In recent years, Campylobacter jejuni has been recognized as an important enteric pathogen of human beings causing acute and subacute gastrointestinal illness. Recent reports have suggested that infected household pets may be vectors for the human infection. It has been theorized that as more research will be conducted\u27 the zoonotic implications of C. jejuni will rival and probably exceed those of salmonellosis. Therefore, as veterinarians, it is important to be aware of the disease in animals, the zoonotic implications, and be able to advise our clientele

Beran, George W.

Tapper, Ronald A.

English

In recent years, Campylobacter jejuni has been recognized as an important enteric pathogen of human beings causing acute and subacute gastrointestinal illness. Recent reports have suggested that infected household pets may be vectors for the human infection. It has been theorized that as more research will be conducted' the zoonotic implications of C. jejuni will rival and probably exceed those of salmonellosis. Therefore, as veterinarians, it is important to be aware of the disease in animals, the zoonotic implications, and be able to advise our clientele.</p

Tapper, Ronald

Beran, George

Digital Repository @ Iowa State University (ISU)

Campy/abaeter jejuniTransmission from Pet Animals:A New Zoonosis?Ronald A. Tapper, BS, DVM*George W. Beran, DVM, PhD* *IntroductionIn recent years, Campylobacter jejuni has beenrecognized as an important enteric pathogenof human beings causing acute and subacutegastrointestinal illness. Recent reports havesuggested that infected household pets may bevectors for the human infection. 1 It has beentheorized that as more research will be con-ducted' the zoonotic implications of C. jejuniwill rival and probably exceed those ofsalmonellosis. 2 ,3 Therefore, as veterinarians,it is important to be aware of the disease inanimals, the zoonotic implications, and beable to advise our clientele.Campylobacter species (formerly known asVibrio) have been known to cause abortion incattle and sheep since the initial isolation in1909. 4 In 1947, V fetus was first cultured froma human being. 4 However, it was not until1969 that reseachers using a selective mediumwere successful in isolating related vibriosfrom the stools of human patients with diar-rhea. 4In 1981, Skirrow reported the present hu-man incidence of diarrheic disease caused byC. jejuni to be just less than 9,000 reportedcases per annum. 5 The symptoms and signs ofcampylobacter infection are not so distinctivethat the human physician can differentiate itfrom illness caused by other enteric patho-gens. Symptoms vary from those appearing asa 24-hour viral gastroenteritis to that of a re-lapsing colitis that mimics ulcerative colitis orCrohn's disease. 4 Other differentials includesalmonellosis and shigellosis. 6 The typicalcourse of the disease is a moderate to mild,self-limiting illness of one-week duration.Fever is a common symptom and is often ac-*Dr. Tapper is a 1984 graduate of the College of Veteri-nary Medicine at Iowa State University.**Dr. Beran is a professor of Veterinary Microbiologyand Preventive Medicine at Iowa State University.Vol. 46) No.2companied by malaise, headache, backache,myalgia, and arthralgia. Abdominal paingenerally precedes the onset of diarrhea.Feces are loose to watery and commonly con-tain mucus and frank blood. 2 ,4,5 The diseaseappears to spread readily amongst childrenand immunosuppressed adults. 7 The incuba-tion period may be 2-5 days, with some aslong as 10. 7 People who become infected willshow a rise in antibody titer against the orga-nism which is very helpful in making thediagnosis. 4The reservoir for C. jejuni is enormous. Theorganism has been isolated from healthy cat-tle, sheep, goats, swine, horses, poultry, ro-dents, dogs, cats, and monkeys. t,2,3,4,8 Infec-tion with C. jejuni may cause diarrheal illnessin calves, lambs, dogs, cats, and monkeys.Commercial pork, lamb, beef and poultrycarcasses have been cultured positive for C.jejuni. 4 It has also been isolated from fresh wa-ter and sea water, with a survival rate of up tofive weeks in fresh water. 4 Feces from infectedanimals or persons may contain viable orga-nisms for up to four weeks and could be asource for contamination of the environ-ment. 4PathogenesisThe pathogenicity of C. jejuni or other cam-pylobacter species in the dog has not been es-tablished. Campylobacter jejuni has been isolatedfrom the feces of clinically normal dogs as wellas dogs with diarrhea. 2 ,9 Campylobacter en-teritis has been reproduced, using pure cul-tures of human or canine isolates of C. jejuni)in conventional as well as gnotobiotic pup-pies. tOClinically, the disease induced in gnoto-biotic pups was mild, being associated withtransient malaise and inappetence, mild diar-rhea, and tenesmus. In conventional pups,the signs are soft to watery diarrhea with mu-101CUS. 9 ,10 Adult dogs inoculated with a canineisolate of C. jejuni developed watery to mucoiddiarrhea and small intestinal lesions charac-terized by blunted villi, a mixed inflammatorycell infiltration in the lamina propria, andenlarged Peyer's patches. 9 There have beenother short reports published which describevomiting as a characteristic, with loose fecesbeing produced for about 10 days; in somecases the feces have contained blood. 2 C. jejunihas been implicated in cases of fatal hemor-rhagic enteritis, but there is some doubt as tothe reliability of these reports due to thefailure to differentiate it from toxicoses orother intestinal infections. 2 The organism istissue invasive, causing acute enterocolitisand sometimes bacteremia. 11 Campylobaeter hasbeen found as a secondary invader in dogswith canine parvovirus infection andsalmonellosis. 11Infection in human beings after contactwith sick animals, especially puppies and kit-tens, has been well-documented. 4 Pet birdshave also been suspected as sources of humaninfections. 3 However, most zoonotic out-breaks have appeared to be associated withingestion of infected or contaminated poultryor untreated milk. 3 ,5 Skirrow estimated in1981 the number of human cases associatedwith canine and feline campylobacter infec-tions to represent about 5 % .12 A typical his-tory is the acquisition of a young pup by ahousehold, the development of diarrhea bythe animal, and the subsequent developmentof diarrhea in the owner of the pUp.2 In con-trast to the situation in dogs, there have beenfew reports of transmission of C. jejuni fromdiarrheic kittens to their owners, which sug-gests that naturally occurring C. jejuni diar-rhea in kittens is uncommon. 2DiagnosisThe isolation of C. jejuni from the feces canbe challenging. For optimal recovery, feces orswabs of feces should be refrigerated at 4°C.Swabs should be kept in Cary-Blair mediumwith 0.16 % agar. Culturing should be per-formed on the day of collection. Feces can beexamined by dark-field microscopy for dart-ing, motile, corkscrew-shaped bacteria. Theuse of a selective medium designated"Campy-BAP" has given better recovery after48 hours incubation than has other direct-plating selective media. This medium is avail-able commercially. Optimal microaerophilic102incubation conditions for isolation are 5 %oxygen, 10 % carbon dioxide, and 85 % nitro-gen. Plates are incubated at 42°C and ex-amined after 48 hours. Campylobaeter spp. aregram-negative, curved-shaped rods withsingle polar flagellae. Campylobaeterjejuni is mi-croaerophilic' catalase-positive, and cyto-chrome-C positive. It will grow at 42°C, butnot 25°C, and most strains are hippurate hy-drolysis positive. It will grow in 1% glycine.Most strains are sensitive to nalidixic acid (30ug), but resistant to cephalothin (30ug). 2,4, 13, 14PreventionIn countries with high standards of publichealth, lower animals are perceived as the ma-jor reservoirs of C. jejuni responsible for hu-man disease. Almost always where conditionsof poor hygiene exist, human infections arecontracted from animals with diarrhea ratherthan from clinically normal infected animals. 5A common example would be a person be-coming infected after sharing a bed with apuppy with diarrhea.Since the available evidence has shown thathousehold animals constitute a reservoir forC. jejuni) the interruption of transmission tohuman beings from these sources should havehigh priority.4 A high standard of personal hy-giene, including thorough handwashing be-tween examination of patients, and steriliza-tion of all diagnostic equipn1ent, isrecommended for all veterinarians. 8 Hospital-ized animals with diarrhea should be iso-lated. 8 Client education is essential, based onpracticing simple hygienic preventivemeasures. 2,4 The risk of acquiring campylo-bacter infections from pet animals is remoteand can probably be abolished by frequenthandwashing and the isolation of dogs andcats with diarrhea from young children. 5TreatmentSince the duration of campylobacter excre-tion following clinical recovery is unknownand the possibility exists for continuingzoonotic spread, dogs and cats from whichcampylobacters have been isolated should betreated. Erythromycin is the drug of choicefor human patients. In dogs, an oral erythro-mycin dose of 40 mg/kg body weight for fivedays appears to eliminate the infection. 5 Inanimals which vomit after oral erythromycintherapy, oral tylosin at a dose of 45 mg/kgdaily n1ay be given for five days.5 The efficacyIowa State Veterinarianof treatment should be confirmed by fecalbacterial cultures one week and one monthlater. 5 Since there is no information regardingcarrier states in dogs and cats, fecal examina-tion for campylobacters should always be re-peated in diarrheic animals with previous pos-itive isolations. 5 As is the case with Salmonella)it appears that C. jejuni can be carried bylower animals without ill effect. 2 Presumably,immunity or resistance to infection can de-velop, and the animals remain as carriers of asyet undetermined duration. Epidemiologicalevidences of human infections transmittedfrom pet animals have been from diarrheic,not carrier animals.ConclusionAs a zoonotic disease, Campylobacter jejunihas. become well-recognized in the last 15years. With improved culturing techniques, itis being diagnosed both in hun1an patientsand in animals much more frequently. It isimportant to be able to diagnose infected ani-mals and to be able to make proper recom-mendations to our clients. We need to workwith physicians in recognizing the source ofthe problem and in controlling the zoonoticdisease caused by Campylobacter jejuni.REFERENCES1. Blaser MJ, LaForce FM, Wilson NA, Wang WLL:Reservoirs for Human Campylobacteriosis. J InfectDis 141 :665 -669, 1980.2 Prescott JF, Manroe DL: Camp)'lobacter jejuni Enteritisin Man and Domestic Animals. ]AVMA 181: 1524-1529, 1982.3. Blaser MJ: Campylobacter Fetus Subspecies jejuni: TheNeedfor Surveillance. J of Inj Dis 141 :670-671, 1980.4. Blaser MJ, Reller, LB: Campylobactcr Enteritis.New England] of Med 305:1444-1451, 1981.5. Holt PE: The Role of Dogs and Cats in the Epidemi-ology of Human Campylobacter Enterocolitis. J ojSmall Animal Practice 22:681-685, 1981.6. Furie WS: Campylobacter and Disease. Comp on ContEd 4:205-209, 1982.7. Symonds J: Campylobacter Enteritis in the Commu-nity: British Medical] 286:243-244, 1983.8. Robinson RA: Campylobacterosis in Humans: AnEmerging Zoonosis. Minnesota Veterinarian 23: 6, 1983.9. Davies AP, Gebhart CJ, Meric SA: Campylobacter-associated chronic diarrhea in a dog. ]AVMA184:496-471,1984.10. Prescott JF, Barker IK, Manninen KI, Miniats OP:Campylobacter jejuni Colitis in Gnotobiotic Dogs. Can]Comp Med 45:377-385,1981.11. Ettinger SJ: 1extbook of Veterinary Internal Medicine. Phi-ladelphia, WB Saunders Co., 1305, 1983.12. Skirrow MB: Campylobacter enteritis in dogs andcats: A "New" Zoonosis. Vet Res Commun 5: 13 - 19,1981.13. McOris S, Browning JW: Carriage of Campylobacterjejuni in healthy and Diarrheic Dogs and Cats. Austra-lian Vet] 58:33-34, 1982.14. Vandenberghe J, Lauwers, S, Plehier P, Itoorews J:Campylobacter jejuni related with Diarrhea in Dog. BrVet] 138:356-361, 1982.SCAVMA SCAMPER5K and 10K • Ames, Iowa • April 14, 1985For More Information Contact:Race Director clo VISCOISU College of Veterinary MedicineAmes, IA 50011vol. 46) No.2 103

Campylobacter jejuni Transmission from Pet Animals: A New Zoonosis?

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Campylobacter jejuni Transmission from Pet Animals: A New Zoonosis?

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