zoonoses and communicable diseases common to ... - PAHO/WHO

CAMPYLOBACTERIOSIS 73Occurrence in Man: Uncommon. Up to 1981, the literature recorded at least 134confirmed cases (Bokkenheuser and Sutter, 1981), most of them occurring in the USand the rest in various parts of the world. The incidence is believed to be muchhigher than that recorded.Occurrence in Animals: The disease is common in cattle and sheep and occursworldwide.The Disease in Man: The strains isolated from man have characteristics similar tothose of C. fetus subsp. fetus (intestinalis), which causes outbreaks of abortion amongsheep and sporadic cases in cattle. Two cases caused by C. fetus subsp. venerealis havealso been described (Veron and Chatelain, 1973). Campylobacteriosis is generally recognizedwhen accompanied by predisposing debilitating factors, such as pregnancy,premature birth, chronic alcoholism, neoplasia, and cardiovascular disease. Themajority of isolations are from pregnant women, premature babies, and men andwomen over 45 years of age. The proportion of cases is higher in men than in women.Infection by C. fetus causes septicemia in man. In more than half of the cases,bacteremia is secondary and follows different localized infections. Between 17%and 43% of septicemic patients die (Morrison et al., 1990). Most cultures have beenobtained from the bloodstream during fever, but the etiologic agent has also beenisolated from synovial and spinal fluid, and sometimes from the feces of patientswith acute enteritis.In pregnant women, the illness has been observed from the fifth month of pregnancy,accompanied by a sustained fever and often by diarrhea. Pregnancy may terminatein miscarriage, premature birth, or full-term birth. Premature infants andsome full-term infants die from the infection, which presents symptoms of meningitisor meningoencephalitis. The syndrome may begin the day of birth with a slightfever, cough, and diarrhea; after two to seven days, the signs of meningitis appear.The case fatality rate is approximately 50%. Malnourished children, and at timesapparently healthy ones, can develop bacteremia along with vomiting, anorexia,diarrhea, and fever. The patient usually recovers spontaneously or after antibiotictreatment. In adults, often those already weakened by other illness, the diseaseappears as a generalized infection with extremely variable symptomatology(Bokkenheuser and Sutter, 1981). C. fetus subsp. fetus is above all an opportunisticpathogen that gives rise to a systemic infection but rarely causes enteritis, in contrastto C. jejuni. Some cases of gastroenteritis caused by C. fetus subsp. fetus have beennoted in men without a compromised immune system (Devlin and McIntyre, 1983;Harvey and Greenwood, 1983).Gentamicin is the recommended antibiotic in the case of bacteremia and otherclinical forms of nonenteric infection. Chloramphenicol is recommended when thecentral nervous system is involved. Prolonged antibiotic treatment is necessary toprevent relapses (Morrison et al., 1990).The Disease in Animals: In cattle and sheep, vibriosis is an important diseasethat causes considerable losses due to infertility and abortions.CATTLE: In this species, the principal etiologic agent is C. fetus subsp. venerealisand, to a lesser degree, subsp. fetus. Genital vibriosis is a major cause of infertility,causing early embryonic death. The principal symptom is the repetition of estrusafter service. During an outbreak, a high proportion of cows come into heat repeat-