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Campylobacter Enterocolitis: General and Surgical Aspects

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Campylobacter Enterocolitis: General and Surgical Aspects Postgraduate Medical Journal (1986) 62, 719-726 Postgrad Med J: first published as 10.1136/pgmj.62.730.719 on 1 August 1986. Downloaded from Review Article Campylobacter enterocolitis: general and surgical aspects David P. Sellu Department ofSurgery, Dudley RoadHospital, Birmingham B18 7QH, UK. Introduction Bacteria of the Campylobacter genus have long been serological properties ofthe two strains were distinctly known to be pathogens to animals but only recently as different. a leading cause of enterocolitis in man. The spectrum Human infections have been recognized since 1947 of illnesses produced by this group of organisms is (Vinzent et al., 1947), although they have been in- broad, and the patients may often present to the frequently reported until recent years. In those early surgeon. It seems timely, therefore, to review the years the organisms were isolated from blood, historical background of the organism, its biological, cerebrospinal fluid and other body fluids, and from epidemiological and other properties, and the clinical abscesses (Bokkenheuser, 1970). For, although the features ofthe infections it causes, with a discussion on patients presented mainly with gastrointestinal symp- those aspects which are of particular interest to the toms, attempts to culture the organisms from faeces copyright. surgeon. were unsuccessful because of overgrowth by coliforms. Two important coproculture methods have been Historical background used to overcome the problem of contamination of faecal specimens by coliforms. The first was reported Bacteria ofthe genus Campylobacter have been known by Cooper & Slee (1971) and by Slee (1972) in to cause abortion and diarrhoea in cattle and sheep Australia who noted that a campylobacter isolated since they were first isolated (MacFadyean & Stock- from the blood culture ofa patient with diarrhoea was man, 1909). Because of their striking morphological resistant to cephalothin. Cephalothin discs were similarity to Vibrio cholerae, they were classified as therefore applied to the surface of a blood agar plate http://pmj.bmj.com/ members of the Vibrio genus and the type species now innoculated with the patient's faeces. Following in- known as Campylobacterfetus (see below) was called cubation under microaerophilic conditions (of greatly Vibrio fetus. The term 'campylobacter', which is reduced oxygen tension), campylobacter colonies were derived from two Greek words meaning 'curved rod', noted in the zone of the cephalothin disc. The second was first proposed by Sebald & Veron in 1963 as a method was introduced by Dekeyser and colleagues generic name for these organisms on the grounds that (1972) in Brussels in 1969 and was based on the fact they differed from the classical cholera and halophilic that campylobacters are small enough to pass through on October 2, 2021 by guest. Protected groups in many important respects. a filter that holds back the other organisms. Using this Elizabeth King (1957 & 1962) was the first to study method they isolated campylobacters from the stools human strains in detail. She realized that while some of of 5.1% of children with diarrhoea and 1.3% of these conformed to the classic type, others formed a children without diarrhoea. similar but distinct group which she provisionally These discoveries received little attention until 1977 called 'related vibrios'. She established the difference when Skirrow, a microbiologist at Worcester Royal between the two species of Vibrio from two character- Infirmary in England, described a method for isolating istics. First, the optimal growth temperature for campylobacters from stools that eliminated the need culture of the related vibrio is 42TC, whereas Vibrio to use the rather tedious filtration technique. In his fetus does not grow at this temperature. Second, the method (Skirrow, 1977) stools were directly in- noculated on to a selective culture medium containing Correspondence: D.P. Sellu, Ch.M., F.R.C.S. the antibiotics vancomycin, polymyxin B, and Accepted: 13 February 1986 trimethoprim, and incubated at 430C in an atmosphere C) The Fellowship of Postgraduate Medicine, 1986 720 D.P. SELLU Postgrad Med J: first published as 10.1136/pgmj.62.730.719 on 1 August 1986. Downloaded from of 5% oxygen, 10% carbon dioxide, and 85% Epidemiology nitrogen. Skirrow examined the stools of 803 patients with diarrhoea and found that campylobacters were Birds, especially chicken and turkeys, are a common the most common enteric organisms cultured, more reservoir for C. jejuni. Wild birds also carry the common even than salmonella, shigella, and en- organism. In nearly all the birds the excretion of the teropathic Escherichia coli. He predicted that cam- organism is not associated with disease. It has been pylobacter would prove to be the commonest iden- demonstrated that C. jejuni can survive the commer- tifiable cause of infectious diarrhoea. Many reports cial processing procedure to which chickens and from other parts of the United Kingdom (Kendall & turkeys are subjected and this source must therefore be Tanner, 1982; Bruce et al., 1977; Dale, 1977; Pearson recognized as important in the spread of infection et al., 1977; Telfer Brunton & Heggie, 1977; Anon- (Simmons & Gibbs, 1979). ymous, 1978), the continent of Europe (Lindquist et Mammals are also an important source of the al., 1978; Severin, 1978; Muytjens & van Dis, 1978), organism. C. jejuni has been isolated from healthy Canada (Karmali & Fleming, 1979; Kalnins & Jack- pigs, cattle, horses and sheep, and in some of these son, 1977), United States of America (Drake et al., animals the organism may cause an illness with 1981; Blaser & Barth Reller, 1981), and Africa (De diarrhoea as a prominent symptom. Turnbull & Rose Mol & Bosmans, 1978) have confirmed this predic- (1982) have reported on the examination ofover 6,000 tion. The campylobacters are, therefore, an important raw red meat samples from retail and other outlets: C. cause of disease worldwide. jejuni was isolated from 1.6% and the workers con- cluded that contamination of meats by this organism was in general very low. Household dogs and cats are The campylobacters commonly infected, and are known to be a source of infection causing diarrhoea in man (Blaser et al., Campylobacters are small, curved, S-shaped or spiral, 1981a). Humans, both infected and symptomless motile Gram-negative rods. They are microaerophilic, carriers, may be a common source of environmental being neither truly anaerobic nor aerobic, but requir- contamination. ing an environment of reduced oxygen tension for Fresh water (Blaser et al., 1980a) and unpasteurized optimal growth. Failure to appreciate this point was in or incompletely pasteurized milk (Robinson & Jones, copyright. part responsible for the delay in recognizing this 1981) are important external sources of C. jejuni: organism as a human pathogen. They neither oxidize the organism has been cultured from fresh water in nor ferment carbohydrates. Veron & Chatelain (1973) which it has been shown to survive for up to four proposed a scheme which, with slight modification, is weeks. now widely used for classifying these organisms. Five Transmission of C. jejuni is almost certainly by the species ofthe genus Campylobacter are recognized: C. faecal-oral route by ingestion of contaminated food, fetus, C. jejuni, C. coli, C. fecalis and C. water or milk (Pearson et al., 1983). One boys' sputorum. Two ofthese, C.fetus and C. sputorum have boarding school in Sussex experienced a major subspecies which have been characterized: for the epidemic attributable to unpasteurized milk (Pearson http://pmj.bmj.com/ former they are subspecies (ss)fetus and ss veneralis, et al., 1983), and in another in Essex, 257 cases of and for the latter ss sputorum, ss bulbus and ss campylobacter gastroenteritis were almost certainly mucosalis. Classic Vibriofetus now becomes C. fetus, due to drinking water from an unchlorinated un- and King's related vibrios C. jejuni and C. coli. As covered storage tank supplied from a borehole (Pal- these latter two species oforganism differ only slightly mer et al., 1983). Person-to-person transmission is in phenotypic characteristics (Skirrow & Benjamin, probably unimportant but it has been reported (Blaser 1980), and C.jejuni is a more common et al., pathogen, they 1981b). on October 2, 2021 by guest. Protected are often collectively referred to as C. jejuni. If the subspecies to which the organism belongs is known, the organism will be described by its genus name, Age and sex distribution followed by its species and subspecies name, for instance, C.fetus ss veneralis. At the present time only The infection has been reported in all ages from 2 C. jejuni and C. fetus ss fetus are known to cause weeks (Karmali & Fleming, 1979) to well into the 90s. disease in man. In the laboratory the organisms are Infections have also occurred in neonates who have recognized by their physical properties on light acquired the organisms from their asymptomatic microscopy, and are cultured using a selective culture mothers (Karmali & Tan, 1980). In the study by medium (usually Skirrow's medium) and incubated at Karmali & Fleming (1979) of campylobacter enteritis 42°C in a microaerophilic environment, as described in patients under the age of 15 years the highest earlier. incidence (20%) occurred in those below the age of three years. Many of the adult patients were aged CAMPYLOBACTER ENTEROCOLITIS 721 Postgrad Med J: first published as 10.1136/pgmj.62.730.719 on 1 August 1986. Downloaded from between
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