How is Clostridium jejuni contracted?

How Campylobacter jejuni is Contracted

Campylobacter jejuni is primarily contracted through consumption of contaminated food (especially undercooked poultry), unpasteurized milk, and contaminated water, with person-to-person transmission occurring through the fecal-oral route. 1, 2

Primary Routes of Transmission

Food-Related Transmission

• Poultry products: The most common source of C. jejuni infection is through consumption of raw or undercooked poultry 1
• Unpasteurized milk: Consumption of raw milk is a significant risk factor 3
• Contaminated water: Drinking water contaminated with C. jejuni can cause infection 3

Environmental Factors

• Poor hygienic infrastructure: Countries with inadequate sanitation systems show higher rates of C. jejuni infection 1
• Food handling practices: Cross-contamination during food preparation can spread the bacteria 1

Mechanism of Infection

Once ingested, C. jejuni employs several mechanisms to establish infection:

1. Penetration of gastrointestinal mucus: The bacteria use their high motility and spiral shape to move through the intestinal mucus layer 4
2. Adherence to gut enterocytes: After penetrating the mucus, C. jejuni adheres to intestinal epithelial cells using adhesins like CadF and FlpA 5
3. Invasion of cells: The bacteria can invade epithelial cells through multiple mechanisms, including:
   • Triggering membrane ruffling
   • Utilizing host cell structures like fibronectin, clathrin, and dynein 5
4. Toxin production: C. jejuni releases enterotoxins and cytotoxins that contribute to diarrhea and tissue damage 4

Epidemiological Patterns

• Regional variations: C. jejuni infection is more prevalent in certain regions:

  • Higher rates in Bangladesh, China, and Curaçao (~60-70% of GBS cases) compared to other countries (30-32%) 1
  • Gastroenteritis is the most frequent antecedent event associated with GBS in India and Bangladesh (36-47%) 1

• Public health interventions: Targeted interventions can reduce infection rates:

  • New Zealand implemented measures to reduce Campylobacter contamination in poultry, resulting in a 52% decline in campylobacteriosis and 13% reduction in GBS hospital admissions 1

High-Risk Groups

• Travelers: People traveling to regions with poor sanitation are at increased risk 1
• Children: Particularly vulnerable in developing countries 1
• Immunocompromised individuals: More susceptible to severe infection

Prevention Strategies

• Proper food handling: Cook poultry thoroughly and avoid cross-contamination
• Water safety: Consume only treated or bottled water in high-risk areas
• Hand hygiene: Thorough handwashing with soap and water, especially after contact with raw poultry or potential fecal contamination 1
• Avoiding unpasteurized dairy products: Only consume pasteurized milk and dairy products

Clinical Implications

The importance of understanding C. jejuni transmission extends beyond acute gastroenteritis, as infection is associated with serious sequelae:

• Guillain-Barré Syndrome (GBS): C. jejuni is the most frequently identified infectious agent triggering GBS worldwide 1, 3
• Irritable Bowel Syndrome: C. jejuni infection can lead to post-infectious IBS 2
• Reactive Arthritis: Can develop following infection in some individuals

Understanding these transmission pathways is crucial for developing effective prevention strategies and reducing the burden of both acute infection and serious post-infectious complications.