The illness

According to a recent study published in the British Journal of Clinical Pharmacology, individuals who take medications for conditions such as heartburn and gas may prone to infections with Clostridium difficile (C. diff) and Campylobacter bacteria. US Food and Drug Administration once warned of similar risks associated with proton pump inhibitors (PPIs) back in 2012. (MROZ, 2017)

Proton pump inhibitors (PPIs) are a group of drugs function to reduce the amount of acid produced by the stomach. They are commonly used to treat acid reflux and ulcers of the stomach the duodenum. They include lansoprazole, omeprazole and pantoprazole. (Knott, 2014)

In this study, the researchers looked at approximately 565,000 adults, and over 188,000 had been given at least one prescription for a PPI while the rest had no prescription for the drugs. The researchers found that “those on certain heartburn drugs had higher risks of infection with C. difficile and Campylobacter bacteria” . The study results indicated that, “on average, people on the drugs were roughly four times more likely to develop a Campylobacter infection.” (MROZ, 2017)

A professor of pharmacology at the University of Dundee in Scotland,  Dr. Thomas MacDonald, suspects that drugs that suppress stomach acids can change the balance of “good” and “bad” bacteria in the gut, which may make people more susceptible to infections. Dr. David Bernstein, a gastroenterologist who was not involved in the study, agreed that stomach acid suppression could be the culprit. (HealthDay, 2017)

Although the study does not prove that these medications increase the risk of gastrointestinal infections, there is a plausible connection because the medications suppress stomach acids and impact the balance between the good and bad bacteria in the gut, making patients vulnerable to gut infections causing bacteria.  (MROZ, 2017)

References

MROZ, D. (2017) Heartburn medications dealt another blow by new study. Available at: http://www.contagionlive.com/news/heartburn-medications-dealt-another-blow-by-new-study (Accessed: 11 January 2017).

Knott, L. (2014) Proton pump inhibitors (PPIs). Stomach medication; Information. Available at: http://patient.info/health/proton-pump-inhibitors (Accessed: 11 January 2017).

HealthDay (2017) Heartburn drugs may raise risk of stomach infections: Study: MedlinePlus health news. Available at: https://medlineplus.gov/news/fullstory_162900.html (Accessed: 11 January 2017).

 

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The disease

If the chicken is not cooked to 73 degrees Celsius, the bacteria can survive and cause serious illnesses to those who consumes it.(Larsen, 2016)

A  study by Michigan State University research team is the first to show that Campylobacter jejuni triggers Guillian-Barre Syndrome. A professor of MSU, Linda Mansfield, said that it takes a certain genetic makeup combined with a certain Campylobacter strain to cause this disease. However, these strains may be antibiotic resistant and treatment with antibiotics could potentially worsen the disease. The antibiotics used in this study intensified neurological lesions and the number of immune antibodies that attack a patient’s own organs and tissues. (State, 2016)

The scientists conducting this study want to test drugs against the syndrome. Mansfield said, “Treatment is great but therapeutics to prevent GBS from developing in the first place would be the best strategy so that people don’t have to suffer with paralysis.” (Larsen, 2016)

GBS is an autoimmune disease and  is the number one cause of acute neuromuscular paralysis. Symptoms include vomitting, diarrhea, tingling and weakness in the legs. Paralysis can spread to the upper body and arms and affect the lungs. Patient’s respiration is then assisted with ventilator Other complications include Reiter’s Syndrome which  causes reactive arthritis, and inflammatory bowel disease. Despite the severity of GBS, treatments have been very limited and fail in many cases.

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Mayo Clinic

 

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(Hageman, 2016)

The immune system starts to destroy the meylin sheath that surrounds the axon, or the axon themselves. As a results, transmission of nerve signals cannot be done effeciently. The muscles starts to lose its ability to respond to the brain’s commands. The brain also receives fewer sensory signals from the rest of the bost, resulting in disability to feel.

References

Larsen, L. (2016) New study shows how Campylobacter in chicken causes Guillain-Barre. Available at: https://foodpoisoningbulletin.com/2016/new-study-shows-how-campylobacter-in-chicken-causes-guillain-barre/ (Accessed: 30 December 2016).

State, M. (2016) New evidence shows how bacterium in undercooked chicken causes GBS. Available at: http://msutoday.msu.edu/news/2016/new-evidence-shows-how-bacterium-in-undercooked-chicken-causes-gbs/ (Accessed: 30 December 2016).

Hageman, P. (2016) Guillain-Barré syndrome (GBS) lawyer for lawsuit. Available at: http://www.pritzkerlaw.com/campylobacter/guillain-barre-syndrome/ (Accessed: 30 December 2016).

Available at: https://www.ninds.nih.gov/Disorders/Patient-Caregiver-Education/Fact-Sheets/Guillain-Barr%C3%A9-Syndrome-Fact-Sheet (Accessed: 30 December 2016).

The water

A public apology was issued on Aug 15 by New Zealand’s Hastings district Mayor after thousands of people fell sick due to the outbreak of a waterborne illness.

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According to Radio New Zealand, the water supply was contaminated with Campylobacter, resulting in 2000 people showing symptoms of gastroenteritis. Symptoms includes vomitting and diarrhea. 50 people taken to the emergency department at Hawke’s Bay Hospital in which 2 elderlies taken care in the intensice care unit, 18 people hospitalised (they were tested positive for Campylobacter) and there was a death of a citizen from gastro-like illness. According to Hastings District Mayor, this is the largest outbreak in the history of New Zealand. (CNN, 2016) Having elderlies hospitalised has prompted health officials to encourage the community to keep an eye out for older people living alone.(Herriman, 2016)

The mayor stated that the contamination was very serious and the contamination was mostly likely a result of animal feces finding its way to the bore. (CNN, 2016)

References

The council said the water is being treated but all residents should boil their tap water (BBC, 2016) because of the possibility of resitance to chlorination in the water.(Herriman, 2016)

CNN (2016) Suspected animal faeces contamination in New Zealand town water supply, inquiry launched. Available at: http://www.channelnewsasia.com/news/asiapacific/suspected-animal-faeces/3044542.html (Accessed: 25 December 2016).

BBC (2016) Tap water in New Zealand town causes hundreds to fall ill. Available at: http://www.bbc.com/news/world-asia-37086445 (Accessed: 24 December 2016).

Herriman, R. (2016) Hawke’s bay outbreak update, what is Campylobacter? Available at: http://outbreaknewstoday.com/hawkes-bay-outbreak-update-what-is-campylobacter-88315/ (Accessed: 20 December 2016).

Herriman, R. (2016) Havelock north outbreak: Patient testing reveals Campylobacter in most cases. Available at: http://outbreaknewstoday.com/havelock-north-outbreak-patient-testing-reveals-campylobacter-in-most-cases-87909/ (Accessed: 25 December 2016).

The milk

A Campylobacter outbreak happened in Pueblo County, Colorado where atleast 20 people were affected. Those affected reported that they drank raw milk from Larga Vista Ranch. Government warned consumers not to consume raw milk and its products from Larga Vista. Its complications is greater for infants, elderly, pregnant women and those will weakened immune system.

Many animals carry Campylobacter in their intestines and shed in feces. Cow’s teas is positioned closed to its anus, thus feces may get into the milk and contaminate it. Less than 500 organisms of Campylobacter are needed to cause infectious disease. (Desk, 2016)

As a result of not purchasing the Ranch’s products, the revenue reduced by half. And more money has to be invested in investigating the source of campylobacter and the treatment so that the product is bug-free.

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On 22 December 2016, six cases of campylobacter so far have been linked to consumption of unpasteurised milk from Low Sizergh Barn Farm in Kendal. Public Health England (PHE) created an online questionnaire for those who visited the farm, regardless of whether they drank raw milk.

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https://surveys.phe.org.uk/TakeSurvey.aspx?SurveyID=l2306l6K#

The results from the survey will be used for investigation led by South Lakeland Council and Food Standards Agency (FSA). The council’s spokesman said that it is important for people to know about the situation in case they get infected. FSA is taking measures to prevent public consumption of unsafe products. One of the measures includes removing unpasteurised milk from the sales when the Campylobacter results were confirmed.

The farm sells about 70 litres of unpastuerised milk from its vending machine each day. When FSA ceases its sales, it results in the loss of revenue for the farm. Some of the workers there may even be jobless for the time being. (BBC, 2016)

References

Desk, N. (2016) Campylobacter outbreak in Pueblo county CO linked to raw milk. Available at: https://foodpoisoningbulletin.com/2016/campylobacter-outbreak-in-pueblo-county-co-linked-to-raw-milk/ (Accessed: 25 December 2016).

BBC (2016) Kendal food poisoning ‘linked to raw milk’. Available at: http://www.bbc.com/news/uk-england-cumbria-38409110 (Accessed: 24 December 2016).

The chickens

Consumer NZ studied 40 chickens, and found out that 65 percent (26 chickens) tested positive for Campylobacter. This test is highly sensitised to pick up the smallest trace of Campylobacter, varying from the requirements of Ministry for Primary Industries.

Director of Poultry Industry Association, Mr Michael Brooks, mentioned that chicken only accounts for 40 per cent of NZ’s Campylobacter cases. However, the team went on to further study the effects of consuming the infected chicken. They concluded that consuming those chicken only increases the chance, not necessarily getting ill. One can get infected if the meat was undercooked or if the raw meat came in contact with other food, resulting in the survival and the spread of Campylobacter.

Apart from testing chicken at meatworks, Ministry of Primary Industries suggested for retail testing to test for the bacteria in chicken carcase. In UK, retail testing was carried out. It brings on public awareness to reduce contamination when handling chicken. As a result of this initiative, UK had 32 fewer Campylobacter-related illness as compared to NZ, which had 135 cases last year. Furthermore, NZ Ministry of Health stated that Campylobacterosis is the most common foodborne illness in NZ. Thus, retail testing could possibly reduce the numbers of cases gradually.

In rhe UK, more than 2 million chickens are consumed in the UK and about half of the chickens sold carry Campylobacter jejuni. Campylobacteriosis reaches up to 280 000 cases per year in UK while globally, scientists calculated that were were 100 million illnesses by Campylobacter and more than 20 000 deaths. Dr Grant, the scientist at Department of Veterinary Medicine sayd that the bacteria might just change; from attacking just the gut to infecting the liver and some deep muscles in chickens – making it difficult for elimination. One of the main points of transmission is during processing where the chicken guts can spill and contaminate other carcasses. The scientist raises the issue of everyone – including the farmer, the processor, the supermarket, food inspectors and consumers – play a role in keeping the bacteria under control.

At the same time, we need continued research to understand how Campylobacter colonises chickens so that we can devise novel interventions and vaccines, as well as develop an understanding of how it causes disease in humans so that therapeutics can be developed. (Cooke, 2017)

References

Limited, F.N.Z. (2016) More than half of chicken could have campylobacter – consumer NZ. Available at: http://www.stuff.co.nz/national/health/87438060/More-than-half-of-chicken-could-have-campylobacter-Consumer-NZ (Accessed: 22 December 2016).

Cooke, K. ] (2017) Cambridge University scientists lead battle against chicken bacteria. Available at: http://www.cambridgeindependent.co.uk/business/science/cambridge_university_scientists_lead_battle_against_chicken_bacteria_1_4844088 (Accessed: 5 February 2017).

 

 

The research

An Australian researcher at the Griffith University Institute for Glycomics recently identified a campylobacter sensor. It is the first known finding of a bacterial sensor that can bind sugar directly. The research showed that the ability of the bacteria to cause disease are based on bacterias’ ability to move toward target host cells, and the movement are dependent on specialized structures on the cells, known as “sensory receptors”. These highly specific receptors can sense chemicals in their environment . The receptor identified in invasive strains of Campylobacter jejuini is a direct-sensing galactose chemoreceptor. (News, 2016)

Electron micrograph of C. jejuni in chicken gut by Griffith University

A study is made where 1 of the receptors, KD of CcrG sensor that binds specifically to galactose, of the Campylobacter is mutated. As a result, it altered the phenotype of the bacteria, which includes reducing the ability to colonise and infect chickens. In the study, the bacteria had increased chemotaxis towards galactose of allelic addition strains, 81116ΩccrG and FF34ΩccrG. This further confirmed that the chemotaxis response to galactose was affected by CcrG. (Day et al., 2016)

This suggest the desgin of antimicrobial drugs to specifically target certain foodborne pathogens without affecting the normal flora. In addition, it could reduce the chances of developing antimicrobial resistance since the bacterial cells are not killed, but inhibiting the cells’ ability to reach host cells.

Understanding how the bacterial sensors bind to chemicals poses huge potential for the future. With the understanding, bacteria can be engineered with sensors that may selectively direct cancer-killing bacteria towards cancer cells or direct bacteria to degrade chemicals released in the environment. (University, 2016)

References

News, F.S. (2016) Australian research reveals how Campylobacter bacteria work. Available at: http://www.foodsafetynews.com/2016/10/australian-research-reveals-how-campylobacter-bacteria-work/#.WChjO_l97IV (Accessed: 13 November 2016). (News, 2016)

Griffith University. “New way to attack gastro bug: Pathogenicity and host-bacterial interactions of bacteria Campylobacter jejuni.” ScienceDaily. ScienceDaily, 21 October 2016. <www.sciencedaily.com/releases/2016/10/161021121622.htm>.

Day, C.J., King, R.M., Shewell, L.K., Tram, G., Najnin, T., Hartley-Tassell, L.E., Wilson, J.C., Fleetwood, A.D., Zhulin, I.B. and Korolik, V. (2016) ‘A direct-sensing galactose chemoreceptor recently evolved in invasive strains of Campylobacter jejuni’, 7.

The response

WHO partners with other stakeholdersis to develop policies that will further promote the safety of food. These policies cover the entire food chain from production to consumption.

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WHO

WHO promotes the strengthening of food safety systems, promoting good manufacturing practices and educating retailers and consumers about appropriate food handling and avoiding contamination. These efforts are the most critical interventions in the prevention of foodborne illnesses.

  • WHO’s brochure A guide on safe food for travellers gives practical advice for safeguarding health when travelling (http://www.who.int/foodsafety/publications/consumer/en/travellers_en.pdf?ua=1)
  • Ensure food is properly cooked and still hot when served.
  • Avoid raw milk and products made from raw milk. Drink only pasteurized or boiled milk.
  • Avoid ice unless it is made from safe water.
  • When the safety of drinking water is questionable, boil it, or if this is not possible, disinfect it with a reliable, slow-release disinfectant agent (usually available at pharmacies).
  • Wash hands thoroughly and frequently using soap, in particular after contact with pets or farm animals, or after having been to the toilet.
  • Wash fruits and vegetables carefully, particularly if they are eaten raw. If possible, vegetables and fruits should be peeled.
  • Both professional and domestic food handlers should be vigilant while preparing food and should observe hygienic rules of food preparation.
  • Professional food handlers who suffer from fever, diarrhoea, vomiting or visible infected skin lesions should report to their employer immediately.
  • More information for food handlers is provided in the WHO Five keys to safer food (http://apps.who.int/iris/bitstream/10665/43546/1/9789241594639_eng.pdf?ua=1)  

References

WHO (2016) Campylobacter. Available at: http://www.who.int/mediacentre/factsheets/fs255/en/ (Accessed: 13 November 2016).

The Fact

Campylobacteriosis is a major infectious disease caused by Campylobacter sps, topping Salmonella. According to WHO, there are currently 17 known species and six subspecies of Campylobacter. C. jejuni and C. coli being the most frequently reported subspecies in connected to human diseases (WHO, 2016). They are Gram negative bacteria with variety of shapes; spiral, rod, curved and S shaped. They are microaerophiles (Carlone and Lascelles, 1982) and are motile (Guerry, 2007).

Tzu Chi Med J, 2004

Clinical symptoms include diarrhea, abdominal pain, fever, vomitting and nausea. Death due to Campylobacter is rare, but is possible in very young patients, elderly patients and those with weak immunity (WHO, 2016).

Campylobacter is distributed in warm blooded animals like cattles, pigs, sheeps, cats and dogs.

Campylobacter is transmitted to human from animal product (zoonosis) by consuming uncooked food, raw or contaminated milk and water. Once in the body, Campylobacter can cause complications like bacterimia, hepatitis, pancreatitis and miscarriage (WHO, 2016).

Usually, campylobacteriosis is a felf-limiting disease. However, in some cases it requires treatment. Treatment includes rehydration with electrolytes. Antimicrobial treatment (erythromycin, tetracycline, quinolones) is recommended when bacteria invade the intestinal mucosa cells and damage the tissues or to eliminate the carrier state (WHO, 2016).

References

WHO (2016) Campylobacter. Available at: http://www.who.int/mediacentre/factsheets/fs255/en/ (Accessed: 13 November 2016).

Guerry, P. (2007) ‘Campylobacter flagella: Not just for motility’, Trends in microbiology., 15(10), pp. 456–61.

Carlone, G. and Lascelles, J. (1982) ‘Aerobic and anaerobic respiratory systems in Campylobacter fetus subsp. Jejuni grown in atmospheres containing hydrogen’, Journal of bacteriology., 152(1), pp. 306–14.

F Mushi, M., Paterno, L., Tappe, D., Deogratius, A.P., Seni, J., Moremi, N., Mirambo, M.M. and Mshana, S.E. (2014) Research Gate. Available at: https://www.researchgate.net/publication/271214444_Evaluation_of_detection_methods_for_Campylobacter_infections_among_under-fives_in_Mwanza_City_Tanzania?_sg=BmWDFyWEHJk7wM86-wF25qYFD3UqpY2g8A3CRGEblhuVpZ1ezx_pWDBYfPZHhVWg2Iwp1U_gZyaaJBOMVbfJIA (Accessed: 12 January 2017).