### Microbiology *Campylobacter* are gram-negative, comma shaped, rods. Includes *C*. *coli*, *C*. *fetus* subsp. *fetus*, *C*. *hyointestinalis*, *C*. *jejuni*, *C*. *lari*, *C*. *sputorum* subsp. *bubul*, *C*. *sputorum* subsp. *sputorum*, and *C*. *upsaliensis*. ### Epidemiologic Risks A worldwide zoonosis, *Campylobacter* are found in the gastrointestinal tracts of wild or domesticated cattle, cats, dogs, goats, rodents sheep, swine, and all varieties of fowl. Cases have been increasing in the US, along with ciprofloxacin resistance . [^1] Upscale cooking trends are a disease risk, such as eating less than completely cooked chicken livers,[^2] as is eating undercooked veal liver.[^3] Chicken and cow liver sashimi. Bad idea. Castrating sheep with your teeth, as they do in Wyoming, can lead to human disease.[^4] Probably not good for the sheep as well. That one still boggles the mind. As the CDC noted: > Increased risk for enteric infection among workers in agriculture, health care, food, and personal care occupations might be related to workplace exposures to pathogens. *Campylobacter*iosis or salmonellosis should be considered when workers have symptoms compatible with these diseases.[^5] What? I should think of those organisms in at risk patients with compatible symptoms? What a concept. Thank god for the CDC. *Campylobacter* is also spread by raw milk,[^6] with some outbreaks from quinolone-resistant organisms. [^8] *Campylobacter* is transmitted by men who have sex with men [^9] including *C*. *fetus*,[^10] often due to multi-drug resistant strains. [^11] Drinking water or slurry contaminated with cattle or swine feces by mistake (one hopes) during events like obstacle adventure races, where > all three patients had participated October 6-7 in a long-distance obstacle adventure race on a cattle ranch in Beatty, Nevada, in which competitors frequently fell face first into mud or had their heads submerged in surface water. [^12] There was a multistate outbreak of MDRO associated with puppies that were also multidrug resistant. [^13] I am reasonably sure I acquired my case from mussels.[^7] I was sick. Nasty disease. *Campylobacter* *fetus* subsp. *testudinum* subsp. nov. is acquired from reptiles. [^14] ### Syndromes *Campylobacter* primarily causes gastroenteritis. Immunoglobulin deficient patients often develop prolonged, severe, and recurrent *C*. *jejuni* infections. Bacteremia typically occurs in the elderly or immunocompromised with *C*. *fetus* or *C*. *jejuni* being the most common.[^15]  *C*. *jejuni* and *C*. *coli* bacteremia occur mainly in moderately young individuals without severe underlying diseases, are susceptible to antimicrobial agents, and the outcome is good, whether or not appropriate or inappropriate antimicrobial treatment given in the hospital. [^16] At least in Finland. Your mileage may vary. While usually self-limited, one person had *Campylobacter* isolated from their stool for more than a decade. The organism had "adapted to the internal environment of the patient". [^17] Poor bacteria. So much for location, location, location. One hint: the fevers and rigors can occur up to 24 hours before the diarrhea. I learned that on a case years ago and remembered it when I was in the ER with fevers and rigors with my case. I suggested a stool culture to the ER doc. It was positive. *Campylobacter* is one of those odd organisms that can set off autoimmune disease. A post *Campylobacter* reactive arthritis in HLA-B27 can occur and getting *Campylobacter* can increase your risk of Guillain-Barré 77 times. Whoa! [^18] *C*. jejuni is also associated with Immunoproliferative Small Intestinal Disease, a form of lymphoma. [^23] ### Treatment The effect of antibiotic treatment on gastroenteritis is not impressive, antibiotics will shorten symptoms by 1.3 days, hardly enough time to finish a good novel. [^19] A single dose of aztihromcin can be curative , [^20] although the usual duration is for 3 days. Erythromycin or doxycycline are also effective. Gentamicin or imipenem if iv needed. Quinolone resistance is increasing, probably from the use of quinolones in chickens. [^21] There is an ongoing issue of erythromycin and ciprofloxacin-resistant *Campylobacter* jejuni subspecies jejuni in MSW in Quebec, Canada. [^22] Do NOT use first-generation cephalosporins or penicillins. *Campylobacter* species most likely in the blood are *C*. *fetus* and *C*. *jejuni* and are likely susceptible to imipenem or another carbapenem. Many bloodstream isolates are resistant to fluoroquinolones and erythromycin. Combine the beta-lactam with gentamicin in patients with severe bacteremia and endovascular infections. ### Pushwhisperers [Chicken Feed](http://www.pusware.com/PW1/ChickenFeed.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop6.mp3) [Happy Thanksgiving](http://www.pusware.com/PW1/HappyThanksgiving.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop67.mp3) [Wrong. Again. And again. And again](http://www.pusware.com/PW1/WrongAgainAndagainAndagain.html) [Audio. The Gobbet 'o Pus Podcast](http://www.pusware.com/gobbet/gop1405.mp3) ### Rationalizations [^1]: Aimee L Geissler and others, Increasing _Campylobacter_ Infections, Outbreaks, and Antimicrobial Resistance in the United States, 2004–2012, _Clinical Infectious Diseases_, Volume 65, Issue 10, 15 November 2017, Pages 1624–1631, [https://doi.org/10.1093/cid/cix624](https://doi.org/10.1093/cid/cix624) [^2]: Jones, A. K., Rigby, D., Burton, M., Millman, C., Williams, N. J., Jones, T. R....Cross, P. (2016). Restaurant Cooking Trends and Increased Risk for Campylobacter Infection. _Emerging Infectious Diseases_, _22_(7), 1208-1215. https://doi.org/10.3201/eid2207.151775. [^3]: Gaulin, C., Ramsay, D., Dion, R., Simard, M., Gariépy, C., Levac, É....Fiset, M. (2018). Veal Liver as Food Vehicle for Human Campylobacter Infections. _Emerging Infectious Diseases_, _24_(6), 1130-1133. https://doi.org/10.3201/eid2406.171900. [^4]: Notes from the Field: _Campylobacter jejuni_ Infections Associated with Sheep Castration — Wyoming, 2011 December 9, 2011 / 60(48);1654-165 [^5]: Su C, de Perio MA, Fagan K, et al. Occupational Distribution of Campylobacteriosis and Salmonellosis Cases — Maryland, Ohio, and Virginia, 2014. MMWR Morb Mortal Wkly Rep 2017;66:850–853. DOI: [http://dx.doi.org/10.15585/mmwr.mm6632a4External](http://dx.doi.org/10.15585/mmwr.mm6632a4). [^6]: Hauri AM, Just M, McFarland S, Schweigmann A, Schlez K, Krahn J. Campylobacteriose-Ausbrüche in Hessen, 2005-2011 - und immer wieder Rohmilch [Campylobacteriosis outbreaks in the state of Hesse, Germany, 2005-2011: raw milk yet again]. Dtsch Med Wochenschr. 2013 Feb;138(8):357-61. German. doi: 10.1055/s-0032-1332884. Epub 2013 Feb 12. PMID: 23404322. [^7]: Jurinović L, Ječmenica B, Džafić N, Brlek Gorski D, Šimpraga B, Krstulović F, Amšel Zelenika T, Humski A. First Data on _Campylobacter_ spp. Presence in Shellfish in Croatia. Pathogens. 2022 Aug 19;11(8):943. doi: 10.3390/pathogens11080943. PMID: 36015062; PMCID: PMC9413699. [^8]: Burakoff A, Brown K, Knutsen J, et al. Outbreak of Fluoroquinolone-Resistant _Campylobacter jejuni_ Infections Associated with Raw Milk Consumption from a Herdshare Dairy — Colorado, 2016. MMWR Morb Mortal Wkly Rep 2018;67:146–148. DOI: [http://dx.doi.org/10.15585/mmwr.mm6705a2](http://dx.doi.org/10.15585/mmwr.mm6705a2) [^9]: Gaudreau, C., Helferty, M., Sylvestre, J., Allard, R., Pilon, P. A., Poisson, M....Bekal, S. (2013). Campylobacter coli Outbreak in Men Who Have Sex with Men, Quebec, Canada, 2010–2011. _Emerging Infectious Diseases_, _19_(5), 764-767. https://doi.org/10.3201/eid1905.121344. [^10]: Marchand-Senécal X, Bekal S, Pilon PA, Sylvestre JL, Gaudreau C. Campylobacter fetus Cluster Among Men Who Have Sex With Men, Montreal, Quebec, Canada, 2014-2016. Clin Infect Dis. 2017 Oct 30;65(10):1751-1753. doi: 10.1093/cid/cix610. PMID: 29020280. [^11]: Alexander L Greninger and others, International Spread of Multidrug-Resistant _Campylobacter coli_ in Men Who Have Sex With Men in Washington State and Québec, 2015–2018, _Clinical Infectious Diseases_, Volume 71, Issue 8, 15 October 2020, Pages 1896–1904, [https://doi.org/10.1093/cid/ciz1060](https://doi.org/10.1093/cid/ciz1060) [^12]: Zeigler M, Claar C, Rice D, Davis J, Frazier T, Turner A, Kelley C, Capps J, Kent A, Hubbard V, Ritenour C, Tuscano C, Qiu-Shultz Z, Leaumont CF; Centers for Disease Control and Prevention (CDC). Outbreak of campylobacteriosis associated with a long-distance obstacle adventure race--Nevada, October 2012. MMWR Morb Mortal Wkly Rep. 2014 May 2;63(17):375-8. PMID: 24785983; PMCID: PMC4584888. [^13]:  Montgomery MP, Robertson S, Koski L, et al. Multidrug-Resistant _Campylobacter jejuni_ Outbreak Linked to Puppy Exposure — United States, 2016–2018. MMWR Morb Mortal Wkly Rep 2018;67:1032–1035. DOI: [http://dx.doi.org/10.15585/mmwr.mm6737a3external icon](http://dx.doi.org/10.15585/mmwr.mm6737a3). [^14]: Patrick ME, Gilbert MJ, Blaser MJ, Tauxe RV, Wagenaar JA, Fitzgerald C. Human infections with new subspecies of Campylobacter fetus. Emerg Infect Dis. 2013 Oct;19(10):1678-80. doi: 10.3201/eid1910.130883. PMID: 24050521; PMCID: PMC3810764. [^15]: Pacanowski J, Lalande V, Lacombe K, Boudraa C, Lesprit P, Legrand P, Trystram D, Kassis N, Arlet G, Mainardi JL, Doucet-Populaire F, Girard PM, Meynard JL; CAMPYL Study Group. Campylobacter bacteremia: clinical features and factors associated with fatal outcome. Clin Infect Dis. 2008 Sep 15;47(6):790-6. doi: 10.1086/591530. PMID: 18699745. [^16]: Feodoroff B, Lauhio A, Ellström P, Rautelin H. A nationwide study of Campylobacter jejuni and Campylobacter coli bacteremia in Finland over a 10-year period, 1998-2007, with special reference to clinical characteristics and antimicrobial susceptibility. Clin Infect Dis. 2011 Oct;53(8):e99-e106. doi: 10.1093/cid/cir509. PMID: 21921217; PMCID: PMC3174097. [^17]: Bloomfield SJ, Midwinter AC, Biggs PJ, French NP, Marshall JC, Hayman DTS, Carter PE, Thornley C, Yap R, Benschop J. Long-term Colonization by Campylobacter jejuni Within a Human Host: Evolution, Antimicrobial Resistance, and Adaptation. J Infect Dis. 2017 Dec 27;217(1):103-111. doi: 10.1093/infdis/jix561. PMID: 29099940. [^18]: Tam CC, Rodrigues LC, Petersen I, Islam A, Hayward A, O'Brien SJ. Incidence of Guillain-Barré syndrome among patients with Campylobacter infection: a general practice research database study. J Infect Dis. 2006 Jul 1;194(1):95-7. doi: 10.1086/504294. Epub 2006 May 26. PMID: 16741887. [^19]: Ternhag A, Asikainen T, Giesecke J, Ekdahl K. A meta-analysis on the effects of antibiotic treatment on duration of symptoms caused by infection with Campylobacter species. Clin Infect Dis. 2007 Mar 1;44(5):696-700. doi: 10.1086/509924. Epub 2007 Jan 25. PMID: 17278062. [^20]: Tribble DR, Sanders JW, Pang LW, Mason C, Pitarangsi C, Baqar S, Armstrong A, Hshieh P, Fox A, Maley EA, Lebron C, Faix DJ, Lawler JV, Nayak G, Lewis M, Bodhidatta L, Scott DA. Traveler's diarrhea in Thailand: randomized, double-blind trial comparing single-dose and 3-day azithromycin-based regimens with a 3-day levofloxacin regimen. Clin Infect Dis. 2007 Feb 1;44(3):338-46. doi: 10.1086/510589. Epub 2006 Dec 28. PMID: 17205438. [^21]: Agunos, A., Léger, D., Avery, B. P., Parmley, E., Deckert, A., Carson, C. A....Dutil, L. (2013). Ciprofloxacin-Resistant Campylobacter spp. in Retail Chicken, Western Canada. _Emerging Infectious Diseases_, _19_(7), 1121-1124. https://doi.org/10.3201/eid1907.111417. [^22]: Gaudreau C, Rodrigues-Coutlée S, Pilon PA, Coutlée F, Bekal S. Long-Lasting Outbreak of Erythromycin- and Ciprofloxacin-Resistant Campylobacter jejuni Subspecies jejuni From 2003 to 2013 in Men Who Have Sex With Men, Quebec, Canada. Clin Infect Dis. 2015 Nov 15;61(10):1549-52. doi: 10.1093/cid/civ570. Epub 2015 Jul 17. PMID: 26187024. [^23]: Peterson MC. Immunoproliferative small intestinal disease associated with Campylobacter jejuni. N Engl J Med. 2004 Apr 15;350(16):1685-6; author reply 1685-6. doi: 10.1056/NEJM200404153501619. PMID: 15084705.