Campylobacter spp.

Characteristics
Morphology	Campylobacter are motile mainly spiral-shaped, “S”-shaped, or curved, gram-negative rod-shaped bacteria. They range in size from 0.5 to 5 microns in length by 0.2 to 0.9 microns in width. Currently, there are 17 species and 6 subspecies assigned to the genus Campylobacter, the most frequently reported in human diseases are C. jejuni and C. coli. Other species such as C. lari and C. upsaliensis have also been isolated from patients with diarrheal disease, but are reported less frequently.
Growth Conditions	Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar (TCBS) is ideal for isolation and identification.

Characteristics

Morphology

Campylobacter are motile mainly spiral-shaped, “S”-shaped, or curved, gram-negative rod-shaped bacteria. They range in size from 0.5 to 5 microns in length by 0.2 to 0.9 microns in width. Currently, there are 17 species and 6 subspecies assigned to the genus Campylobacter, the most frequently reported in human diseases are C. jejuni and C. coli. Other species such as C. lari and C. upsaliensis have also been isolated from patients with diarrheal disease, but are reported less frequently.

Growth
Conditions

Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar (TCBS) is ideal for isolation and identification.

Health Hazards
Host Range	Humans, poultry, cattle, pigs, sheep, ostriches, cats, and dogs
Modes of Transmission	Transmission is generally believed to be foodborne, via undercooked meat and meat products, as well as raw or contaminated milk. Contaminated water or ice is also a source of infection. Cases can also occur following contact with contaminated water during recreational activities.
Signs and Symptoms	Infections usually characterized by diarrhea (frequently bloody), abdominal pain, fever, and occasionally nausea and vomiting. More severe illness can occur, including dehydration, bloodstream infection, and symptoms mimicking acute appendicitis or ulcerative colitis.
Infectious Dose	The infectious dose is small; <500 organisms can cause disease
Incubation Period	Symptoms usually develop in 2 to 5 days after infection, but can range from 1 to 10 days

Medical Precautions/Treatment
Prophylaxis	Prevention is best achieved by adhering to standard food and water safety precautions and thorough handwashing
Vaccines	None readily available
Treatment	Treatment is not generally required, except electrolyte replacement and rehydration. Antimicrobial treatment is recommended in invasive cases (when bacteria invade the intestinal mucosa cells and damage the tissues) or to eliminate the carrier status of a patient
Surveillance	Monitor for symptoms. Diagnosed when Campylobacter is isolated from stool specimens or rectal swabs by using selective media. Rapid culture-independent diagnostic tests, including both antigen tests and nucleic acid–based tests, are becoming widely available and commonly used.
GWU Requirements	Report all incidents to the Office of Risk Management as well as the Office of Research Safety (ORS) IMMEDIATELY FOLLOWING THE OCCURRENCE.

Containment
BSL-2/ABSL-2	Risk Group 2 classification is applied to Campylobacter species. BSL-2 practices, containment equipment, and facilities are recommended for activities with cultures or potentially infectious clinical materials. ABSL-2 practices, containment equipment, and facilities are recommended for activities with naturally or experimentally infected animals.

Spill Procedures
Small Spills (<1 liter)	If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup. Campylobacter species are not commonly transmitted via aerosols, but caution should be taken during a spill outside of a BSC. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against the bacteria (bleach, ethanol, glutaraldehyde), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.
Large Spills	Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Spill Procedures

Small Spills (<1 liter)

If the spill occurred inside a biological safety cabinet, close the sash and allow the cabinet to operate for 15 minutes before continuing with the spill cleanup.

Campylobacter species are not commonly transmitted via aerosols, but caution should be taken during a spill outside of a BSC. Leave the room immediately and allow the aerosols to dissipate for 15 minutes. Notify others working in the lab. Don appropriate PPE. Cover area of the spill with paper towels or any absorbent material and apply an EPA registered disinfectant effective against the bacteria (bleach, ethanol, glutaraldehyde), working from the perimeter towards the center. Allow 30 minutes of contact time before disposal and cleanup of spill materials.

Large Spills

Alert lab personnel in the laboratory to the spill and keep people out of the area to prevent spread of the contamination. Check if you have been contaminated or if any of your PPE has been breached. If so follow exposure procedures. Remove any contaminated clothing and place it the biohazard waste. Wash your hands and post a sign on the door. Notify your supervisor of the incident and call ORS (4-8258) for assistance. If the situation involves an imminently life-threatening injury or has catastrophic potential, call 911.

Exposure Procedures
Mucus Membrane	Flush eyes, mouth or nose for 15 minutes at eyewash station.
Other Exposure	Wash with soap and water for 15 minutes (open wounds, sores, etc.)
Reporting	Report ALL injuries to the PI immediately and reported to the Office of Risk Management at [email protected] IMMEDIATELY FOLLOWING THE OCCURRENCE. Exposures that involve a bloodborne-pathogen or recombinant DNA also need to be reported to the Office of Research Safety at [email protected]. If the injury requires immediate medical attention, call GWPD at 202-994-6111 or call 911.
Medical Monitoring	Seek immediate medical evaluation, treatment, and post exposure follow-up at the Employee Health Office at GWU Hospital (900 23rd St., NW, Suite G-1090, Phone: 202-715-4275). Students should go to the Students Health Office at Marvin Center. After hours treatment can be received at the GWU hospital emergency room.

Stability
Disinfection	Susceptible to 0.15% phenolic compound, 10 mg of iodophor per liter, 1:50,000 quaternary ammonium compound, 70% ethanol, 0.125% glutaraldehyde, and 10% bleach
Inactivation	Campylobacter cannot tolerate drying. Freezing reduces the number of Campylobacter bacteria on raw meat.
Survival Outside Host	Cannot survive for a long period of time on food contact surfaces, such as cutting boards, countertops, equipment or kitchen utensils. However, the bacteria can remain viable on fresh foods and uncooked meat for up to 3 weeks.

Personal Protective Equipment (PPE)
Minimum PPE Requirements	At minimum, personnel are required to don gloves, closed toed shoes, lab coat, and appropriate face and eye protection prior to working with Campylobacter. Additional PPE may be required depending on lab specific SOPs.
Additional Precautions	Additional protection may be worn over laboratory clothing when infectious materials are directly handled, such as solid-front gowns with tight fitting wrists, gloves, and respiratory protection. Wash hands with soap and water after removing gloves.

References
CDC (https://www.cdc.gov/campylobacter/index.html) CDC Travelers’ Health (https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-…) BMBL 6th Edition (https://www.cdc.gov/labs/BMBL.html) WHO (https://www.who.int/news-room/fact-sheets/detail/campylobacter) Effects of disinfectants on Campylobacter jejuni (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC242439/) Survival and Control of Campylobacter (https://www.frontiersin.org/articles/10.3389/fcimb.2020.615049/full)

References