Campylobacter jejuni infection is one of the most widespread infectious diseases of the last century. The incidence and prevalence of campylobacteriosis have increased in both developed and developing countries over the last 10 years. The dramatic increase in North America, Europe, and Australia is alarming, and data from parts of Africa, Asia, and the Middle East indicate that campylobacteriosis is endemic in these areas, especially in children. In addition to C. jejuni, there is increasing recognition of the clinical importance of emerging Campylobacter species, including Campylobacter concisus and Campylobacter ureolyticus. Poultry is a major reservoir and source of transmission of campylobacteriosis to humans. Other risk factors include consumption of animal products and water, contact with animals, and international travel. Strategic implementation of multifaceted biocontrol measures to reduce the transmission of this group of pathogens is paramount for public health. Overall, campylobacteriosis is still one of the most important infectious diseases that is likely to challenge global health in the years to come. This review provides a comprehensive overview of the global epidemiology, transmission, and clinical relevance of Campylobacter infection.

Global Epidemiology of Campylobacter Infection

Campylobacteriosis is the most reported foodborne gastroenteritic disease and poses a serious health burden in industrialized countries. Disease in humans is mainly caused by the zoonotic pathogen Campylobacter jejuni. Due to its wide-spread occurrence in the environment, the epidemiology of Campylobacter remains poorly understood. It is generally accepted, however, that chickens are a natural host for Campylobacter jejuni, and for Campylobacter spp. in general, and that colonized broiler chicks are the primary vector for transmitting this pathogen to humans. Several potential sources and vectors for transmitting C. jejuni to broiler flocks have been identified. Initially, one or a few broilers can become colonized at an age of >2 weeks until the end of rearing, after which the infection will rapidly spread throughout the entire flock. Such a flock is generally colonized until slaughter and infected birds carry a very high C. jejuni load in their gastrointestinal tract, especially the ceca. This eventually results in contaminated carcasses during processing, which can transmit this pathogen to humans. Recent genetic typing studies showed that chicken isolates can frequently be linked to human clinical cases of Campylobacter enteritis. However, despite the increasing evidence that the chicken reservoir is the number one risk factor for disease in humans, no effective strategy exists to reduce Campylobachter prevalence in poultry flocks, which can in part be explained by the incomplete understanding of the epidemiology of C. jejuni in broiler flocks. As a result, the number of human campylobacteriosis cases associated with the chicken vector remains strikingly high.

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Poultry as a host for the zoonotic pathogen Campylobacter jejuni.

https://backend.staging.orbit.dtic.dk/ws/files/52965039/jan13%20FoNAO.pdf

EFSA Panel on Biological Hazards (BIOHAZ) Panel; Scientific Opinion on the risk posed by pathogens in food of non-animal origin. Part 1 (outbreak data analysis and risk ranking of food/pathogen combinations)

[Campylobacter jejuni infection and Guillain-Barré syndrome]].

Understanding of chronic sequelae development after Campylobacter infection is limited The objective of the study was to determine via systematic review and meta-analysis the proportion of Campylobacter cases that develop chronic sequelae A systematic review of English language articles published prior to July 2011 located using Pubmed, Agricola, CabDirect, and Food Safety and Technology Abstracts Observational studies reporting the number of Campylobacter cases that developed reactive arthritis (ReA), Reiter’s syndrome (RS), haemolytic uraemic syndrome (HUS), irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) ,Guillain Barre syndrome (GBS) or Miller Fisher syndrome (MFS) were included Data extraction through independent extraction of articles by four reviewers (two per article) Random effects meta-analysis was performed and heterogeneity was assessed using the I2 value Meta-regression was used to explore the influence of study level variables on heterogeneity A total of 31 studies were identified; 20 reported on ReA, 2 reported on RS, 9 reported on IBS, 3 studies reported on IBD, 8 reported on GBS, 1 reported on MFS and 3 reported on HUS The proportion of Campylobacter cases that developed ReA was 286% (95% CI 140% - 561%, I2 = 977%), irritable bowel syndrome was 401% (95% CI 141% - 1088%, I2 = 992%) Guillain Barre syndrome was 007% (95% CI 003% - 015%, I2 = 727%) A significant number of Campylobacter cases develop a chronic sequela However, results should be interpreted with caution due to the high heterogeneity

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Systematic review and meta-analysis of the proportion of Campylobacter cases that develop chronic sequelae

Background. Campylobacter jejuni is a leading cause of acute gastroenteritis worldwide, and most cases are identified as sporadic events rather than as parts of recognized outbreaks. We report findings from a substantial 2008 campylobacteriosis outbreak with general implications for fresh produce safety. Methods. We conducted a matched case-control study to determine the source of the outbreak and enhanced surveillance to identify additional cases. Clinical and environmental specimens were tested for Campylobacter, and isolates were subtyped by pulsed-field gel electrophoresis (PFGE). Results. By routine surveillance, we identified 63 cases of laboratory-confirmed infection. Only raw peas, consumed by 30 (67%) of 45 case-patients and by 15 (17%) of 90 control participants, were associated with illness (adjusted odds ratio: 8.2; P < .001). An additional 69 patients (26 laboratory-confirmed) who reported eating raw peas within 10 days of illness onset were identified through enhanced surveillance. In all, 5 cases were hospitalized, and Guillain-Barre syndrome developed in 1 case; none died. The implicated pea farm was located near a Sandhill crane (Grus canadensis) stopover and breeding site. Of 36 environmental samples collected, 16 were positive for C. jejuni—14 crane-feces samples and 2 pea samples. We identified 25 unique combined SmaI-KpnI PFGE patterns among clinical isolates; 4 of these combined PFGE patterns identified in 15 of 55 human isolates were indistinguishable from PFGE patterns identified in environmental samples. Conclusions. This investigation established a rare laboratory-confirmed link between a campylobacterosis outbreak and an environmental source and identified wild birds as an underrecognized source of produce contamination.

Outbreak of Campylobacteriosis Associated With Consumption of Raw Peas

From August to September 2008, the Centers for Disease Control and Prevention (CDC) assisted the Alaska Division of Public Health with an outbreak investigation of campylobacteriosis occurring among the residents of Southcentral Alaska. During the investigation, pulsed-field gel electrophoresis (PFGE) of Campylobacter jejuni isolates from human, raw pea, and wild bird fecal samples confirmed the epidemiologic link between illness and the consumption of raw peas contaminated by sandhill cranes for 15 of 43 epidemiologically linked human isolates. However, an association between the remaining epidemiologically linked human infections and the pea and wild bird isolates was not established. To better understand the molecular epidemiology of the outbreak, C. jejuni isolates (n = 130; 59 from humans, 40 from peas, and 31 from wild birds) were further characterized by multilocus sequence typing (MLST). Here we present the molecular evidence to demonstrate the association of many more human C. jejuni infections associated with the outbreak with raw peas and wild bird feces. Among all sequence types (STs) identified, 26 of 39 (67%) were novel and exclusive to the outbreak. Five clusters of overlapping STs (n = 32 isolates; 17 from humans, 2 from peas, and 13 from wild birds) were identified. In particular, cluster E (n = 7 isolates; ST-5049) consisted of isolates from humans, peas, and wild birds. Novel STs clustered closely with isolates typically associated with wild birds and the environment but distinct from lineages commonly seen in human infections. Novel STs and alleles recovered from human outbreak isolates allowed additional infections caused by these rare genotypes to be attributed to the contaminated raw peas.

Multilocus sequence typing confirms wild birds as the source of a Campylobacter outbreak associated with the consumption of raw peas.

Objectives Wildlife may harbour clinically important antimicrobial-resistant bacteria, but the role of wildlife in the epidemiology of antimicrobial-resistant bacterial infections in humans is largely unknown. In this study, we aimed to assess dissemination of the blaKPC carbapenemase gene among humans and gulls in Alaska. Methods We performed whole-genome sequencing to determine the genetic context of blaKPC in bacterial isolates from all four human carbapenemase-producing Enterobacteriaceae (CPE) infections reported in Alaska between 2013–2018 and to compare the sequences with seven previously reported CPE isolates from gull faeces within the same region and time period. Results Genomic analysis of CPE isolates suggested independent acquisition events among humans with no evidence for direct transmission of blaKPC between people and gulls. However, some isolates shared conserved genetic elements surrounding blaKPC, suggesting possible exchange between species. Conclusion Our results highlight the genomic plasticity associated with blaKPC and demonstrate that sampling of wildlife may be useful for identifying clinically relevant antimicrobial resistance not observed through local passive surveillance in humans.

Catherine Xavier

Papers

Outbreak of Campylobacteriosis Associated With Consumption of Raw Peas

Multilocus sequence typing confirms wild birds as the source of a Campylobacter outbreak associated with the consumption of raw peas.

Genomic comparison of carbapenem-resistant Enterobacteriaceae from humans and gulls in Alaska.