Pathogenesis

The number of organisms required to produce symptomatic infection is 500 or less. The bacteria penetrate the intestinal epithelial cells of the small and large intestine, multiply within and beneath the cells, and cause an inflammatory reaction. As with most strains of Shigella and Salmonella, penetration into the bloodstream is uncommon. A mysterious sequel to C. jejuni infections, Guillain-Barre syndrome, occurs in about 0.1% of cases. While C. jejuni infections are probably not a direct cause of this syndrome, almost 40% of all cases are preceded by campylobacteriosis, most of the rest by viral infections, and in one group of cases, immunization with swine influenza vaccine. Evidence suggests that autoimmu-nity could be responsible for C. jejuni-associated cases. The syndrome begins abruptly within about 10 days of the onset of diarrhea, with tingling of the feet followed by progressive paralysis of the legs, arms, and rest of the body. Most victims require hospitalization, but over 80% recover completely. About 5% of patients die of the syndrome despite treatment.

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