Campylobacter infection

Campylobacter infection is an infectious diarrheal disease caused by contaminated food. In most cases the diarrhea clears up on its own after a few days. In babies, infants and older people, however, it can cause life-threatening loss of fluids and salts. Late complications occasionally arise such as arthritis or paralysis.

It is generally passed on from food of animal origin contaminated with gut bacteria. Frequent sources of infection are chicken and unpasteurized milk. It can be prevented by following strict hygiene rules.

The first symptoms appear around 2 to 5 days after infection with the bacteria. General pathological symptoms such as a high temperature, headache and joint pain occasionally occur 12 to 24 hours before onset of diarrhea.

Typical symptoms are: 

• abdominal pain and abdominal cramps
• loose or watery, occasionally also bloody diarrhea
• nausea and vomiting 

The condition lasts around a week, sometimes even longer. Many people do not have any symptoms despite being infected.

Campylobacter is a bacterium that is found throughout the world and is frequently the cause of diarrheal diseases. Campylobacter jejuni and Campylobacter coli are the most important forms. They live in animal gut. Although they cannot reproduce on food, they can survive and remain infectious for some time. They survive sub-zero temperatures, for example in a freezer.

The campylobacter infection is most often passed on from food contaminated with minute particles of feces. This frequently occurs when the animals are being slaughtered or milked. Chicken, other poultry meat, uncooked meat or meat that has not been cooked through, uncooked sausages, raw (unpasteurized) milk and unpasteurized dairy products are particularly affected. Pet feces, well water and water in swimming lakes may also be infectious. 

There are around 60,000 to 70,000 cases of diarrheal disease due to campylobacter infection every year in Germany. Campylobacter bacteria are found throughout the world. In Germany and Europe, the condition is most prevalent in the warmer seasons. Children under 5 and young adults between 20 and 29 are particularly affected. 

It can sometimes take longer than usual to eliminate the pathogens. In patients who have no pre-existing conditions, this generally happens without symptoms.

Possible complications of campylobacter infection are:  

Reactive arthritis 

Arthritis may occur a few days or weeks after a bacterial infection, with the body’s immune defenses attacking the cartilage and bones. It is not exactly clear why this happens. However, some people are predisposed to develop this type of arthritis. They generally recover after around 6 months after a course of anti-inflammatory drugs. 

Guillain-Barré syndrome

Paralysis and numbness can occur after an infection, starting in the hands and feet and spreading to the torso. This often also affects the respiratory muscles. This neural disorder appears to be caused by a faulty response from the body’s immune defenses.

Irritable bowel syndrome and chronic inflammatory disorders of the intestine

Doctors believe it is possible that irritable bowel syndrome or a chronic inflammatory disorder of the intestine can develop following a diarrheal disease with campylobacter infection.

There are numerous precautions that people can take to protect themselves and others from food-related diarrheal disease: 

General hygiene

People should wash their hands thoroughly in soap and water and dry them off with a clean towel afterwards to avoid being infected by gut bacteria in the following situations:

• after going to the toilet
• before eating
• before preparing meals 
• immediately after working with uncooked food 
• after changing diapers 
• after disposing of pet feces 

Uncooked food of animal origin

This includes, for example, raw (unpasteurized) milk, unpasteurized dairy products, certain types of uncooked sausage such as meat paste and all types of uncooked meat or meat that has not been cooked through.

• Babies, infants, pregnant women, older people and people with an immune deficiency should refrain from eating uncooked food of animal origin. 
• Raw milk, milk labeled “direct from the farm” or “Vorzugsmilch” should be boiled before consumption. 

Hygiene in the kitchen

• Food should always be washed before it is eaten or prepared.
• Meat, particularly poultry, must always be fully cooked through.
• Dispose of melted ice from thawed meat immediately and clean objects and work surfaces that have been in contact with it.
• Do not wash poultry before cooking. This is to prevent germs being sprayed in and around the kitchen.
• Clean work surfaces and equipment after each step in dishwashing liquid and warm water. 
• Use separate kitchen utensils for uncooked and cooked food. 
• Replace dishwashing brushes and sponges regularly. Wash wiping cloths and kitchen towels at a minimum temperature of 60 degrees.

The website of the German Federal Institute for Risk Assessment (BfR) provides answers to frequently asked questions on protection against food-related campylobacter infection.

Attending community facilities

Children under 6 suffering from an infectious diarrheal disease should not attend community facilities such as schools or nurseries. Their parents must inform the community facility of their illness. Once the children have been symptom-free for 48 hours they may resume attendance at the community facility after being assessed by a doctor. A written doctor’s certificate is not required. 

Working in the food or catering sector

People with an infectious diarrheal disease must temporarily cease working anywhere where they come into contact with food or meals. Infected people’s stools can remain infectious over a prolonged period. That means that, although they can return to work after the symptoms clear up, they must follow strict hand hygiene rules for 4 weeks.  

Treatment of contacts

No special measures are required for people who come into contact with infected persons, provided that they do not exhibit any symptoms such as diarrhea or vomiting. 

At the acute stage of a diarrheal disease, doctors can detect the bacterium directly from a fresh stool sample or cultivate it in a bacterial culture. They can also check what antibiotics the bacterium may be resistant to. The stool sample needs to reach the lab fairly quickly for the cultivation of the bacteria to be successful.

Ensuring an adequate intake of fluids and salt as well as easily digestible food will normally be enough to treat even severe cases of diarrheal disease. Campylobacter infections generally clear up on their own after a few days. Hospital treatment may be necessary in very severe cases of diarrhea, lasting more than 2 to 3 days. Doctors will only prescribe antibiotics in exceptional cases.