Re-analysis of the risks attributed to ciprofloxacin-resistant Campylobacter jejuni infections

Host-Pathogen Interactions inCampylobacterInfections: the Host Perspective

“…The incubation time is 1 to 7 days (mean, 3 days), which is longer than the incubation times of most other intestinal pathogens. The diarrhea can be either watery or, in almost one-third of the cases, bloody (79,151,174), indicating that the extents of intestinal inflammation vary among individuals. Inflammatory diarrhea points to a role for polymorphonuclear leukocytes (PMN) in pathology and suggests that infection can lead to extensive intestinal damage either as a direct result of bacterial toxins or as a result of the inflammatory infiltrate.…”

“…Using a highly sensitive culture-based detection assay, Kapperud et al observed carriage in 16% of individuals during convalescence, with a median carriage time of 31 days (89). Although a large proportion of the patients feel nauseous, only about 15% of patients vomit (151,174). In 30% of patients, the disease does not start with diarrhea but with a prodrome of influenza virus-like symptoms such as fever, headache, dizziness, and myalgia (reviewed in reference 151), indicating that there is some systemic, probably immune-mediated, effect of local infection.…”

Antimicrobial Drug Resistance

“…However, some investigators claim that the presumptive human health benefits of employing such an approach is unsubstantiated by meaningful clinical data (Pfaller 2006;Phillips 2007). Wassenaar et al (2007) addressed the concern that fluoroquinolone-resistant Campylobacter infections could result in more severe disease than susceptible strains. In a detailed analysis of the apparent link between fluoroquinolone resistance in C. jejuni and its presumed increased virulence, Wassenaar et al (2007) argued that there were no significant differences in the duration of disease between susceptible and resistant infections.…”

“…Wassenaar et al (2007) addressed the concern that fluoroquinolone-resistant Campylobacter infections could result in more severe disease than susceptible strains. In a detailed analysis of the apparent link between fluoroquinolone resistance in C. jejuni and its presumed increased virulence, Wassenaar et al (2007) argued that there were no significant differences in the duration of disease between susceptible and resistant infections. However, for both resistant and susceptible infections, disease symptoms were prolonged by 1-2 days on an average in British patients that had recently travelled abroad compared to those who had not travelled.…”

Immunity to Campylobacter: its role in risk assessment and epidemiology

“…Infrequently systemic infections occur, as well as chronic illness and sequelae such as polyarthropathies (in particular reactive arthritis, ReA (Hill Gaston and Lillicrap 2003;Pope et al 2007;Doorduyn et al 2007) or neuropathies (in particular Guillain-Barré syndrome, GBS (Hughes and Cornblath 2005)). Furthermore, acute Campylobacterenteritis may be linked to the induction of irritable bowel syndrome (Cumberland et al 2003;Marshall et al 2006;Gomez-Escudero, Schmulson-Wasserman, and Valdovinos-Diaz 2003) and, possibly, inflammatory bowel disease (Newman and Lambert 1980;Wassenaar, Kist, and de Jong 2007;Karlinger et al 2000). The basis of the diversity in the manifestation of campylobacteriosis is not known but may be caused by differences in the pathogenicity of Campylobacter strains (which may or may not be dose dependent) and/or differences in the host susceptibility (innate or acquired) to the infection.…”