Campylobacter infection

Category: Illness or disabilities

Type

Involuntary

Introduction and description

Campylobacter (meaning "curved bacteria") is a genus of Gram-negative bacteria. They typically appear comma or s-shaped, are motile and are able to move via unipolar or bipolar flagella. They generally survive in environments with low oxygen.  Although the symptoms of Campylobacter infections in infants were described in 1886 by Theodor Escherich, the genus was not described until 1963 and the organism was not isolated until 1972, as such most of the information concerning this bacteria is very new.

One of the illnesses they cause is called Campylobacteriosis, but the bacteria can cause quite a number of illnesses and diseases, which is why we have used the more general term of Campylobacter infection.

An estimated 2 million cases of Campylobacter enteritis occur annually in the USA, accounting for 5-7% of cases of gastroenteritis.  

About Campylobacter

Some species

At least a dozen species of Campylobacter have been implicated in human disease, with C. jejuni and C. coli being the most common.  The family is very well adapted to survive changes in environment. Recombination is a particularly strong evolutionary force in Campylobacter, leading to the emergence of new lineages and even large-scale genome-wide interspecies introgression between C. jejuni and C. coli. 

C. avium C. butzleri C. canadensis C. cinaedi C. coli C. concisus C. corcagiensis C. cryaerophilus

C. cuniculorum C. curvus C. fennelliae C. fetus C. gracilis C. helveticus C. hominis C. hyoilei

C. hyointestinalis C. insulaenigrae C. jejuni C. lanienae C. lari C. mucosalis C. mustelae C. nitrofigilis C. peloridis

C. pylori C. rectus C. showae C. sputorum C. subantarcticus C. upsaliensis C. ureolyticus C. volucris

 Some example Campylobacter species that cause illness in humans include:

• Campylobacter jejuni – causes enteritis.  Most strains of C jejuni produce the toxin cytolethal distending toxin see below.
• Campylobacter coli – also causes enteritis and produces cytolethal distending toxin
• Campylobacter fetus fetus - Most reported bacteremias have been due to Campylobacter fetus fetus infection.  Cytolethal distending toxin (CLDT) production by Campylobacter fetus subsp. fetus has been found in twenty-five of the 26 strains tested [PMID:  8357933]
• Campylobacter lari, - which is found in ‘healthy seagulls’, has also been reported to produce mild recurrent diarrhoea in children. All three cytolethal distending toxin (cdt) genes may be functional [PMID: 22558801]
• Campylobacter upsaliensis may cause diarrhoea or bacteremia.  C. upsaliensis in tests produced 64 to 2,340 times higher CDT titer in comparison to other campylobacters [PMID:  28202878]
• Campylobacter hyointestinalis - Increasing numbers of Campylobacter hyointestinalis have been isolated from humans and animals with gastroenteritis, it too produces cytolethal distending toxin (CDT).   
• Campylobacter rectus is implicated as a pathogen in chronic periodontitis, no papers as yet on CDT.

So from the above extracts from the papers, we can see that Cytolethal distending toxin is present in most species and strains and is thus a significant player in the activity of this family of bacteria.

Cytolethal distending toxin

Cytolethal distending toxin is the bacteria’s defence mechanism.  Superficially, CDT-producing bacteria attack the mucosal linings, such as those in the stomach and intestines.  CDT toxins are capable of directly damaging DNA in target cells.  But this damage to cells has a purpose.  CDT hinders the cells from dividing and activating the immune system. In other words CDT helps the bacteria to evade the immune system.  There is a reason why it should want to do this and it related to our normal intestinal flora:

Campylobacter as intestinal flora

Commensalism, in ecology, is a class of relationships between two organisms where one organism benefits from the other without affecting it.  Enteric here means native to the gastrointestinal tract - a natural part of the flora.  So what is being said here is that there are Campylobacter bacteria in our intestines already and they not only do no harm, they are a fundamental part - albeit a small part - of its working.

Campylobacteria in the mouth

There is a growing realisation that the mouth is just like the intestines and contains a very diverse flora of various sorts of bacteria:  Again the bacteria work together and do various jobs, keeping each other in balance. 

In other words, just like the intestinal flora, disease occurs when imbalance in the delicate inter-relationship of bacteria occurs.  At the moment it is unclear whether Campylobacter are part of the flora or not.

Campylobacteria in other species

Campylobacter (C.) are ubiquitous in nature and in domestic animals .  Campylobacter organisms have a large animal reservoir, with up to 100% of poultry, including chickens, turkeys, and waterfowl having asymptomatic intestinal ‘infections’. The major reservoirs of C fetus are cattle and sheep and again with no symptoms.  In other words this bacteria is everywhere - in animals, birds and so on, but generally does no harm.

Infection is a meaningless word

In developing countries, Campylobacter ‘infection’, meaning presence, is very common in the first 5 years of life.  BUT, this so called infection is asymptomatic infection. In Bangladesh, up to 39% of all children younger than 2 years have asymptomatic ‘infection’. 

People are not ill from this bacteria, animals are not ill from it.  As in human beings, the bacteria is present as part of the intestinal flora of numerous animals.  Campylobacter bacteria are not inherently pathogenic, something is making them so.

Illness appears to occur when the Campylobacter bacteria are completely out of balance in the organism – too many or too few.

When there is a danger of there being too few, the remaining bacteria fight back using the toxin.  Thus Cytolethal distending toxin is only used when there is imbalance and there are not enough for the role they perform.  We make the somewhat tragic assumption that bacteria are ‘bad’, but it is clear that numerous bacteria in our body have an absolutely vital role – a role we do not understand.  It makes our attempts to kill them all the more ludicrous. 

Symptoms

Overdose

We do not know the role of Campylobacter in the intestines or the mouth.  But we do know that if we overdose on them – so the delicate balance is disturbed in the intestines, we get campylobacteriosis. 

Campylobacteriosis

Diagnosis of campylobacteriosis is made by testing a specimen of faeces.  Symptoms of Campylobacter infection begin after an incubation period of up to a week.  It is characterized by inflammatory, sometimes bloody diarrhoea or dysentery, mostly including cramps, fever, and pain.  Symptoms typically last five to seven days.  Normally the body flushes the excess bacteria away and the person recovers. 

Periodontitis

Campylobacter has also been associated with periodontitis, but because the work to map the mouth flora is still in its early phases, it is not clear whether it is causative or not. 

Deficiency

Illness occurs when the Campylobacter bacteria are completely out of balance in the organism  – too many or too few; we saw above what happens when too many enter the body, but despite the fact we do not know the role of Campylobacter in the intestines, we do know the bacteria fight back when they are in danger of being destroyed.  When there is a danger of there being too few, the remaining bacteria fight back using the toxin.  Thus Cytolethal distending toxin is principally used when there is a danger of destruction.  A symptom is the bloody diarrhoea.

Cytolethal distending toxin is the bacteria’s defence mechanism.  CDT-producing bacteria attack the mucosal linings, such as those in the stomach and intestines and hinders the cells from dividing and activating the immune system. In other words CDT helps the bacteria to evade the immune system.   But in doing so a long train of damage can result:

Intestinal disease and damage, IBS

The bacteria can damage the intestine.  The sites of tissue injury include the jejunum, the ileum, and can extend to involve the colon and rectum. The bacteria appears to invade and destroy epithelial cells, but it is the CDT that is the actual culprit released in defence.  Gastrointestinal perforation is thus a possible complication.  Campylobacteria appear to have no role in the rest of the body, and Epithelial tissues line the cavities and surfaces of blood vessels and organs throughout the body, as such potentially the bacteria is dangerous if it manages to reach the blood circulatory system, when it does, it is called Bacteremia. 

Bacteremia

Bacteremia (also bacteraemia) is the presence of bacteria in the blood. Blood is normally a sterile environment, so the detection of bacteria in the blood (most commonly accomplished by blood cultures) is always abnormal.  And bacteremia caused by Campylobacteria has occurred, for example:

Heart disease and endothelial dysfunction

There are a growing number of cases like this one appearing on PubMed, as there is more recognition that the bacteria could be linked to heart disease:

Arthritis and other joint problems

Reactive arthritis (ReA) is a disorder characterized by inflammation of the joints and tissues occurring after gastrointestinal or genitourinary infections.  It indicates that the bacteria has probably reached and is attacking the joints:

And

In fact from the statistics Antibiotic treatment would seem to increase the likelihood of getting joint pains, of which more shortly.

Guillain–Barré syndrome

In some cases, a Campylobacter infection can be the underlying cause of Guillain–Barré syndrome.

Septic abortion and premature birth

In contrast to the situation in cattle, goat and sheep, Campylobacter fetus subspecies fetus only rarely causes disease in humans. While a major inducer of septic abortion in animals, only a minority of clinical infections in humans are found during pregnancy.  However, it has happened

Cavernous sinus thrombosis

Cavernous sinus thrombosis (CST) is the formation of a blood clot within the cavernous sinus, a cavity at the base of the brain which drains deoxygenated blood from the brain back to the heart. The cause is usually from a spreading infection in the nose, sinuses, ears, or teeth. Symptoms include: decrease or loss of vision, chemosis, bulging eyes, headaches, and paralysis of the cranial nerves which course through the cavernous sinus. This infection is life-threatening;

Skin diseases

Cellulitis is a bacterial infection involving the inner layers of the skin. It specifically affects the dermis and subcutaneous fat. The borders of the area of redness are generally not sharp and the skin may be swollen and this paper provides proof that it can be caused by Campylobacter bacteria

Brain damage

Once in the blood stream the bacteria can travel round the body.  We found no papers that implicated this bacteria in the destruction of the blood brain barrier – although this does not say it does not happen –but we did find evidence that those with a compromised BBB can be affected

Disability and Death

Campylobacter infections can cause mortality and disability.  For example:

Causes

Generally speaking Campylobacter infection can be traced back to faecal-oral ingestion of contaminated food or water.  Foods implicated include raw or under-cooked poultry and other contaminated produce. For example:

Occasionally it can be traced to water supplies.  For example, in August 2016, an estimated 4,000+ residents of Havelock North, in New Zealand, a town with 13,000 or so residents, had gastric illness after the water supply was thought to be contaminated by Campylobacter.

But this is not the real cause.  If we are healthy individuals with a sound immune system this bacteria should prove no problem at all, after all it is everywhere and we have it within us.  No, something – agents – are destroying the balance of this bacteria.  As we said above illness is caused by imbalance – too many or too few – so what is the real cause of the problem?

Overall there are four main causes

• Stress – and other negative emotions, which weaken the immune system and thus renders us unable to fight any excess bacteria that might arrive via contaminated food and water
• Nutritional deprivation – which similarly weakens the immune system
• Surgery   Removal of the gall bladder the source of bile acid, or surgery which damages our intestines, for example gastric band which reduces gut flora; or surgery which leaves us open temporarily to invaders, or plastic surgery.
• Pharmaceuticals, toxins and heavy metals

The latter causes will now be explored in more detail.

Pharmaceuticals

Antacids and Proton Pump Inhibitors

Campylobacter is sensitive to the stomach's normal production of hydrochloric acid: as a result, the infectious dose is relatively high, and the bacteria rarely cause illness when a person is exposed to less than 10,000 organisms.  However, if people take antacid medication or proton pump inhibitors, they are at higher risk of contracting disease from a smaller amount of organisms, since this type of medication inhibits normal gastric acid.

And

Antibiotics in farming and medicine

Antibiotics are used in farming, and have been used completely indiscriminately by the medical profession.  They are used in farming to keep animals kept in inhumane conditions alive long enough so they can be sold as food, they are also used in farming to fatten animals – providing proof, if proof were needed, that antibiotics are implicated in obesity of people as well as animals.   They are used as a ‘preventative’, when they have no ability to prevent anything.  They are used for viral illnesses when they have no ability to tackle viruses.  The mis-use of antibiotics is probably one of the medical and farming profession’s most negligent acts.  Antibiotics destroy the balance of the intestinal flora and the mouth flora.  As such they can result in deficiency of Campylobacter bacteria or overdose.

Nature has responded to crass incompetence on the part of farmers and medics by ensuring that gradually Campylobacter has become anti-biotic resistant.  It has done so remarkably quickly, probably indicating it is a very key species ecologically, if only we were prepared to be a bit more humble and do some research into how key it actually is:

And

And

Immunosuppressants

Immunosuppressants suppress the immune system, which must be one of the most bizarre actions the medical profession undertake.  Suppression of the immune system increases the risk of bacterial overdose and imbalance. 

Mouthwashes

Mouthwashes with antibacterial properties affect the mouth's natural protection causing imbalance.

Anti-emetics 

Anti-emetics stop us vomiting out pathogens.  If we get an overdose of any bacteria and use anti-emetics, then the bacteria simply enters the stomach and intestines.

Anti-diarrhoea medication

Diarrhoea is the natural flushing mechanism of the body, enabling it to remove excesses of bacteria or other pathogens.  By using any medication that stops us pooing out pathogens we have effectively given them free access to do as much damage as they wish.

Antihistamines 

For example cough medicines or nasal sprays, that dry up a runny nose.  The runniness of noses and the sticky fluid used is designed to trap pathogens and prevent them from entering the body.  By using anti-histamines we remove our natural defences and pathogens can enter via the nose, affecting the nose and via the olfactory organs enter the brain

Diuretics

Diuretics are intended to flush water away from the body.  But that water may be needed and be being used to flush pathogens away.  The body may actually be storing water in cells in order to have enough supplies to do the flushing.  Use a diuretic and your oedema – a symptom after all not a cause – may appear to be better.  On the other hand, the pathogens now in your intestines may be breeding like crazy because the body has no water to flush them away.

Toxins

Dental fillings

We fill our mouths full of heavy metals - amalgam is a mix of silver, tin, zinc, copper and of course the ultimate in heavy metals - mercury.  Mercury leaks from fillings and it interacts with gold, so if we have gold and mercury fillings together we have a really heady mix - literally as it generates an electric current likely to seriously affect the mouth biota.

Pesticides, insecticides, defoliants and herbicides

There are now very clear links between the use of pesticides, insecticides, herbicides and the sorts of defoliants used to harvest peas and potatoes on non organic farms; and the destruction of the intestinal flora of animals – including humans.  There is now a general consensus amongst the more responsible researchers, for example, that coeliac disease may be herbicide related.  There are a considerable number of published papers on this now, this is a recent one:

Prevention

Avoid the causes

From the above you can see what causes the imbalances in this bacteria, thus you are in a position to be able to avoid these sources of illness.

Go organic

Consumption of organic foods may help to reduce exposure to toxins such as pesticide, antibiotic-resistant bacteria and the bacteria used in farming.

Avoid ‘infected’ areas [and people]

Travelling to Asia, Africa, Latin America, the Caribbean and Southern Europe significantly increases the risk of acquiring campylobacteriosis compared to travelling within Western Europe. Most responsible medical text books recommend that you not go abroad if you have chronic enteropathies, the following paper also identified the fact that the immune systems of people may be unable to deal with the more ‘exotic’ species:

In other words, avoid anyone who has been abroad for their holidays, to the places mentioned, as they may be carriers of ‘exotic species’ that you are not capable of fighting. 

Treatment

A straight forward Campylobacter infection is usually self-limiting and, in most cases, symptomatic treatment by liquid and electrolyte replacement is enough in human infections.  It is exceptionally important that an overdose of this bacteria is flushed from the system, so a constant intake of water must be maintained.  On the other hand, any action that further disrupts the intestinal flora is not helpful, as such water intake must not be excessive.

NEVER us anti-diarrhoeal medication or pharmaceuticals.  The body must be allowed to flush the bacteria from the system, however inconvenient or embarrassing this may be.

There may be a case for helping to remove toxins from our system by using other bacteria, but it is most important that imbalance does not occur as a result of using other bacteria unwisely.  We consider the case to be unproven as yet, but it is important that the research is continued and known about:

 

References and further reading

• Vet Res. 2005 May-Jun;36(3):351-82. - Campylobacter. - Moore JE1, Corcoran D, Dooley JS, Fanning S, Lucey B, Matsuda M, McDowell DA, Mégraud F, Millar BC, O'Mahony R, O'Riordan L, O'Rourke M, Rao JR, Rooney PJ, Sails A, Whyte P.
• Nature. 403 (6770): 665–8. doi:10.1038/35001088 -  "The genome sequence of the food-borne pathogen Campylobacter jejuni reveals hypervariable sequences".. Parkhill, J.; Wren, B. W.; Mungall, K.; Ketley, J. M.; Churcher, C.; Basham, D.; Chillingworth, T.; Davies, R. M.; Feltwell, T.; Holroyd, S.; Jagels, K.; Karlyshev, A. V.; Moule, S.; Pallen, M. J.; Penn, C. W.; Quail, M. A.; Rajandream, M-A.; Rutherford, K. M.; van Vliet, A. H. M.; Whitehead, S.; Barrell, B. G. (2000) PMID 10688204.
• Clin Microbiol Rev. 2015 Jul;28(3):687-720. doi: 10.1128/CMR.00006-15.  Global Epidemiology of Campylobacter Infection.  Kaakoush NO1, Castaño-Rodríguez N1, Mitchell HM1, Man SM2.1 School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, NSW, Australia; 2 School of Biotechnology and Biomolecular Sciences, The University of New South Wales, Sydney, NSW, Australia Department of Immunology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
• J Med Microbiol. 2015 Oct;64(10):1124-34. doi: 10.1099/jmm.0.000145. Epub 2015 Jul 27.  A new variant of cytolethal distending toxin in a clinical isolate of Campylobacter hyointestinalis.  Samosornsuk W1, Kamei K2, Hatanaka N3, Taguchi T3, Asakura M3, Somroop S3, Sugimoto N3, Chaicumpa W4, Yamasaki S3.
• Microbiol Spectr. 2015 Jun;3(3). doi: 10.1128/microbiolspec.MBP-0008-2014.  The Roles of Inflammation, Nutrient Availability and the Commensal Microbiota in Enteric Pathogen Infection.  Stecher B.

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