Campylobacter enteritis
| Classification according to ICD-10 | |
|---|---|
| A04.5 | Campylobacter enteritis |
| ICD-10 online (WHO version 2019) | |
The campylobacteriosis is a by various species of bacteria of the genus Campylobacter caused, reportable, inflammatory diarrhea in humans. The infectious disease is also known as campylobacteriosis and is the most common digestive tract disease . Campylobacter species are gram-negative , spirally curved rods and belong to the group of zoonotic pathogens that are transmitted from animals to humans and can lead to disease there. In animals such as cattle or poultry, the disease often goes undetected because the animals usually show no symptoms .
Disease mechanism
The pathogens in humans are Campylobacter jejuni , Campylobacter coli , Campylobacter lari and Campylobacter fetus ssp. fetus . 2010 could in reported cases of campylobacteriosis in 35.7% C. jejuni , in 2.3% C. coli , in 0.22% C. lari and 0.01% C. upsaliensis as pathogens to be identified. In most cases (51.8%), only the genus , rather than the species , was identified, or the species could not be identified unequivocally.
Like Shigella , Campylobacter is one of the pathogens that invade the mucous membranes of the intestine. They form a heat-resistant toxin ( enterotoxin ), which is believed to be responsible for the symptoms of diarrhea.
Campylobacter is enteroinvasive, i. i.e., it penetrates through the intestinal epithelia and spreads from there. It can also get into the blood ( bacteremia ) and cause sepsis .
course
It takes about 1–7 days from infection to onset of disease. This leads to symptoms that are common with other enteritis . These include abdominal pain , severe, sometimes bloody diarrhea and a pronounced feeling of illness with a fever of up to 40 ° C. Fever (38-40 ° C), headache , myalgia , arthralgia and fatigue often occur 12–24 hours before the onset of enteric symptoms .
After four days to two weeks, the symptoms of the disease usually disappear spontaneously. Recurrences are rarely observed (in about 5–10% of untreated patients). Many infections are also asymptomatic. A immunity is not acquired. Patients remain infectious for a period of time because the pathogens are excreted in the stool. This period is two to four weeks. With chronic carriers is not normally expected. In immunocompromised people, e.g. B. in AIDS patients, however, long-term elimination can occur. The elimination time can be shortened by administration of antibiotics, provided that there is no resistance in the Campylobacter species involved .
According to Section 7 of the German Infection Protection Act (IfSG), there is an obligation to report positive pathogen detection by the verifying laboratory with the patient's name. According to § 6 IfSG, the disease must also be reported as acute infectious gastroenteritis if an epidemic connection is likely or suspected.
frequency
Campylobacter is meanwhile in Germany - as in the whole of the European Union - the most common pathogen of a bacterial gastrointestinal infection, even before the Salmonella . In 2010, 218,963 confirmed cases of campylobacteriosis were reported from the 27 member states of the EU, more than twice as many cases as in salmonellosis (102,323 confirmed cases). In 2010, 65,713 cases of campylobacteriosis were reported in Germany, compared to 4,404 in Austria . For comparison: the number of reported salmonellosis cases was 25,306 (Germany) and 2,179 (Austria). The incidence rate in the EU is 56.89 cases per 100,000 inhabitants, which means an increase of 4.25 cases per 100,000 inhabitants compared to the previous year 2009. The Czech Republic had the highest incidence rate of 200.58 cases per 100,000 inhabitants followed by the United Kingdom (Great Britain) with 113.34 cases per 100,000 population.
The number of campylobacteriosis cases has been increasing for years. Usually they occur sporadically, but outbreaks of disease are also regularly reported. In 2010, 470 food-related disease outbreaks were documented, affecting over 1,700 people. The disease occurs mainly in summer (June to August). In the European Union, children up to five years of age are affected to a large extent, with the highest incidence rate found in boys (up to four years of age) with 155.54 cases per 100,000 population.
Route of infection
Campylobacter jejuni and Campylobacter coli are normally found in the intestines of pigs and poultry and other bird species . Poultry meat is the main cause of food- borne campylobacteriosis, and 20-30% of cases can be attributed to this. The transmission occurs mainly through insufficiently cooked poultry meat, since on average every second product is contaminated (as of 2017). Other sources of infection are unpasteurized milk ( raw milk ), contaminated, untreated drinking water and raw minced meat . Infections when bathing in contaminated surface waters (bathing lakes and other stagnant bodies of water in summer) also occur. Transmission through pets (especially puppies and cats with diarrhea) or through contact with their excretions is also possible. The rare Campylobacter fetus ssp. Can be found in unpasteurized milk and beef . fetus .
The foods identified as sources of infection are mainly contaminated by excreted animals. Direct fecal-oral transmission from person to person is rare . Direct smear infection also occurs, especially in children.
Campylobacter can survive in the environment or in food for some time, especially at low ambient temperatures. The pathogen cannot spread outside the host organism, e.g. B. in food, multiply. The ingestion of a relatively small amount of Campylobacter is enough to cause an infection; in children this is already possible with an infection dose of around 500 bacterial cells.
Diagnosis
Evidence can usually be obtained from the stool culture . The cultivation on selective media takes place under microaerophilic conditions at 37-42 ° C.
Prophylaxis and treatment
For consumers, the most effective protection against infection is compliance with kitchen hygiene . For example, contact of the meat with other foods via kitchen appliances or hands should be avoided by washing and disinfecting the same.
Campylobacter enteritis usually heals spontaneously. Since antibiotic treatment does not normally reduce the duration of the illness, its use should only be considered in people at risk of complications (small children, old or immunocompromised patients).
As with all diarrheal diseases, it is particularly important to replace fluids and electrolytes with Campylobacter enteritis .
Macrolides are primarily antibiotically effective . The drug of choice is erythromycin ; alternatively, ciprofloxacin can be used. Quinolone antibiotics are only moderately effective in systemic infections. Gentamicin or imipenem are effective for septic courses . However, some Campylobacter coli strains are resistant to gentamicin.
Complications
While the disease is uncomplicated in most people, in some cases the pathogens stay in the intestines and can cause a chronic infection. This offers a similar picture to chronic inflammatory bowel disease .
Especially in immunosuppressed patients, septic courses can occur in rare cases . Reactive arthritis and erythema nodosum sometimes occur after the infection has healed . There is also evidence that Guillain-Barré syndrome could be associated with Campylobacter infections.
literature
- Wolfgang R. Heizmann u. a .: Short textbook medical microbiology and immunology , Schattauer Verlag, 1999, ISBN 3-7945-1961-2 .
- H.-W. Baenkler, U. Clement: Dual series of internal medicine . Georg Thieme Verlag, 2001, ISBN 3-13-128751-9 .
Web links
- Information on Campylobacter enteritis. Robert Koch Institute
- Campylobacter infections - information from the Robert Koch Institute
Individual evidence
- ↑ a b c d e f Annual Epidemiological Report 2012 with data for 2010 and 2011. (PDF; 10.0 MB) European Center for Disease Prevention and Control , accessed on November 20, 2013 (English).
- ↑ a b Michael T. Madigan, John M. Martinko, Jack Parker: Brock Mikrobiologie. German translation edited by Werner Goebel, 1st edition. Spektrum Akademischer Verlag, Heidelberg / Berlin 2000, ISBN 3-8274-0566-1 , pp. 1108–1109.
- ↑ a b c d e f g Campylobacter infections - RKI guide for doctors. Robert Koch Institute (RKI), August 17, 2011, accessed on November 20, 2013 .
- ↑ Campylobacter coli. In: Genome. National Center for Biotechnology Information (NCBI), accessed November 20, 2013 .
- ↑ Text of the Infection Protection Act (IfSG) at juris. Retrieved November 19, 2013.
- ↑ Why you shouldn't wash raw poultry after all. In: Welt Online . September 12, 2017. Retrieved November 30, 2017 .
- ↑ a b Herbert Hof, Rüdiger Dörries: Dual Series: Medical Microbiology . 3. Edition. Thieme Verlag, Stuttgart 2005, ISBN 3-13-125313-4 , p. 335-336 .
- ↑ Y. Chen, S. Mukherjee et al. a .: Whole-genome sequencing of gentamicin-resistant Campylobacter coli isolated from US retail meats reveals novel plasmid-mediated aminoglycoside resistance genes. In: Antimicrobial agents and chemotherapy. Volume 57, Number 11, November 2013, pp. 5398-5405, ISSN 1098-6596 . doi: 10.1128 / AAC.00669-13 . PMID 23959310 . PMC 3811239 (free full text).
