How can those so cute cause so much diarrhea? It’s campy.
Not campy as in “ha, ha,” but campy as in the nickname for Campylobacter jejuni, a bacteria that each year in the United States alone causes approximately 1.3 million diarrheal illnesses, according to the U.S. Centers for Disease Control and Prevention (CDC). That’s a load of poop.
Now the CDC is describing in its Morbidity and Mortality Weekly Report (MMWR) a Campylobacter jejuni outbreak that affected at least 118 persons in 18 states from January 5, 2016 to February 4, 2018. That’s over a hundred people who may have had 2 to 10 days of abdominal cramping and pain, nausea, vomiting, fever, and bloody diarrhea. Bloody diarrhea means real blood in the diarrhea and is not a person from the UK cursing the presence of diarrhea.
Oh, and whence did this diarrhea come? Of the 118 people reported to have Campylobacter jejuni infections, 101 (95%) had had contact with pet store puppies. Yes, puppies. Oh, puppies, don’t you look at me with those puppy dog eyes. Look at what you’ve done.
You, puppies, have apparently caused 26 hospitalizations (no deaths, though). You’ve also spread a strain of Campylobacter jejuni that is resistant to many commonly used antibiotics, including those in the macrolide and quinolone classes. These include azithromycin, ciprofloxacin, clindamycin, erythromycin, nalidixic acid, telithromycin, and tetracycline. Bad, bad puppies.
However, the puppies are ultimately not to blame for this outbreak. Nearly all (142 of 149 or 95%) of those puppies investigated puppies had received at least one course of antibiotics. And, of course, the puppies didn’t go to the vets and say, “I have a sore throat. Can you please give me some antibiotics? Oh and by the way, woof.”
No, the concern here is that people may have been misusing and over-treating the puppies with antibiotics. Over half (78 or 55%) of the 142 investigated puppies had received antibiotics just for prophylaxis. Prophylaxis is giving the puppies antibiotics only to prevent infections not to really treat anything. Ugh.
Over a third (54 or 38%) had been given antibiotics for prophylaxis and treatment for a condition. Only 2 or 1% had received for just treatment. Moreover, a number of the puppies had received broad-spectrum antibiotics or those that can kill a wide variety of bacteria such as tetracyclines, quinolones, aminoglycosides, and chloramphenicol. Double ugh.
Unless really necessary, you typically want to avoid using broad spectrum antibiotics, because this can be like using a nuclear warhead when something less drastic can suffice. Broad spectrum antibiotics can clear out both good and bad bacteria, allowing bacterial strains that survive and are more resistant to antibiotics free room to reproduce and take over.
The MMWR report refers to company A, a national pet store chain based in Ohio, as a source of the Campylobacter jejuni outbreak. Company A is probably not the real name of the company as it would be an odd name for a national pet store chain. Thus, the MMWR report authors (lead by Martha P. Montgomery, MD from the Ohio Department of Health and the Epidemic Intelligence Service at CDC) are concealing the true identity of the company. However, as I wrote previously for Forbes, a CDC report had named Petland as a source of a multi-state Campylobacter jejuni outbreak so assume whatever you’d like from the information in this CDC report.
This outbreak shows the urgent need to take a closer look at pet antibiotic prescribing, as this British Veterinary Association video urges:
The spread of antibiotic resistance among bacteria is a major and growing problem. We are running out of antibiotics to treat infections. Remember the days when simple skin infections and urinary tract infections were highly likely to kill you? Probably not, thanks to antibiotics. But treating antibiotics like candy and not having enough new antibiotics being developed has left us teetering at the edge of true disaster.
Concerns about this disaster have led to programs to try to limit the antibiotics prescribed by human doctors. But human doctors are not the only culprits. As the MMWR report shows, antibiotic misuse and overuse are occurring among veterinarians and others that can give companion animals antibiotics. Antibiotics should not be routinely given as prophylaxis (i.e., to prevent infections) to anyone with 2 legs, 4 legs, or more legs. This is an important oversight because what puppy gets, you can get too.
Getting an antibiotic-resistant Campylobacter jejuni infection can be, dare we say it, “ruff.” While the the vast majority of healthy people recover fully without needing antibiotics, you can in rare situations develop arthritis or Guillain Barre Syndrome, a condition that may result in paralysis. Those with weaker immune systems such as infants or those 65 years and older, pregnant, or with a chronic disease can be at higher risk for complications from a Campylobacter infection.
But since you shouldn’t be treating routine Campylobacter jejuni infections with antibiotics, the bigger worry is that antibiotic misuse and overuse among pets may be leading to even more dangerous antibiotic-resistant bacteria, the kind that can cause more harm or even kill you.