Campylobacter are a group of germs (bacteria) that are a common cause of food poisoning. Typically, food poisoning causes gastroenteritis, an infection of the gut (intestines), leading to diarrhoea and often being sick (vomiting) too.
Campylobacter bacteria are commonly found in raw meat, particularly poultry. Infection usually causes relatively mild symptoms but complications, including lack of fluid in the body (dehydration), can occur in some cases. The usual treatment is to drink lots of fluid to avoid dehydration. Antibiotic medicines are sometimes needed in severe cases. The Foods Standards Agency in the UK has identified the '4 Cs' to help prevent food poisoning, including food poisoning caused by campylobacter.
What is campylobacter?
Campylobacter are a group of germs (bacteria) that are a common cause of food poisoning. Food poisoning occurs when food or water contaminated with germs (microbes), poisons (toxins) or chemicals is eaten or drunk. Microbes include bacteria, viruses and parasites. A parasite is a living thing that lives in, or on, another living organism. Typically, food poisoning causes gastroenteritis, an infection of the gut (intestines), leading to diarrhoea, and sometimes also being sick (vomiting).
How do you get campylobacter?
Campylobacter germs (bacteria) are commonly found in raw meat, particularly raw poultry such as chicken, turkey, etc. Cooking meat thoroughly usually kills the bacteria. Campylobacter may also be found in unpasteurised milk or untreated water (including ice cubes made from untreated water). Occasionally, mushrooms and shellfish can contain campylobacter.
Pets (including cats and dogs) and other animals infected with campylobacter can also pass on the bacteria to you. For example, cases of campylobacter have occurred after visiting farms. (Note: in animals, campylobacter rarely causes any symptoms for the animals themselves.)
How common is campylobacter and who gets it?
Campylobacter germs (bacteria) are the most common bacteria causing food poisoning in the UK. Campylobacter food poisoning can affect anyone of any age. However, it is more common in certain groups of people. These include:
- Children under the age of five and adults over the age of 60.
- People who travel to developing countries where sanitation and food hygiene may be less strict.
- People working with farm animals.
- People who work in the meat industry.
What are the symptoms of campylobacter?
The typical symptoms are feeling sick (nausea), diarrhoea, and being sick (vomiting), although vomiting does not always occur. The diarrhoea can sometimes be bloody. You may also get crampy stomach pains and develop a high temperature (fever). Symptoms tend to come on within 2-5 days of eating the contaminated food or of being in contact with the contaminated animal. But sometimes the time period before symptoms appear (known as the 'incubation period') can be as long as 10 days.
In most people, symptoms are relatively mild and improve within 2-3 days. About 9 in 10 affected people recover from the illness within one week. However, sometimes, symptoms can be more severe and/or complications can occur. If symptoms are severe, lack of fluid in the body (dehydration) can occur. You should consult a doctor quickly if you suspect that you (or your child) are becoming dehydrated. Mild dehydration is common and is usually easily reversed by drinking lots of fluids. Severe dehydration can be fatal unless quickly treated because the organs of your body need a certain amount of fluid to function.
Symptoms of dehydration in children
- Symptoms of dehydration in children include passing little urine, a dry mouth, a dry tongue and lips, fewer tears when crying, sunken eyes, weakness, being irritable or lacking in energy (lethargic).
- Symptoms of severe dehydration in children include drowsiness, pale or mottled skin, cold hands or feet, very few wet nappies, and fast (but often shallow) breathing. Severe dehydration is a medical emergency and immediate medical attention is needed.
Dehydration is more likely to occur in:
- Children under the age of 1 year (and particularly those under 6 months old). This is because babies don't need to lose much fluid to lose a significant proportion of their total body fluid.
- Children under the age of 1 year who were a low birth weight and who have not 'caught up' with their weight.
- An infant that has stopped breast-feeding during their illness.
- Any child who does not drink much when they have campylobacter infection.
- Any child with severe diarrhoea and vomiting (particularly if they have passed six or more diarrhoeal stools and/or vomited three or more times in the previous 24 hours).
Symptoms of dehydration in adults
- Symptoms of dehydration in adults include tiredness, dizziness or light-headedness, headache, muscular cramps, sunken eyes, passing little urine, a dry mouth and tongue, weakness, and becoming irritable.
- Symptoms of severe dehydration in adults include profound loss of enthusiasm (apathy), weakness, confusion, rapid heart rate, coma, and producing very little urine. Severe dehydration is a medical emergency and immediate medical attention is needed.
Dehydration in adults is more likely to occur in:
- Elderly or frail people.
- Pregnant women.
- People with severe diarrhoea and vomiting. In particular, if you are not able to replace the fluid lost with sufficient drinks.
How is campylobacter diagnosed?
Many people will recognise food poisoning from the typical symptoms. If your symptoms are mild, you do not usually need to seek medical advice or receive specific medical treatment. So, you may have campylobacter infection that is not 'confirmed'.
However, in some circumstances, you may need to seek medical advice when you have food poisoning (see below about when to seek medical advice). The doctor or nurse may ask you questions about recent travel abroad or any ways that you may have eaten or drunk contaminated food or water. They will also usually check you for signs of lack of fluid in the body (dehydration). They may check your temperature, pulse and blood pressure. They may also examine your tummy (abdomen) to look for any tenderness.
The doctor or nurse may ask you to collect a stool (faeces) sample. Campylobacter is usually diagnosed after a sample of your stool is sent to the laboratory for testing.
When should I seek medical advice?
If your child has gastroenteritis from any cause (including possible food poisoning caused by campylobacter), you should seek medical advice in the following situations (or if there are any other symptoms that you are concerned about):
- If they are under the age of 6 months.
- If they have an underlying medical condition (such as heart or kidney problems, diabetes, history of premature birth).
- If they have a high temperature (fever).
- If you suspect dehydration is developing (see earlier).
- If they appear drowsy or confused.
- If they are being sick (vomiting) and unable to keep fluids down.
- If there is blood in their diarrhoea or vomit.
- If they have severe tummy (abdominal) pain.
- If they have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, HIV infection.
- Infections caught abroad.
- If they have severe symptoms, or if you feel that their condition is getting worse.
- If their symptoms are not settling. For example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days.
- If you suspect that your child may have contracted food poisoning from eating restaurant or takeaway food (see below).
If you have gastroenteritis from any cause (including possible food poisoning caused by campylobacter), you should seek medical advice in any of the following situations (or if there are any other symptoms that you are concerned about):
- If you suspect that you are becoming dehydrated.
- If you are vomiting a lot and unable to keep fluids down.
- If you have blood in your diarrhoea or vomit.
- If you have severe abdominal pain.
- If you have severe symptoms, or if you feel that your condition is getting worse.
- If you have a persisting high fever.
- If your symptoms are not settling; for example, vomiting for more than 1-2 days, or diarrhoea that does not start to settle after 3-4 days.
- Infections caught abroad.
- If you are elderly or have an underlying health problem such as diabetes, epilepsy, inflammatory bowel disease, kidney disease.
- If you have a weakened immune system because of, for example, chemotherapy treatment, long-term steroid treatment, HIV infection.
- If you are pregnant.
- If you suspect that you may have contracted food poisoning from eating restaurant or takeaway food (see below).
What is the treatment of campylobacter in children?
Most children with campylobacter do not need any specific treatment. The symptoms usually improve in a few days as their immune system has time to clear the infection. The aim is to make sure that your child has plenty of fluids to avoid a lack of fluid in the body (dehydration). Children with campylobacter can usually be cared for at home. Occasionally, admission to hospital is needed if symptoms are severe, or if complications develop.
The following are commonly advised until symptoms ease:
Fluids to prevent dehydration
You should encourage your child to take plenty of fluids. The aim is to prevent dehydration. The fluid lost in their vomit and/or diarrhoea needs to be replaced. Your child should continue with their normal diet and usual drinks. In addition, they should also be encouraged to drink extra fluids. However, avoid fruit juices or fizzy drinks as these can make diarrhoea worse.
Babies under six months old are at increased risk of dehydration. You should seek medical advice if they develop gastroenteritis. Breast or bottle feeds should be encouraged as normal. You may find that your baby's demand for feeds increases. You may also be advised to give extra fluids (either water or rehydration drinks) in between feeds.
Rehydration drinks may be advised by a doctor, for children at increased risk of dehydration (see above for who this may be). They are made from sachets available from pharmacies and on prescription. You should be given instructions about how much to give. Rehydration drinks provide a perfect balance of water, salts, and sugar. The small amount of sugar and salt helps the water to be absorbed better from the gut (intestines) into the body. Home-made salt/sugar mixtures are used in developing countries if rehydration drinks are not available but they have to be made carefully as too much salt can be dangerous to a child. Rehydration drinks are cheap and readily available in the UK, and are the best treatment for your child.
If your child is sick (vomits), wait 5-10 minutes and then start giving drinks again, but more slowly (for example, a spoonful every 2-3 minutes). Use of a syringe can help in younger children who may not be able to take sips.
Note: if you suspect that your child is dehydrated, or is becoming dehydrated, you should seek medical advice.
Fluids to treat dehydration
If your child is mildly dehydrated, this may be treated by giving them rehydration drinks. Your doctor or nurse will advise about how to make up the drinks and about how much to give. The amount can depend on the age and the weight of your child. If you are breast-feeding, you should continue with this during this time. Otherwise, don't give your child any other drinks unless the doctor or nurse has said that this is OK. It is important that your child is rehydrated before they have any solid food.
Sometimes a child needs admission to hospital if they are dehydrated. Treatment in hospital usually involves giving rehydration solution via a special tube called a 'nasogastric tube'. This tube passes through your child's nose, down their throat and directly into their stomach. An alternative treatment is with intravenous fluids (fluids given directly into a vein).
Eat as normally as possible once any dehydration has been treated
Correcting any dehydration is the first priority. However, if your child is not dehydrated (most cases), or once any dehydration has been corrected, then encourage your child to have their normal diet. Do not 'starve' a child with gastroenteritis. This used to be advised but is now known to be wrong. So:
- Breast-fed babies should continue to be breast-fed if they will take it. This will usually be in addition to extra rehydration drinks (described above).
- Bottle-fed babies should be fed with their normal full-strength feeds if they will take it. Again, this will usually be in addition to extra rehydration drinks (described above).
- Older children - offer them some food every now and then. However, if he or she does not want to eat, that is fine. Drinks are the most important, and food can wait until the appetite returns.
Medication is not usually needed
You should not give medicines to stop diarrhoea to children under 12 years old. They sound attractive remedies, but are unsafe to give to children, due to possible serious complications. However, you can give paracetamol or ibuprofen to ease a high temperature or tummy (abdominal) pains. If infection is severe, a course antibiotic medicine is sometimes needed.
What is the treatment of campylobacter in adults?
Symptoms often settle within a few days or so as your immune system usually clears the infection. Occasionally, admission to hospital is needed if symptoms are severe or if complications develop (see below).
The following are commonly advised until symptoms ease:
Fluids - have lots to drink
The aim is to prevent lack of fluid in the body (dehydration) or to treat dehydration if it has developed. (Note: if you suspect that you are dehydrated, you should contact a doctor.)
- As a rough guide, drink at least 200 mls after each bout of diarrhoea (after each watery stool (faeces)).
- This extra fluid is in addition to what you would normally drink. For example, an adult will normally drink about two litres a day, but more in hot countries. The '200 mls after each bout of diarrhoea' is in addition to this usual amount that you would drink.
- If you are sick (vomit), wait 5-10 minutes and then start drinking again, but more slowly. For example, a sip every 2-3 minutes, but making sure that your total intake is as described above.
- You will need to drink even more if you are dehydrated. A doctor will advise on how much to drink if you are dehydrated.
For most adults, fluids drunk to keep hydrated should mainly be water, Also, ideally, include some fruit juice and soups. It is best not to have drinks that contain a lot of sugar, such as cola or pop, as they can sometimes make diarrhoea worse.
Rehydration drinks are recommended for people who are frail, or over the age of 60, or who have underlying health problems. They are made from sachets that you can buy from pharmacies. (The sachets are also available on prescription.) You add the contents of the sachet to water. Rehydration drinks provide a good balance of water, salts, and sugar. The small amount of sugar and salt helps the water to be absorbed better from the gut (intestines) into the body. They do not stop or reduce diarrhoea. As with children do not use home-made salt/sugar drinks, as the quantity of salt and sugar has to be exact.
Eat as normally as possible
It used to be advised to 'starve' for a while if you had gastroenteritis. However, now it is advised to eat small, light meals if you can. Be guided by your appetite. You may not feel like food and most adults can do without food for a few days. Eat as soon as you are able - but don't stop drinking. If you do feel like eating, avoid fatty, spicy or heavy food at first. Plain foods such as wholemeal bread and rice are good foods to try eating first.
Antidiarrhoeal medicines are not usually necessary. However, a medicine called loperamide may be advised in some situations. For example, to help you over a special event such as a wedding, or it you have difficulty reaching the toilet quickly. Loperamide works by slowing down your gut's activity and it can reduce the number of trips that you need to make to the toilet. You can buy loperamide from pharmacies. The adult dose of loperamide is two capsules at first. This is followed by one capsule after each time you pass some diarrhoea, up to a maximum of eight capsules in 24 hours. You should not take loperamide for longer than five days.
Note: although loperamide is usually safe, there have been reports of very serious gut problems developing in some people who have taken loperamide. These problems were mainly in people who had severe inflammation of the gut. So, do not use loperamide or any other antidiarrhoeal medicine if you pass blood or mucus with the diarrhoea or if you have a high temperature (fever). Also, people with certain conditions should not take loperamide. Therefore, to be safe, read the leaflet that comes with the medicine. For example, pregnant women should not take loperamide.
Preventing the spread of campylobacter to others
If you (or your child) have campylobacter, the following are recommended to prevent the spread of infection to others:
- Wash your hands thoroughly after going to the toilet. Ideally, use liquid soap in warm running water, but any soap is better than none. Dry properly after washing. If your child wears nappies, be especially careful to wash your hands after changing nappies and before preparing, serving, or eating food.
- If a potty has to be used, wear gloves when you handle it, dispose of the contents into a toilet, then wash the potty with hot water and detergent and leave it to dry.
- Don't share towels and flannels.
- Don't prepare or serve food for others.
- If clothing or bedding is soiled, first remove any faeces into the toilet. Then wash in a separate wash at as high a temperature as possible.
- Regularly clean with disinfectant the toilets that you use. Wipe - with hot water and detergent - the flush handle, toilet seat, bathroom taps, surfaces and door handles, at least once a day. Keep a cloth just for cleaning the toilet (or use a disposable one each time).
- Stay off work, school, college, etc, until at least 48 hours after the last episode of diarrhoea or being sick (vomiting). Avoid contact with other people as far as possible during this time.
- Food handlers: if you work with food and develop diarrhoea or vomiting, you must inform your employer and immediately leave the food-handling area. If campylobacter is confirmed, you should inform your employer and stay away from work until at least 48 hours after the last episode of diarrhoea or vomiting.
If you have campylobacter infection and you work with vulnerable groups of people such as the elderly, the unwell or the young, you should inform your employer.
Are there any complications that can develop?
Complications are uncommon in the UK. They are more likely in the very young, in pregnant women, or in the elderly. They are also more likely if you have an ongoing (chronic) condition such as diabetes or if your immune system is compromised in some way; for example, if you are taking long-term steroid medication or you are having chemotherapy treatment for cancer. Possible complications include the following:
- Lack of fluid (dehydration) and salt (electrolyte) imbalance in your body. This is the most common complication. It occurs if the water and salts that are lost in your stools (faeces), or when you are sick (vomit), are not replaced by your drinking adequate fluids. If you can manage to drink plenty of fluids then dehydration is unlikely to occur, or is only likely to be mild, and will soon recover as you drink. Severe dehydration can lead to a drop in your blood pressure. This can cause reduced blood flow to your vital organs. If dehydration is not treated, kidney failure may also develop. Some people who become severely dehydrated need a 'drip' of fluid directly into a vein. This requires admission to hospital.
- Reactive complications. Rarely, other parts of your body can 'react' to an infection that occurs in your gut (intestines). This can cause symptoms such as joint inflammation (arthritis), skin inflammation and eye inflammation (either conjunctivitis or uveitis). Joint inflammation can last some months after campylobacter infection.
- Spread of infection to other parts of your body such as your bloodstream, your liver and your pancreas gland can occur; however, this is rare.
- Miscarriage. Campylobacter infection can occasionally cause miscarriage if a woman is pregnant.
- Persistent diarrhoea syndromes may rarely develop.
- Irritable bowel syndrome is sometimes triggered by campylobacter infection.
- Lactose intolerance can sometimes occur for a while after gastroenteritis. It is known as 'secondary' or 'acquired' lactose intolerance. Your child's gut lining can be damaged by the episode of gastroenteritis. This leads to lack of a chemical (enzyme) called lactase that is needed to help the body digest a sugar (lactose) that is in milk. Lactose intolerance leads to bloating, tummy (abdominal) pain, wind and watery stools after drinking milk. The condition gets better when the infection is over and the gut lining heals. It is more common in children.
- Guillain-Barré syndrome may rarely be triggered by campylobacter infection. This is a condition that affects the nerves throughout your body and limbs causing weakness and sensory problems. See separate leaflet called Guillain-Barré syndrome for more details.
- Reduced effectiveness of some medicines. During any episode of food poisoning, certain medicines that you may be taking for other conditions or reasons may not be as effective. This is because the diarrhoea and/or vomiting means that reduced amounts of the medicines are absorbed into your body. Examples of such medicines are those for epilepsy, diabetes and contraception. Speak to your doctor or practice nurse if you are unsure of what to do if you are taking other medicines and have food poisoning.
Reporting the food poisoning episode
If you suspect that you (or your child) have campylobacter or any other type of food poisoning from eating takeaway or restaurant food, you should report this to your local Environmental Health Office. This is so that the business can be investigated by environmental health officers and further action may be taken if there is a problem with their food hygiene practices. This will hopefully help to reduce the chance that other people will get food poisoning. You can find your local food standards enforcer at http://www.food.gov.uk/enforcement/enforceessential/yourarea/ .
If your doctor suspects that you have food poisoning, or campylobacter infection is confirmed from your stool (faeces) sample, they are also required by law to report this.
Can campylobacter be prevented?
The Foods Standards Agency in the UK has identified the '4 Cs' to help prevent food poisoning, including food poisoning caused by campylobacter:
- Keep work surfaces and utensils clean.
- Wash and dry your hands regularly but especially after going to the toilet, before preparing food, after handling raw food and before touching 'ready-to-eat' food.
- Don't prepare food for others if you have diarrhoea or vomiting.
- Cover sores or cuts on hands with a waterproof plaster before you touch food.
- Change dishcloths and tea towels regularly.
To help avoid campylobacter infection, you should also wash your hands after touching pets or animals, after visiting farms and after gardening.
- Make sure that you cook food thoroughly, especially meat. This will kill germs (bacteria). Food should be cooked right through and be piping hot in the middle.
- If you are reheating food, it needs to be cooked right through and be piping hot in the middle.
- Don't reheat food more than once.
You should also make sure that you only drink pasteurised or boiled milk and avoid drinking water thought to be unsafe (including avoiding drinks containing ice cubes that may have been made from unsafe water).
- Food that needs to be chilled or refrigerated, should be. If food is left out of the fridge, bacteria may multiply to levels that can cause food poisoning.
- Your fridge needs to be kept between 0°C and 5°C. Also, don't leave the door open unnecessarily.
- Cool leftover food quickly and then refrigerate. Taking it out of the cooking pot and putting it into a shallow container can speed up the cooling process.
This is when bacteria pass from foods (commonly raw foods) to other foods. It can occur if foods touch directly, if one food drips on to another, if your hands, or utensils or equipment - such as knives or chopping boards - touch one food and then another.
- Wash your hands after touching raw foods.
- Separate raw and cooked or 'ready-to-eat' foods.
- Keep raw meat in a sealable container at the bottom of the fridge.
- Don't use the same surface or chopping board for preparing raw and ready-to-eat foods.
- Make sure that knives and utensils are cleaned after preparing raw foods.
Further help & information
Dr Michelle Wright
Dr Laurence Knott
Dr Adrian Bonsall