This equates to about 2 million cases per year in the United States. There is a number of different species of Campylobacter. The more common species causes gastroenteritis but other less common species can cause systemic diseases.
The Campylobacter bacteria can be spread through several routes and is also one of the possible pathogens to cause traveler’s diarrhea especially in areas of south and southeast Asia like Thailand. The infection is usually acute and rarely leads to death. However, people with weakened immune systems and the elderly are at a greater risk of complications particularly if proper medical management is not forthcoming. Dehydration is one of the main concerns as it can lead to fatal complications but this can be mitigated with proper hydration. Antidiarrheal drugs should be avoided because it can worsen the condition.
Causes and Spread
Campylobacter diarrhea is caused by Campylobacter species of bacteria but most commonly by Campylobacter jejuni. It is also known as campylobacteriosis and is one of the most common bacterial gastroenteritis spread among individuals in close contact(community-acquired). Campylobacter diarrhea tends to affect the jejunum and ileum of the small intestine but can extend to the large intestine, sometimes extending all the way to the rectum. The bacteria causes inflammation by invading the lining of the bowels and destroying cells.
However, not all Campylobacter species only cause intestinal infections and diarrhea illnesses. Sometimes the bacteria can enter the bloodstream (bacteremia) which allows it to travel throughout the body and affect other organs beyond the digestive system. Bacteremia is uncommon with Campylobacter jejuni but can occur in people who have weak immune systems. However, bacteremia is more likely to occur with other Campylobacter species, particularly Campylobacter fetus.
Less common Campylobacter species which cause human diseas includes C. lari, C. upsaliensis and C. hyointestinalis. Some can cause diarrhea, others bacteremia but only in immune compromised individuals and species like Campylobacter upsaliensis can cause diarrhea or bacteremia.
Picture of Campylobacter jejuni (scanning electron microscope image)
Transmission of Campylobacter
There are several routes by which Campylobacter bacteria can be transmitted.
- Feco-oral route: Bacteria in fecal particles gain entry into the mouth.
- Food: Unpasteurized milk an poultry in particular.
- Water: Contaminated water particularly where sanitation standards are not well maintained.
- Animals: Sick pets and birds (domestic like chickens or wild like seagulls).
- Sexual contact: It is not a sexually transmitted disease (STD) but can be transmitted from one person to another during sex.
Although many of these routes like contaminated water supplies are not a concern in developed nations most of the time, it can become a problem during periods of natural disaster. In addition travelers needs to be cautious. Campylobacter bacteria are one of the common microbes responsible for traveler’s diarrhea that is often transmitted to travelers through contaminated food and water.
The number of bacteria that needs to be ingested to cause disease can vary from just 100 bacteria to 10,000. This is known as the infectious dose. Normally a dose of 10,000 of more bacteria are needed to cause illness in people who are relatively. However, a lower infectious dose can cause disease in certain people. In other words relatively small doses could cause an infection. Most of the time the stomach acid can destroy these bacteria but this can be a problem for people who are taking acid-suppressing medication.
Signs and Symptoms
Not all Campylobacter infections will cause symptoms. However, with regards to Campylobacter diarrheal ollnesses the symptoms are largely the same irrespective of which Campylobacter species causes the bowel infection. The incubation period varies from 1 to 7 days. This means that during this time there are no symptoms despite the bacteria having gained entry into the body. The variation in the time period is most likely related to the infectious dose – meaning that a higher infectious dose will have a shorter incubation period.
The signs and symptoms of Campylobacter enteritis includes:
- Abdominal pain usually described as cramping in nature and often in the right lower quadrant of the abdomen.
- Fever which can be low grade or as high as 40C and may occur as one of the first symptoms along with a headache and muscle pains.
- Diarrhea which is usually watery and often bloody, and may be as many as 10 bowel movements in a day.
- Vomiting is sometimes present either before the diarrhea starts or along with it.
Duration of Illness
Campylobacter diarrhea rarely lasts for more than one week. However, the illness can be longer in the elderly and people with weakened immune systems. Some people experience relapses over several weeks. Prompt medical treatment, adequate hydration and avoidance of behavior, foods or fluids that may have caused the infection is essential to shorten the duration of the illness.
Treatment of Campylobacter Diarrhea
As with any diarrheal illness, proper hydration is essential to avoid complications like dehydration which could turn deadly. Oral rehydrating solutions (ORS) is the best choice as it contains the correct balance of fluid and electrolytes to ensure adequate hydration without exacerbating the diarrhea. If oral hydration is insufficient to prevent dehydration then intravenous (IV) fluid administration is necessary.
The use of medication for Campylobacter diarrheal illness is not always necessary. In fact anti-diarrheal drugs like loperamide should be avoided. It can worsen and prolong the illness thereby increasing the risk of severe dehydration and the spread of bacteria into the bloodstream (bacteremia). Even antibiotics to eradicate the bacteria may not be required.
People who are immune compromised, pregnant, do not show any signs of improvement or resolution of symptoms, where the fever is very high or the diarrhea is bloody will probably require antibiotics.