1. CampylobacteriaceaeCampylobacteriaceae Campylobacter Heliobacter Heliobacter (Gram-negative curved rods)

2. Campylobacter Gram(-), “curved”, small rods Polar flagella Non-fermentative Microaerophilic - grow best at 5% O 2, 10% CO 2 (capnophilic) Commensals of poultry, pigs, cattle, dogs, cats

3. Campylobacter Genera Campylobacter sputorum: –Normal oral flora of humans, cattle, pigs –Abscess, meningitis Campylobacter fetus: –Cattle, sheep –Septicemia, gastroenteritis, abortion, meningitis Campylobacter jejuni: –Animals, humans –Gastroenteritis, septicemia, meningitis, abortion, gastritis Campylobacter coli: –Pigs, poultry, bulls, sheep, birds –Gastroenteritis, septicemia, abortion, meningitis

4. Campylobacter: Lab Culture Media Enteric species (C. jejuni, C. coli) best isolated at 42 0 C: –optimal growth temperature –suppress other enteric MOs Grow well on CBA, CHOC – 2 days, small, translucent colonies Poor growth on Mac CampyBAP – Enriched, selective –Brucella Agar base, 10% sheep blood –Vancomycin, trimethoprim, polymyxin B, amphotericin B, cephalothin supress NF in stool

5. Campylobacter: Lab ID Catalase(+) (except sputorum) Oxidase(+) Various growth requirements – enriched media, microaerophilic, elevated temperature Serotyped by antigens: –Somatic O –Capsular K –Flagella H

6. Campylobacter : Virulence Factors Enterotoxin Endotoxin Adhesions Survive phagocytosis Ability to penetrate, invade, destroy intestinal mucosal cells (edematous, bloody, ulceration, abscesses) Role of MO in causing disease poorly defined

7. Campylobacter: Infection Most common cause of bacterial gastroenteritis in USA, estimate ~2 M infections/year Mainly due to Campylobacter jejuni Zoonotic infections, various animal reservoirs (chicken, dog, cat) Ingest contaminated milk, water, poultry (50% of infections); contact with infected animal MO invades epithelium of small intestine, multiplies Causes acute enteritis, inflammatory response (may be responsible for many of disease symptoms)

8. Campylobacter: Gastroenteritis Symptoms 1-10 days after ingestion Abdominal cramps, progress to crampy pain, bloody diarrhea, chills, fever 3-6 days May have >10 bowel movements/day Self-limited; replace fluids, electrolytes Untreated patients may excrete MO several months Treat severe cases with erythromycin Prevention by: –Proper handling & preparation of food, especially poultry –Drink pasteurized milk –Clean water supply

9. Campylobacter : Systemic Infection Usually Campylobacter fetus Initial gastroenteritis, followed by septicemia, spread to target organs Debilitated or immunocompromised individuals Treat with aminoglycoside (gentamycin)

10. Helicobacter pylori Campylobacter-like MOs Gram(-), small, “spiral”, rod Ubiquitious, world-wide Common in developing countries, low socioeconomic groups Person-to-person spread, fecal- oral route Lab culture: same media as Campylobacter, may take 5 days Differentiated from Campylobacter by strong urease test (positive within 1-2 hrs.)

11. Helicobacter: Virulence Factors Adhesions Cytotoxin Endotoxin Flagella – highly motile, penetrate gastric mucus Urease – NH 3 raises stomach pH, cause cell damage, inflammation, access to cell nutrients, colonize stomach Mucinase –degrades mucus, expose epithelium to gastric acid

12. Helicobacter: Infection & Disease Peptic ulcers Chronic, superficial (type B) gastritis Symptoms - nausea, vomiting, anorexia, epigastric pain Association H. pylori and stomach carcinoma, possibly due to chronic inflammation

13. Helicobacter: Lab ID Tissue biopsy Non-invasive urea breath test – 14 C labeled urea given orally –Breath monitored for 14 CO 2 Serology test for H. pylori antibody – indicates infection, possible etiology for peptic ulcer, gastritis

14. Helicobacter: Treatment Use of single antibiotic combined with bismuth (Pepto-Bismo) ineffective Combination therapy: beta-lactam (amoxicillin), macrolide (clarithromycin), a proton pump inhibitor (omeprazole), 7-10 days Eliminates MO and resolves pathology

15. Summary: Campylobacter, Helicobacter Infection

16. Class Assignment Textbook Reading: Chapter 20 Campylobacter and Campylobacter- Like Species Key Terms Learning Assessment Questions

17. Case Study - Campylobacter A mother and her 4-year-old son came to the local emergency room with a 1-day history of diarrhea and abdominal cramping. Both patients had low-grade fevers, and blood was grossly evident in the child’s stool specimen.

18. Case Study - Campylobacter The symptoms had developed 18 hours after the patients had consumed a dinner consisting of mixed green salad, chicken, corn, bread, and apple pie. Culture of blood samples was negative for organisms, but C. jejuni was isolated from stool specimens of both the mother and the child.

19. Case Study - Questions 1. Which food that they consumed is most likely responsible for these infections? What measures should be used to prevent these infections? 2. Name three Campylobacter species that have been associated with gastroenteritis. Name the species of Campylobacter that is most commonly associated with septicemia. 3. What diseases have been associated with H. pylori?