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CAMPYLOBACTER

Campylobacter spp. are the most common bacterial etiology of diarrhea in the United States, causing more than 1,300,000 acute illnesses with 80% attributed to foodborne transmission.1 The clinical significance of these illnesses is compounded by the occasional occurrence of Guillain-Barre syndrome (GBS), the most common cause of acute flaccid paralysis worldwide.2 Globally, Campylobacter spp. cause an estimated 96 million foodborne illnesses and 21,000 deaths.3 As a result of GBS, Campylobacter spp. accounts for the most years lived with disability among diarrheal disease agents.3 In the United States an estimated 17% of confirmed infections result in hospitalization with a 0.1% death rate.1 C. jejuni causes approximately 86% of human infections with 10% caused by C. coli.4 Both Campylobacter species are carried by a variety of food animals and domestic pets. Despite their prominence as causes of foodborne illness, confirmed foodborne outbreaks caused by Campylobacter spp. are remarkably uncommon.5 Less than 1% of Campylobacter cases reported to the Foodborne Diseases Active Surveillance Network (FoodNet) from 1996 to 2018 were associated with outbreaks.6 Outbreak detection among reported Campylobacter cases has been limited, in part, due to the lack of routine subtype characterization of isolates needed to identify clusters of likely related cases, and by the lack of routine interviewing of cases to identify potential common exposures. However, the bigger reason appears to be the characteristics of Campylobacter spp. that limit amplification of contamination in common exposure settings linked to foodborne outbreaks.

Microbiology

Campylobacter spp. are motile, nonspore forming, Gram-negative rods with a distinctive curved morphology.7 They share growth characteristics that distinguish them from other foodborne pathogens, such as Salmonella spp., in epidemiologically important ways. Campylobacter spp. are microaerophilic. Their growth may be inhibited at atmospheric oxygen concentrations, which limits their growth in ambient environments, such as kitchens.7 This also limits their survival in clinical samples during transport and culture by clinical laboratories. C. jejuni are thermophilic with growth temperature ranges from 37oC to 42oC, reflecting the body temperatures of their primary reservoir hosts.8 They do not grow at temperatures below 30°C.9 This also prevents amplification in most ambient environments. They are sensitive to drying, heating, freezing, common disinfectants, and low pH environments.7,9 Under conditions of stress they may enter a viable but nonculturable state that permits survival under unfavorable conditions.8 The role of these cells in transmission of foodborne illness is unknown. Because Campylobacter spp. are limited in their ability to survive and grow in the environment, they pose a food safety threat primarily from direct contamination of raw or ready-to-eat foods.

C. jejuni possess several virulence and stress response factors associated with motility, chemotaxis, adhesion, invasion, multidrug resistance, and survival.8 These include specific antimicrobial resistance determinants and a multidrug efflux pump that promotes resistance to bile salts, heavy metals, and a broad range ...

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