Foodborne Biological Hazard: Campylobacter Jejuni

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Foodborne Biological Hazard: Campylobacter Jejuni

The past few decades have seen the emergence of a wide range of foodborne pathogens, which have become a significant and worrying cause of mortality and morbidity in both developing and developed countries. One pathogen that stands out in this respect is the zoonotic bacterial agent Campylobacter jejuni, which is a leading cause of gastrointestinal illness. This paper examines this pathogen as a serious emerging infectious foodborne biological hazard.

Background Information

Campylobacter jejuni is responsible for most cases of bacterial diarrhea reported in the world (Silva et al., 2011; Wagenaar et al., 2013). According to Silva and colleagues (2011), Campylobacter genus was first reported in 1886 when spiral-shaped non-culturable bacteria was observed by Theodore Escherich (Altecruse et al., 1999). Identification and confirmation of this bacteria was to follow later in 1906 when veterinarians observed what they called a “peculiar organism” in a pregnant sheep’s uterine mucus. As time went on and research on the bacteria intensified, its taxonomic structure was observed to be changing, and based on it many species and subspecies have been identified. Campylobacter jejuni is one of the several (about 20) species of campylobacter, and it is commensally found in the gastrointestinal tract of most warm-blooded animals, among them poultry. The agent is Gram-negative, curved or helical in shape, and is capable of degenerating into a coccoid form. It has high motility and is mesophilic. Its growth characteristics are captured in table 1 below:

Table 1: Campylobacter jejuni’s growth characteristics

Source: ANSES (2011)

Many a disease outbreak related to this agent have implicated the consumption of undercooked or raw red meat, chicken, untreated water, and unpasteurized milk (Hadush & Pal, 2013). The major amplification vessel for Campylobacter jejuni has been identified as the intestines of most warm-blooded animals, hence the above implication concerning consumption of the said products.  It also follows that the feces of these animals and abortion products as well as vagina discharges are the main sites where the bacteria are found. If these find their way into water sources and food (for instance through irrigation with contaminated water), then the food and water become potential sources of infection (Allos, 2001).

Potential Role as A Foodborne Chemical Hazard

Natural infections as a result of Campylobacter jejuni are reported in various parts of the world. Isolation of this zoonic bacterial agents has been done in cats, cattle, baboons, goats, horses, dogs, ostriches, monkeys, sheep, pigs, waterfowls, and turkeys among others (World Health Organization, 2016). Its main transmission mode is the faecal-oral route. Humans get infected through the consumption of uncooked cattle/sheep/pig meat, unpasteurized milk, fresh chicken, and untreated water containing the pathogen. Transmission can also happen by coming in close contact with discharges of diseased animals or the animals themselves. It is also possible for clinically healthy animals to cause infection. According to the World Health Organization (2016), animal food carcass stands the risk of being contaminated through contact with feces during the slaughtering process. Another potential source of infection identified in literature is swimming in contaminated water sources (Schonberg-Norio et al., 2004). As for the role of human in transmission, they can transfer the pathogen to areas such as poultry structures with contaminated footwear or clothing. Most cases of Campylobacter infection in humans involve poultry.

Campylobacter jejuni infection has an incubation period of between 1 to 10 days, and most patients would typically exhibit symptoms within 4 days (Epps et al., 2013). Symptoms include diarrhea (stained with blood and mucus), headache, vomiting and nausea, malaise, fever, abdominal pain (acute), arthritis, myalgia, abortion septicaemia, and meningitis. Abdominal pain in this case may be so acute/severe that it can easily be confused with appendicitis, and it may persist up to a week. Other symptoms may include inflammation of the colon, jejunum, and ileum. Since the infection is in most cases self-limiting, signs and symptoms disappear in a week or so, but they may persist longer in other patients. Cases of the development of Guillain-Barre Syndrome have been reported in some patients (Pal, 2014).

Diagnosis of campylobacteriosis must be confirmed through thorough standard laboratory testing since the infection manifests itself in a manner resembling that of other infections like colibacollosis, shigellosis, and salmonellosis among others. One of the surest ways of diagnosing the infection is to confirm the pathogen’s comma or ‘S’ shape in fresh stool through dark field microscopic procedure. Isolation from blood, bile, and stool or any clinical specimen can be done using media like Campylobacter thioglycolate, Skirrow medium, and Butzler’s agar just to mention but a few (Pal, 2014).

Using antimicrobial drugs to treat Campylobacteriosis is not recommended or attempted before of the self-liming and mild nature of the infection(s). However, for patients whose immune systems are compromised, suffer prolonged illness or display bloody stools and high fever, treatment with azithromycin or erythromycin is recommended (Altecruse et al., 1999; Pal, 2014). Imperative to note here is the fact that some Campylobacter jejuni isolates have shown high susceptibility to erythromycin, clarithromycin, azithromycin, gentamicin, and chloramphenicol, with some showing significant resistance to nalidixic acid, ofloxacin, norfloxacin, and ciprofloxacin (Mukherjee et al., 2013). It is important to avoid dehydration by maintaining electrolyte balance in patients.

Legislation

Screening for this bacterial agent in food is subject to the European Commission’s Regulation No. 2017/1495 which addresses hygiene of foodstuffs (The European Commission, 2017).  The regulation lays down sampling and testing procedures that must be conducted on poultry carcasses of broilers, with specific c/n values set to determine satisfactory or unsatisfactory nature. All slaughterhouses must comply with the regulation if they are to remain in business. The legislative agenda to contain Campylobacter jejuni in other jurisdictions is not clear.

Case Study

Davis et al. (2016) report a 2014 outbreak of Campylobacter jejuni infections associated with consumption of raw milk in Utah.  In the outbreak, there were 99 cases of interest, 59 of which were confirmed while 40 remained probable. 10 patients ended up in hospital and there was one death. This case draws attention to the seriousness of the zoonic agent under discussion more so considering that the outbreak was associated with a single dairy. Noting that the milk involved had undergone routine testing, the authors raise an alarm relating to the unreliability of current tests and call for more reliable routine safety tests.

Solution (Control and Prevention)

A prophylactic vaccine has not been found yet to guard against Campylobacter jejuni infection. Nevertheless, infection can be prevented by avoiding raw poultry, unpasteurized milk, untreated water, and undercooked or raw red meat. Additionally, feces and other materials soiled with feces should be disposed off properly. Other useful measures in this regard include but are not limited to the following:

• Handling food hygienically
• Conducting hazard analysis at crucial points
• Maintaining high levels of personal hygiene
• Conducting health education and awareness on basic food hygiene principals
• Maintain minimal contact with sick pets
• Maintaining high standards of hygiene in slaughterhouses and meat-processing plants.