Campylobacteriosis is an acute zoonotic infection caused by Enterobacter Campylobacter and occurring with a predominant lesion of the digestive tract. The localized form of campylobacteriosis in most cases proceeds by the type of gastroenteritis or gastroenterocolitis; the generalized form is accompanied by the development of septicemia or septicopiemia. The diagnosis is confirmed by bacteriological culture of feces, blood; serological reactions, intestinal endoscopy. Specific etiotropic therapy is carried out with antimicrobial drugs (metronidazole, tetracycline antibiotics, groups of macrolides or fluoroquinolones, etc.).
Campylobacteriosis is an acute intestinal infection, the causative agents of which are Campylobacter bacteria. In the structure of diarrheal diseases, campylobacteriosis accounts for 5-15%, which indicates its prevalence and epidemiological significance. Campylobacteriosis is registered in all countries of the world; a higher incidence rate is observed in tropical latitudes. Campylobacteriosis affects representatives of various age groups, but more often the infection is diagnosed in preschool children. Both sporadic and group cases of intestinal infection may occur. The peak incidence of campylobacteriosis occurs in the summer and autumn months, from June to September.
Campylobacteriosis is caused by pathogenic species of intestinal bacteria belonging to the Enterobacteriaceae family, the genus Campylobacter. Currently, there are more than 14 types of campylobacter isolated from humans and animals. The most important in the etiology and pathogenesis of human campylobacteriosis are C.coli, C.jejuni, C.laridis, C.fetus: of these, the first two species cause the majority of cases of diarrheal forms of infection, and the last – hematogenically disseminated forms of the disease.
Campylobacter are gram-negative, non-spore-forming bacteria with small dimensions (length 0.5-0.8 microns, width 0.2-0.5 microns), curved or spiral shape. The mobility of bacteria is provided by one or two flagella located polar. The optimal conditions for the growth of campylobacter is a microaerophilic environment with an oxygen concentration of no more than 5-10% and a temperature of 37-42 ° C, but the bacteria are resistant to low temperatures.
The main source of human infection with campylobacteriosis are farm animals and birds, and the leading method of transmission of pathogens is the alimentary pathway implemented by consuming contaminated meat products, milk, and water. Less often, the penetration of microorganisms through damaged skin is possible, for example, with bites of infected animals. Infection of newborns can occur transplacentally or during childbirth. Rural residents, livestock and poultry workers, as well as tourists visiting developing countries are at risk for the occurrence of campylobacteriosis. Persons suffering from immunodeficiency conditions, children and pregnant women are more susceptible to the incidence of campylobacteriosis.
When ingested, campylobacters reach the small intestine, where they are introduced into its mucous membrane and lymphoid formations, causing the development of an inflammatory process of varying severity. Through the lymphatic pathways, campylobacters penetrate the mesenteric lymph nodes, the vermiform process, and the large intestine. In the course of their vital activity, campylobacters produce entero- and cytotoxins, and when destroyed, they secrete endotoxins that cause the development of diarrheal, pain and intoxication syndromes. During the transition of campylobacteriosis to a generalized form, septicemia and septicopiemia develop, leading to multiple organ damage with the appearance of abscesses in the liver and spleen, polyarthritis, lymphadenitis, meningitis, nephritis, etc.
Based on clinical and pathogenetic features, localized (gastrointestinal) and generalized forms of campylobacteriosis are distinguished. Localized variants of the course of infection include gastroenteritis, gastroenterocolitis, enteritis, enterocolitis, mesadenitis, appendicitis. The generalized form is accompanied by the development of campylobacter septicemia and septicopiemia.
Campylobacteriosis may have a manifest or asymptomatic course. Clinically pronounced forms include mild, moderate and severe degrees. Asymptomatic forms are represented by subclinical and convalescent variants of campylobacteriosis. Depending on the duration of infection, there are acute (up to 3 months), chronic (more than 3 months) and residual phase of campylobacteriosis.
In most cases, campylobacteriosis occurs in a localized form, taking on the character of enteritis, enterocolitis, gastroenterocolitis or colitis. Patients often have concomitant gastrointestinal diseases: gastritis, duodenitis, gastric ulcer and duodenal ulcer, biliary dyskinesia, cholecystitis.
The incubation period lasts from several hours to 10 days (on average 2-5 days). The onset of campylobacteriosis is acute – with chills, fever (38-39 ° C), sweating, myalgia, arthralgia, headache. At the same time or after a few hours, diarrhea joins with a stool frequency of up to 5-10 times a day. Bowel movements have a watery character, a fetid smell, often contain impurities of bile, mucus and blood. Nausea and vomiting are not a mandatory symptom of campylobacteriosis and occur only in a quarter of patients. The most constant sign is cramping abdominal pain. With a benign course, the disease resolves after 3-9 days.
In severe campylobacteriosis, profuse mucosa or bloody diarrhea, severe dehydration may develop; in children, convulsive syndrome or meningism phenomena. Less often localized forms of campylobacteriosis occur in the form of acute mesadenitis, catarrhal or phlegmonous appendicitis. Complications of the localized form of campylobacteriosis can be serous peritonitis, reactive arthritis, toxic megacolon, intestinal bleeding, infectious and toxic shock. There are reports of the association of transferred campylobacteriosis with the development of Guillain-Barre syndrome.
The development of generalized forms of campylobacteriosis is noted in people with an unfavorable concomitant background: cachexia, cirrhosis of the liver, diabetes mellitus, tuberculosis, systemic diseases, malignant tumors, HIV infection, as well as in children of the first months of life. Clinical symptoms include persistent fever (up to 40 °C and above), profuse sweats, chills, exhaustion, dyspeptic phenomena, hepatosplenomegaly, anemia. In some cases, transient bacteremia can progress into a septic process, causing the development of purulent metastatic foci in various organs in the form of arthritis, micropolymphadenitis, peritonitis, endocarditis, myocarditis, pleurisy, pneumonia, meningitis, encephalitis, etc. The course of the generalized form of campylobacteriosis is severe, often fatal.
Chronic campylobacteriosis is usually associated with immunosuppressive conditions, including HIV infection. Patients are concerned about subfebrility, unstable stools, mesogastric pain, decreased appetite, weight loss. Signs of conjunctivitis, keratitis, pharyngitis are often detected; women have recurrent vaginitis or vulvovaginitis, miscarriage. During periods of exacerbation of campylobacteriosis, organ lesions characteristic of the generalized form may develop.
Epidanamnesis (contact with animals, tourist trips, etc.), characteristic symptoms can serve as grounds for suspicion of campylobacteriosis. When examining the coprogram, inflammatory exudate, leukocytes, and erythrocytes are found in the stool. Rectoromanoscopy or colonoscopy in the midst of the disease reveals a picture of catarrhal, catarrhal hemorrhagic, erosive and ulcerative proctosigmoiditis or colitis.
The most accurate confirmation is a bacteriological examination of feces. Sometimes the material for cultural research is blood, abscess pus, liquor, amniotic fluid. Serological diagnostics is also carried out using the methods of RA, ELISA, immunoelectrophoresis, latex agglutination, etc.
The gastrointestinal form requires differentiation from other AKI, primarily dysentery and salmonellosis, as well as mesadenitis and appendicitis of other etiology. An endoscopic biopsy of the intestine makes it possible to exclude nonspecific ulcerative colitis and Crohn’s disease. The generalized form of campylobacteriosis must be distinguished from sepsis caused by another pathogen; the chronic form – from toxoplasmosis, brucellosis, yersiniosis and other chronic infectious diseases.
The volume of therapeutic measures for campylobacteriosis depends on the form and severity of the infection. With a mild degree of localized forms of campylobacteriosis, etiotropic therapy is not carried out: in this case, they are limited to the appointment of diet, oral rehydration, antispasmodics, enzymes, biological bacterial preparations for the correction of intestinal dysbiosis. In the moderate and severe course of gastrointestinal forms of campylobacteriosis, as well as in the generalization of infection, the use of antibacterial drugs to which campylobacters are sensitive (erythromycin, tetracycline, doxycycline, chloramphenicol, clindamycin, fluoroquinolones, aminoglycosides, macrolides, metronidazole, furazolidone, etc.) is indicated for a course of 7-14 days. Pathogenetic therapy involves infusion of glucose-electrolyte and polyionic solutions, the appointment of desensitizing agents. Persons who have undergone campylobacteriosis are under dispensary observation by an infectious disease specialist for 1 month and are subject to a double bacteriological examination.
With localized forms of campylobacteriosis, the prognosis is favorable. Complications are possible only in the severe course of the disease and among people with a burdened concomitant background. With generalized forms developing in children, pregnant women, weakened patients, mortality can reach 25-30%. Prevention should be aimed at preventing infection of domestic animals and birds; sanitary supervision of water supply, storage regime and technology of food processing; education of the population in personal hygiene standards and rules of cooking.