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As of March 22, 1995, an addendum has been appended to this article.

An 8-week-old mixed-breed pup, recently acquired from an animal shelter, was examined because it had diarrhea, poor appetite, and had not been playful for several days. Three days before being examined by a veterinarian, the pup had been wormed because a few round worm eggs were detected by fecal examination, but the diarrhea continued. On the morning of examination, the owner had observed blood and mucus in the pup's loose feces. On examination, the pup's rectal temperature was 39.2 C, and it was sensitive to abdominal palpation. Parasite eggs were not detected by fecal examination.

The client mentioned that just before bringing her pup to be examined, her 3-year-old daughter had vomited and had cried because of sharp stomach pains, which were somewhat relieved when she passed loose, mucus-covered feces. None of the other members of the family (both parents and a 15-month-old brother) had experienced any symptoms of illness in the past few days. The owner asked if she could leave the pup for a few hours while she was seeing their pediatrician.

Because of the history of blood and mucus in the feces, the lack of parasites in the feces, and the age of the pup, and because it came from a place where animals of various origins were penned together, the differential diagnoses included Campylobacter jejuni enteritis, salmonellosis, and enteropathogenic Escherichia coli enteritis. Examination (under oil immersion) of a thin fecal smear that had been dried, gram-stained, and then counterstained with carbol fuchsin revealed numerous "gull wing" forms consistent with Campylobacter.¹

With a tentative diagnosis of campylobacteriosis made, the owner left the pup. A veterinary student, observing the practice during vacation, asked the following questions:

Q. Is there an antibiotic to treat this infection?

A. Erythromycin--40 mg/kg of body weight for dogs, and 15 mg/kg for cats, PO, q 6 h, for 5 days.²³ This regimen reportedly will eliminate the infection in dogs.³ In a double-blind trial in which this antibiotic was used to treat campylobacteriosis in children, there was decreased duration of diarrhea and fewer days in which Campylobacter organisms were excreted in the feces.⁴

Q. How many years have veterinarians recognized Campylobacter as a cause of animal disease?

A. Veterinarians have known it as a cause of abortion in sheep and cattle since 1913.^5,6 Previously, Campylobacter was called Vibrio.

Q. How can we protect ourselves against this disease?

A. To prevent transmission, the pup (or any other infected animal) should be isolated at home while being treated, or better yet, have the pet treated while it is hospitalized. Anyone cleaning up an area soiled by the pup's feces should wash their hands thoroughly with soap and water.⁷ Contaminated items should be cleaned and disinfected or washed and dried. If anyone becomes ill, the physician should be notified that campylobacteriosis has been tentatively diagnosed in the pup.

Q. Can you perform tests to confirm the diagnosis?

A. No. Campylobacter jejuni is best isolated when specimens are plated on special blood agar (containing several antibiotics) and incubated in an atmosphere of 5% O2, 10% CO2, and 85% N2 at 42 C for 24 to 48 hours. Because of the low demand for this test, some veterinary diagnostic laboratories are not equipped to isolate Campylobacter.

Q. Do public health authorities need to be notified?

A. Yes. If the animal shelter has a list of people who have obtained pups during the past 3 weeks, a public health veterinarian or other health official will contact those households to inquire about the health of family members and their new pups. If any family member has symptoms of gastroenteritis, especially those having closest contact with the pup and/or its feces, the official would suggest that the family physician be contacted.

Q. Are dogs and cats frequently infected with C jejuni?

A. Prevalence surveys (conducted in several countries) of this organism indicated isolation rates varying from 0 to 49% of animals tested. Campylobacter infections occurred more commonly in dogs (an average of 27.3% of all dog populations tested) than in cats (an average of 11.2% of all cat populations tested), and the highest prevalence tended to be in younger animals or in those from humane facilities.^3,7

Comments

Vibrios of animal origin were determined to cause disease in man 4 decades ago. However, it was 10 years after the development of appropriate laboratory techniques for its isolation before C jejuni became generally recognized as a common cause of acute diarrhea in man. Surveillance of human diseases has established campylobacteriosis as the leading cause of bacterial gastroenteritis in England and several states in this country.^8-10 It is a worldwide zoonosis.⁹

Campylobacter jejuni commonly is found as a commensal in the gastrointestinal tract of wild and domestic ruminants, swine, dogs, cats, fowl, and rodents, and these reservoirs are the ultimate sources for most human infections. Infection results from consumption of contaminated food and food products, water, and raw milk, or contact with feces of animals (especially young animals with diarrhea). Occupational exposure may cause infection and disease in workers in animal health facilities, animal shelters, poultry processing plants, animal agriculture, and rendering plants. Family members of the aforementioned also are at increased risk of infection.^3,5,7,9

Pasteurization of milk and the thorough cooking of meats and poultry carcasses will destroy C jejuni in these foods. Commonly used disinfectants will inactivate or kill the organism. Hand washing after contact with animals and animal products is an important step in breaking the transmission cycle. Several large waterborne epidemics have demonstrated the necessity for adequate chlorination of public water supplies.^5,9

Investigation of raw milk-associated campylobacteriosis among a number of people revealed that those who frequently consumed this untreated milk developed protective antibody titers and remained well, whereas a high percentage of people newly exposed to raw milk developed diarrhea, and C jejuni was isolated from their feces. Obviously, visitors to a dairy farm (relatives, guests, or touring school children) should not be given raw milk from the bulk tank.¹¹

References

1. Sasie ESM, Titus AE. Rapid diagnosis of Campylobacter enteritis. Ann Intern Med 1982; 96:62-63.

2. Siegmund OH, ed. The Merck veterinary manual. 6th ed. Rahway, NJ: Merck and Co Inc, 1986; 1535.

3. Fox JG, Moore R, Ackerman JI. Canine and feline campylobacteriosis: epizootiology and clinical and public health features. J Am Vet Med Assoc 1983; 183:1420-1424.

4. Salazar-Lindo E, Sack RB, Chea-Woo E, et al. Early treatment with erythromycin of Campylobacter jejuni-associated dysentery in children. J Pediatr 1986;109:355-360.

5. Blaser MJ, Reller LB Campylobacter enteritis. New Engl J Med 1981; 305:1444-1452.

6. Smibert RM. The genus Campylobacter Ann Rev Microbiol 1978; 32:673-709.

7. Prescott JF, Munroe DL. Campylobacter jejuni enteritis in man and domestic animals. J Am Vet Med Assoc 1982;181:1524-1530.

8. Blaser MJ, Reller LB, Luechtefeld NW, et al.Campylobacter enteritis in Denver. West J Med 1982; 136:287-290.

9. Campylobacter enteritis. Lancet 1982; 2:1437-1438.

10. King EO. Human infections with Vibrio fetus and a closely related Vibrio. J Infect Dis 1957; 101:119-128.

11. Blaser MJ, Sazie E, Williams LP. The influence of immunity on raw milk-associated Campylobacter infection. JAMA 1987; 257:43-47.

Addendum (1995)

A case-control study to define risk factors for acquiring Campylobacter jejuni was conducted, using cases from a large health-maintenance organization in the Northwest. Of 218 cases of campylobacteriosis, 6.3% were attributed to exposure to animals with diarrhea (principally dogs). The same risk was not evident in this study for cases in contact with well animals. The highest risk was from travel to underdeveloped countries, followed by consumption of raw milk.¹

Reference

1. Saeed AM, Harris NV, DiGiacomo RF. The role of exposure to animals in the etiology of Campylobacter jejuni/coli enteritis. Am J Epidemiol 1993; 137:108.