Human campylobacteriosis: a challenge for the veterinary profession.

Historical Aspects and Current Problems The first description of a bacterium belonging to the genus Campylobacter is attributed to Theodore Escherich at the end of the 19th century. 1 At the beginning of the 20th century, infections with Campylobacter spp, described as a related Vibrio, were recognized to cause abortions in sheep. Only after a suitable isolation medium was developed in the 1970s were 2 closely related pathogens, C jejuni and C coli, recognized to be common human enteric pathogens. 2 In humans, C jeju-ni causes approximately 90% of confirmed enteric Campylobacter infections. 3,4 In a 1999 report, 5 the national Centers for Disease Control and Prevention estimates that there are 2.5 million human cases of campylobacteriosis in the United States per year. Although there has been a decline of approximately 27% in the incidence of campylobacteriosis in FoodNet surveillance sites between 1996 and 2001, Campylobacter spp remain among the most common bacterial causes of foodborne infection. 6 Postinfectious sequelae of infection include Guillain-Barré syndrome (GBS) and reactive arthritis. Challenges for the veterinary profession include implementation of pathogen reduction measures across the food chain and prevention of foodborne and zoonotic infections and infections caused by fluoroquinolone-resistant Campylobacter strains. This report provides an outline of the illness in humans, risk factors for human infection, Campylobacter ecology, and potential control points to prevent human infections. Human Illness Although C jejuni and C coli can exist as commen-sal organisms of domestic poultry and livestock, they are considered human pathogens. In humans, the clinical spectrum of Campylobacter enteritis ranges from loose feces to dysentery. Self-limiting acute enteritis is the most common syndrome. Prodromal symptoms are common and include headache, low fever, and myalgia lasting from a few hours to a few days. Symptoms of acute infection often begin with abdominal cramps followed by diarrhea and high fever, peaking during the first days of illness. 7 Campylobacter jejuni-specific serum antibodies confer immunity to symptomatic infection; however, the duration of protective immunity is not known. Complications of Infection An estimated 100 people die of C jejuni infections each year in the United States. These fatal infections occur most often in infants, the elderly, or immuno-suppressed individuals. 5 Bacteremia is most often detected in patients with underlying disease 10 and is a potentially fatal complication of HIV/AIDS. 11 Chronic diarrhea is also a complication of HIV-associated campylobacteriosis. The HIV-positive individuals who develop campylobacteriosis have shorter survival times …