CAMPYLOBACTER

& PLESIOMONAS

Ericka Mae P. Cruto

BSMT 3-2
CAMPYLOBACTER
 Campylobacter
The genus name Campylobacter was derived from a Greek word
for curved rod because they are curved, spiral, S- shaped gram-
negative bacteria (0.5 to 8 m long and 0.2 to 0.5 m wide).
Most campylobacters are asaccharolytic
Although they may appear to be strict anaerobes, they have been
grown in a microaerophilic environment.
Most species are microaerophilic and majority appear to be
pathogeniCampylobacter
They have a single polar unsheathed flagellum (monotrichous) or a
flagellum at each end (amphitrichous).
The motility of the bacteria is characteristically rapid and darting
in corkscrew fashion.
 Motility contributes to the ability of
campylobacters to colonize and infect intestinal
mucosa. Multiplication of organisms in the intestine
leads to cell damage and an inflammatory
response.
They also have inability to ferment or oxidize the
usual carbohydrate substrates available in the
diagnostic laboratory.
They reduce nitrates and they are also slow-
growing and fastidious.
 Campylobacter spp. are microaerobic inhabitants of the
gastrointestinal tracts of various animals, including poultry,
dogs, cats, sheep, and cattle, as well as the reproductive
organs of several animal species.
Campylobacter spp. have been known to cause abortion in
domestic animals, such as cattle, sheep, and swine and are
primarily zoonotic organisms.
Within the genus Campylobacter, Campylobacter jejuni and
Campylobacter coli are most often associated with infections
in humans and are usually transmitted via contaminated
food, milk, or water.
Outbreaks have been associated with contaminated drinking
water and improperly pasteurized milk.
 Other campylobacters have been isolated from patients
who drank untreated water, were compromised in some
way, or were returning from international travel.
The disease manifest most on infants and young adults,
but all age is at risk.
The transmission of campylobacterioses has been
attributed to direct contact with animals and handling
infected pets, such as dogs, cats, and birds, and
indirectly by the consumption of contaminated water
and dairy products and improperly cooked poultry.
Person to person transmission has been reported, and
some Campylobacter spp. are also sexually transmitted.
 Campylobacters can cause either gastrointestinal or
extraintestinal infections.

Extraintestinal disease including:

Meningitis

Endocarditis,

Septic arthritis

It is being recognized increasingly, particularly in patients

with acquired immunodeciency syndrome (AIDS) and other
immunocompromised individuals.
Gastroenteritis caused by Campylobacter spp. is usually a
self-limiting illness and does not require antibiotic therapy.
 Meningitis

Septic Arthritis
 Campylobacter spp. produces three syndromes in humans:
febrile systemic disease

periodontal disease

Gastroenteritis

The most common clinical symptoms of Campylobacter infections

(Campylobacteriosis) include:
Diarrhea

abdominal pain

cramps

fever

headache

nausea and vomiting

Gastroenteritis Periodontal disease
 Diagnostic Tool
There are no special requirements for the collection, transport, and
processing of clinical specimens for the detection of campylobacters.
Most common specimens submitted to the laboratory are feces and
blood.
Campylobacter spp. that cause enteric illness are isolated from stool
samples and rectal swabs
Sometimes can be detected by direct Gram stain examination of stool.
Subcultures from broths must be incubated in a microaerobic
atmosphere or the organisms will not multiply.
Turbidity is often not visible in blood culture media; therefore, blind
subcultures or microscopic examination using acridine orange stain may
be necessary.
 The presence of Campylobacter spp. in blood cultures is
detected effectively by carbon dioxide (CO2) monitoring.
Isolation from sources other than blood or feces is extremely
rare but is ideally accomplished by inoculating the material
(minced tissue, wound exudate) to a nonselective blood or
chocolate agar plate and incubating the plate at 37 C in a
CO2-enriched, microaerobic atmosphere.
Selective Media for the cultivation of Campylobacter Species
 Campylobacter jejuni
Campylobacter Selective on a medium with
(Skirrow) Agar blood, 48 hours, 42
C, 10%CO2.
 Biochemical test of Campylobacter spp.
Species Catal Nitrate Urease H2S Hippurat Indoxyl
ase Reducti producti e Acetate
on on (TSI) Hydroly Hydroly
sis sis
C. Jejuni + + - - + +
subsp. jejuni
C. coli + + - Variable - +
result (V)
C. lari + + - - - -

C. fetus + + - - - -
subsp.fetus
C. fetus + + - - - -
subsp.vener
ealis
 GROWTH AT
Species 15 C 25 C 42 C

C. Jejuni subsp. - - +
jejuni
C. coli - - +

C. lari - - +

C. fetus - + -
subsp.fetus
C. fetus - - -
subsp.venerealis
 VIRULENCE FACTORS

FLAGELLA

IRON ACQUISITION

CYTHOLETHAL
ADHESION & DISTENDING TOXIN
INVASION
 Virulence Factor
Flagella contributes to the bacterias motility
Motility & chemotaxis help lead the bacteria to its
colonization site
Adhesion and invasion important factor for colonizing the
host intestinal cells
Lipopolysaccharide (LPS) - plays a role in adherance as well as
invading the immune system
Cytholethal distending toxin (cdt) this toxin stops the cells
growth cycle in G2
cdtA, cdtB and cdtC genes that acitvates the cdt
cdtB can disrupt DNA in cell and causes cell cycle arrest

Iron acquisition for sustaining nutrients w/in the host

Drug of Choice
The drugs of choice for treating intestinal
campylobacteriosis are:
Azithromycin

Erythromycin

Gentamicin

Tetracycline, erythromycin, and chloramphenicol can

be substituted for gentamicin.
Antimicrobial Resistance
Fluoroquinolones
Macrolides
Trimethoprim
Beta lactam antibiotics, including penicillin and most
cephalosporins
Tetracycline
Quinolone
Kanamyci
 Campylobacter species
Campylobacter fetus Campylobacter jejuni subsp. jejuni
Campylobacter coli Campylobacter lanienae
Campylobacter concisus Campylobacter lari
Campylobacter curvus Campylobacter mucosalis
Campylobacter fetus subsp. fetus Campylobacter rectus
Campylobacter fetus subsp. veneralis Campylobacter showae
Campylobacter gracilis Campylobacter sputorum subsp.
Campylobacter helveticus bubulus
Campylobacter hominis Campylobacter sputorum subsp.
mucosalis
Campylobacter hyoilei
Campylobacter sputorum subsp.
Campylobacter hyointestinalis subsp. sputorum
hyointestinalis
Campylobacter upsaliensis
Campylobacter hyointestinalis subsp.
lawsonii
Campylobacter insulaenigrae
Campylobacter jejuni subsp. doylei
 Several Campylobacter spp. have been implicated
in human infection:
Campylobacter jejuni
Campylobacter coli
Campylobacter lari (laridis)
Campylobacter fetus contains two subspecies,
Campylobacter fetus subsp. fetus and Campylobacter
fetus subsp. venerealis.
 Campylobacter jejuni
Known as the major infectious agent of human
the most common cause of bacteria gastroenteritis
most frequent cause of diarrhea
C. jejuni can be isolated to patients with enteritis
Majority of C. jejuni infections in humans is acquired during the
preparation and eating of chicken
highest infection rate of Campylobacter is during summer
Infection with C. jejuni results in an acute inflammatory enteritis
C. jejuni is thermophilic and capable of hydrolyzing hippurate.
C. jejuni possess a gene coding for cytolethal distending toxin
 Patient infected with C.jejuni present with a diarrheal disease
that begins with mild abdominal pain within 2 to 10 days after
ingestion of the organisms.
Cramps and bloody diarrhea often follow the initial signs
Patients may experience fever and chills and, rarely, nausea
and vomiting.
In most patients, the illness is self-limited and usually resolves in
2 to 6 days.
Untreated patients can remain carriers for several month.
Some cases patients are asymptomatic and mild, many
complications have been reported in young children and
immunocompromised patients, including bacteremia, hepatitis,
cholecystitis, pancreatitis, abortion, myocarditis and meningitis.
C. jejuni has been associated with Guillain-Barr syndrome
 Diagnostic tool
Campy-BAP (blood agar plate), is a commonly used
medium to isolate C. jejuni and other enteric
campylobacters.
This commercially available medium contains Brucella agar
base, 10% sheep red blood cells, and a combination of
antimicrobialsvancomycin, trimethoprim, polymyxin B,
amphotericin B, and cephalothin.
Positive hippurate hydrolysis is an important characteristic
for the identification of C. jejuni. C. jejuni and other enteric
campylobacters grow optimally at 42 C, growth of colon
microbiota is inhibited at this higher temperature.
The typical colony morphology of C. jejuni and
other enteric campylobacters is moist, runny
looking, and spreading.
Colonies are usually nonhemolytic; some are

round and raised and others may be flat.

 Campylobacter Blood Free
Blood-free, charcoal-based selective
Selective Medium (Modified
medium agar (CSM) CCDA)

Campylobacter jejuni
Colony appearance of Campylobacter jejuni growing on Butzler agar, 48
hours, 42C.
 Campylobacter coli
Campylobacter coli was found more often in older patients and
in patients having traveled abroad.
C. coli infection is associated with acute enteritis and abdominal
pain lasting for 7 days or more.
The infections are generally self-limiting, complications may also
involve bacteraemia, GuillainBarr syndrome, reactive arthritis,
and abortion.
The primarily source of C. jejuni/ C. coli infections in human is
caused while handling or during consumption of contaminated
meat, especially poultry meat.
Contact with pets and livestock, the consumption of
contaminated water or raw milk and travelling in high
prevalence areas are also considered risks factors in human
disease.
 They are non-spore formers and grow in micro aerobic
conditions.
C. coli grow slowly in culture and have an optimum
temperature of 42C, they do not grow at 25C. Old cultures
or ones exposed to air for extended periods tend to become
spherical or coccoid.
C. jejuni and C.coli Primary Plating Media and Incubation time
Modied Skirrows media Columbia blood agar base, 7%
horse-lysed blood, and antibiotics
(vancomycin, trimethoprim, and
polymyxin B)
Campy-BAP Brucella agar base with antibiotics
(trimethoprim, polymyxin B,
cephalothin, vancomycin, and
amphotericin B) and 10% sheep
blood
Blood-free, charcoal-based Columbia base with charcoal,
selective medium hemin, sodium pyruvate, and
antibiotics (vancomycin,
cefoperazone, and
cyclohexamide)
Modied charcoal cefoperazone
deoxycholate agar (CCDA)
 C. jejuni and C.coli Primary Plating Media and
Incubation time
Semi solid motility agar Mueller Hinton broth II, agar,
cefoperazone, and trimethoprim
lactate
Campy-CVA Brucella agar base with antibiotics
(cefoperazone, vancomycin, and
amphotericin B) and 5% sheep blood

Incubation time: 42 C under microaerophilic conditions*

for 72 hr
 Campylobacter fetus
Campylobacter fetus is a species of Gram-negative, motile bacteria
with characteristic "S-shaped" rod morphology similar to members of
the genus Vibrio.
C. fetus is oxidase-positive. Campylobacter fetus can cause intestinal
illness and, occasionally, severe systemic infections.
Infections mainly affect persons at higher risk, including elderly and
immunocompromised individuals, pregnant, or elderly persons and
those with occupational exposure to infected animals.
The reservoirs for C. fetus are mainly cattle and sheep. Products from
these animals are suspected as sources for human infections.
Campylobacter fetus is rarely isolated from food, causes severe
infections, including bacteremia and meningitis.
 C. fetus is an opportunistic human pathogen and can
cause thrombophlebitis.
It is the only Campylobacter species that can cause
septicemia.
Campylobacter fetus is devided into two subspecies:
C. fetus subsp. venerealis

C. fetus subsp. fetus

 Campylobacter fetus subsp.fetus
Has been isolated from intestinal tracts of sheep and
cattle and from tissues from sporadic abortions in these
species
Most cases of C. fetus infection are caused by C.
fetus subsp. fetus.
Campylobacter fetus subsp. fetus can be recovered from
the intestinal tract of cattle and other animal species.
Although C. fetus is primarily recognized as a veterinary
pathogen, C. fetus subsp. fetus is occasionally diagnosed
as an opportunistic emerging pathogen in humans.
Infections usually occur in pregnant or immuno-
compromised individuals and are often systemic with a
variety of neurological and vascular complications.
 Campylobacter fetus subsp.fetus

Campylobacter fetus
subsp.venerealis
Campylobacter fetus subsp. venerealis

C. fetus subsp. venerealis is restricted to cattle and

causes bovine genital campylobacteriosis.
C. fetus subsp. venerealis is associated with endemic
abortion and fertility problems in certain areas.
Although C. fetus subsp. venerealis has been isolated
from humans, its role in human disease is uncertain.
Bovine genital campylobacteriosis (BGC) is a
venereal disease also known as bovine venereal
campylobacteriosis (BVC). The causal agent of this
sexually transmissible disease is Campylobacter
fetus subsp. venerealis.
 Campylobacter lari (C. laridis)
Campylobacter lari is a species of nalidixic acid-resistant, thermophilic,
microaerophilic bacteria first isolated from human faeces.
It shows anaerobic growth in the presence of trimethylamine N-oxide
hydrochloride.
It is commonly found in sea gulls.
In humans, it has been involved in cases of enteritis, severe abdominal
pain and terminal bacteremia.
Colonies are colorless, round and 1-1.5 mm in diameter after 72 hrs
culture under microaerobic conditions on 5% blood agar.
They do not hydrolyze hippurate.
C.lari can grow at 37 degrees celcius and 42 degrees celcius but not at
25 degrees Celcius. No growth in air at 25 or 37 degrees celcius.
(b) to (e) "C. laridis", showing different morphological forms of the cells
PLESIOMONAS
 Plesiomonas
The genus Plesiomonas was formerly in the family of
Vibrionacea but recent study shows that they are actually
related to Enterobacteriacea.
But unlike the Enterobacteriaceae it does not have the
ability to produce gas from glucose, and it is the only
oxidase-positive member.
Plesiomonas is oxidase positive, glucose fermenting,
facultatively anaerobic, gram negative bacilli
Occur singly, in pairs, or in short chains or filamentous forms.
They do not form spores or capsules and are motile by
monotrichous or two to five lophotrichous flagella.
Plesiomonas shigelloids is the only spp of the genus
Plesiomonas
 Plesiomonas Shigelloides
Found in soil and aquatic environments, isolates are generally found only
in the fresh and estuarine waters of tropical and subtropical climates.
They are widely distributed among warm- and cold-blooded animals,
including dogs, cats, pigs, vultures, snakes, lizards, fish, newts, and shellfish.
P.shigelloides can be a potential cause of enteric diseases in humans and it
is isolated from a number of extraintestinal infections.
The most common vehicle of transmission is the ingestion of contaminated
water or food, particularly uncooked or undercooked seafood such as
oysters, clams, or shrimp.
They are generally 0.3-1.0 m in width, 0.6-6.0 m in length, motile with
polar flagella, non-spore-producing, and facultatively anaerobic.
Plesiomonas can be serotype by somatic O antigens and their H antigen.
Three major clinical types of gastroenteritis are caused
by Plesiomonas:
The more common watery or secretory diarrhea

A subacute or chronic disease that lasts from 14 days

to 2 to 3 months
A more invasive, dysenteric form that resembles colitis
 The most common clinical symptom for all such patients
is abdominal pain but patients also experience fever
and vomiting.
There are also reports of P. shegelloids infection in
immunocompromised patiens.
Occupational exposure can be a source of infections
for veterinarians, zookeepers, aqua culturists, fish
handlers, and athletes participating in water-related
sports.
Bactericimia and meningitis usually occurs in
immunocompromised patiens and neonates.
Gastroenteritis is the disease with which P. shigelloides has
been implicated. Clinical symptoms of gastroenteritis
include:
Fever

Secretory or dysenteric diarrhea

abdominal pain

Vomiting, nausea, chills, arthralgia, and headache

Symptoms usually resolve spontaneously within two weeks

but can last months. Asymptomatic cases are possible, but
very rare.
Extraintestinal infections include:
Septicaemia

Meningitis

Osteomyelitis

Cellulites

septic arthritis

endophthalmitis

spontaneous bacterial peritonitis

acute cholecystitis
 Diagnostic Tool
Plesiomonas spp. grow readily on most media routinely
used in the clinical laboratory.
After 18 to 24 hours incubation at 35 C, shiny, opaque,
nonhemolytic colonies appear, with a slightly raised
center and a smooth and entire edge.
The easiest screening procedure is an oxidase test
performed on colonies from nonselective media, such as
SBA or CHOC agar.
 Plesiomonas colonies are white to pink on this medium, and
most coliform colonies are green or pink. P. shigelloides
can be presumptively differentiated from similar genera
with several key tests.
The positive oxidase activity separates it from other
Enterobacteriaceae, sensitivity to the agent O/129
separates it from Aeromonas, and its ability to ferment
inositol separates it from all Aeromonas and almost all
Vibrio spp.
It can also be separated from the halophilic Vibrio spp. by
its ability to grow in nutrient broth with 0%. NaCl and its
inability to grow in nutrient broth with 6% NaCl.
Biochemical test of P.shigelloides
Substrate or Reaction
Property
Oxidase +
Indole +
Urease -
H2S -
Simon Citrate -
Lysine +
Decarboxylase
Beta-Galactosidase +
Colonial Appearance and
Characteristics
BA and Mac
Shiny, opaque,

smooth, non-hemolytic
Both NLF and LF

COL Agar
 Antimicrobial Resistance
Although most cases of plesiomonad gastroenteritis are
selflimiting, antimicrobial therapy is indicated for patients
with severe or chronic disease.
Similarly, extraintestinal infections, particularly among
neonates, often require antimicrobial therapy.
Studies have shown a general resistance to the penicillin
class of antibiotics, but penicillins combined with a -
lactamase inhibitor, as well as trimethoprim-
sulfamethoxazole, are active.
There have been reports of resistance to more than one
aminoglycoside (e.g., gentamicin, tobramycin, amikacin), but
the quinolones, cephalosporins, and carbapenems appear to
be effective therapy.
Drug of Choice
Ciprofloxalin

Virulence Factor
Unknown
THANK YOU!!!