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Campylobacter

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Campylobacter patogeni

Campylobacter is a genus of bacteria consisting of mobile, curved or spiral-shaped, non-spore-forming bacilli.

Microaerophilic, gram negative, thermophilic and very labile in the external environment, bacteria belonging to the Campylobacter genus are among the microbial contaminants of greatest concern for human infections from contaminated foods.

In particular, among the 15 Campylobacter species currently identified, only four are commonly associated with human diseases:

  • Campylobacter jeujini, Campylobacter coli e Campylobacter lari: represent, in descending order, the species most commonly associated with infection in humans; They mainly cause intestinal infections which are accompanied by the classic symptoms of gastroenteritis.
  • Campylobacter fetus: responsible for extraintestinal infections in newborns and immunocompromised subjects.

Campylobacter infections are zoonoses (diseases transmitted by animals) spread throughout the world, which do not spare even the most industrialized countries. These bacteria are in fact common commensals of many warm-blooded animals, both wild and domestic (cattle, sheep, pigs, dogs, cats, rodents and all varieties of birds), whose gastrointestinal tract represents the main reservoir of pathogenic Campylobacter.

In industrialized countries, Campylobacter infections are much more common than you might think; in the USA, for example, campylobacteriosis affects no less than 2 million people every year, and it is believed that they exceed Salmonella and Shigella infections combined in incidence.

Most infections with pathogenic Campylobacteria result from the ingestion of drinks or foods contaminated with fecal material from infected animals. Unpasteurized milk is also an excellent vehicle, as is close contact with infected household animals. Among the foods most at risk we also remember insufficiently cooked chicken meat, and minced meat (such as hamburgers) in general.

Direct transmission from person to person via the fecal-oral route is also possible.

As compared to Salmonella spp. e
Staphylococcus aureus, Campylobacter do not last long on surfaces such as Teflon and steel, due to their inability to adhere to them. Consequently, work surfaces and utensils are not implicated as a source of food pollution. Furthermore, given the poor resistance to adverse environmental conditions and gastric acidity, the risk of foodborne infection by pathogenic Campylobacter is mostly linked to the consumption of raw or undercooked foods that have undergone recent faecal pollution.

In temperate climates, Campylobacter infections are more frequent in the summer and autumn months, affecting pediatric subjects to a greater extent than adults and the elderly, who resist contagion better also thanks to the acquisition of specific immunity following the previous infections.

Symptoms

The incubation period in humans lasts on average from 2 to 5 days, at the end of which affected patients complain of symptoms characterized by watery, often haemorrhagic diarrhoea, with abdominal pain, fever, myalgia, headache, prostration and nausea, therefore indistinguishable from that associated with diseases caused by other enteric pathogens. These symptoms are caused by the powerful enterotoxins released by the bacterium, responsible for food poisoning which severely damages the cells of the intestinal mucosa and facilitates bacterial invasion. However, the intensity of the symptoms is highly variable, so much so that in subjects affected by mild forms the disease can progress asymptomatically, while in more severe forms it can take on aspects similar to ulcerative colitis and Crohn's disease.

Complications

In most cases the infection remains confined to the intestine and represents a self-limiting pathology, although in the absence of treatment recovery can take up to a couple of weeks. Extra-intestinal infections involving other tracts of the digestive system (pancreatitis, cholecystitis), the joints (reactive arthritis) or the nervous system (Guillan-Barrè syndrome) can only occur in pediatric subjects, or those who are immunocompromised and severely debilitated. .

Treatment

Since it is an often self-limiting disease, the body tends to heal spontaneously within a few days, without the need to administer antibiotics. These, in particular erythromycin (the antibiotic of first choice for Campylobacter enteritis), clarithromycin and azithromycin, can still be useful for accelerating healing and reducing the period in which the bacterium can be excreted in the feces. Unfortunately, over the years antibiotic-resistant Campylobacter strains have appeared, especially to cephalosporins and penicillin, which complicate the treatment of the infection in the most severe cases. The administration of liquids and electrolytes (rehydration therapy) always represents the essential point of the treatment; in the most severe forms it must be performed intravenously.

Prevention

As anticipated, pathogenic Campylobacters are not very resistant in the external environment; for example, they rapidly inactivate when exposed to oxygen and low environmental humidity. Stomach acidity is also an excellent defense against infection, although not always sufficient to prevent contagion; in this regard, we remind you that individuals treated with antisecretory drugs, such as proton pump inhibitors and H2 antagonists, are more exposed to the risk of contracting Campylobacter infections.

Given the bacterium's poor resistance to adverse environmental conditions, cases of epidemic food-borne campylobacteriosis are rare. Prevention is based on cooking food, on the consumption of exclusively drinkable water (in sealed bottles when traveling to developing countries) and on thorough hand cleaning (washing with hot water and soap) after being in contact with with animals, including domestic ones, before food preparation and between the handling of raw foods and already prepared foods.

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