Importance of salmonellae and Campylobacter jejuni in the etiology of diarrheal disease among children less than 5 years of age in a community in Bangkok, Thailand.

The etiology of diarrhea in children less than 5 years of age in a low-income housing project in Bangkok, Thailand, was determined over 1 year. Nontyphoidal salmonellae (13%), Campylobacter jejuni (12%), rotavirus (12%), enterotoxigenic Escherichia coli (7%), shigellae (6%), E. coli that hybridized with the enteropathogenic E. coli adherence factor probe (3%), and enteroinvasive E. coli (1%) were identified in 345 episodes of diarrhea in children less than 5 years of age. Salmonellae were identified in 17% and C. jejuni was identified in 15% of 54 children less than 6 months of age with diarrhea. Shigellae, enteroinvasive E. coli, enteropathogenic E. coli adherence factor, and enterotoxigenic E. coli were not isolated from children less than 6 months of age. Since salmonellae and C. jejuni were the most common bacterial pathogens identified in children less than 6 months of age, efforts to prevent transmission of salmonellae and campylobacter to young children should be a public health priority in Bangkok.     

Influence of strain characteristics and immunity on the epidemiology of Campylobacter infections in Thailand.

To determine how strain differences and immunity affect the clinical expression of Campylobacter infections, we conducted a study of acute diarrheal disease in Thailand in which specimens from children with Campylobacter infections were cultured weekly for up to 12 weeks to determine the serotype-specific length of time of convalescent-phase excretion and rate of reinfection. Levels of immunoglobulin G to cell-surface antigens of C. jejuni were determined in another population of healthy children who were closely related by age and location to the children in the diarrheal disease study. Campylobacter species were initially isolated from 18% of 586 children under 5 years old with diarrhea; most isolates in Thailand belonged to serotypes commonly found in developed countries. C. coli was significantly less often associated with symptomatic infections and with bloody diarrhea than C. jejuni (P less than 0.001 and P = 0.045, respectively). The peak age of isolation and the peak level of immunoglobulin G to Campylobacter species occurred before 2 years of age. The mean duration of convalescent-phase excretion was 14 +/- 2 (standard error of the mean) days for children less than 1 year old and 8 +/- 2 days for children 1 to 5 years old (P = 0.02, t test). Infection with another Campylobacter serotype was found in 34% of 105 children during the 12-week follow-up period. The rate of reinfection in these children was 15% (range, 8 to 22%) each week. Hyperendemic exposure to Campylobacter species in Thailand confers immunity to infection that is associated with an early peak in specific serum antibodies and an age-related decrease in the case-to-infection ratio and duration of convalescent-phase excretion but does not prevent asymptomatic infections.     

The prevalence of bacterial intestinal pathogens in a healthy rural population in southern India

In a one-year prospective survey bacterial intestinal pathogens unassociated with diarrhoeal episodes were isolated from 20.5% of stool samples from 48.5% of a stratified random sample of the population of a village in southern India. Campylobacter jejuni was the pathogen most frequently isolated, followed by enteropathogenic serotypes of Escherichia coli. The incidence of diarrhoea in the study population was lower than the frequency of isolation of bacterial intestinal pathogens. It is necessary to understand the prevalence of intestinal pathogens in this ecosystem to know the dynamics of intestinal infection and the pathogenesis of diarrhoea.     

2010年广州某医疗中心儿童夏季细菌性腹泻的病原学调查

目的研究广州地区小儿夏季细菌性腹泻的病原菌分布。方法采集2010年5～7月广州市妇女儿童医疗中心珠江新城院区腹泻患儿的大便标本进行常规病原菌的分离培养,通过生化反应和血清凝集试验进行鉴定和分型,并使用金标法对空肠弯曲菌抗原进行检测。结果从110份标本中检出44株病原菌,检出率为40.0%。其中致病性大肠埃希菌17株,2岁以下患儿检出15株;空肠弯曲菌12株,2岁以下患儿检出10株;沙门菌6株;念珠菌纯生长6株;产气荚膜杆菌3株。结论广州地区夏季儿童细菌性腹泻的主要病原菌是致病性大肠埃希菌及空肠弯曲菌,两者的易感人群以2岁以下婴幼儿为主。     

Etiology of childhood diarrhea in Korea.

To assess the role of recently recognized enteropathogens in childhood diarrhea in Korea, 231 children with diarrhea admitted to and 104 children without diarrhea seen at the well-baby clinic or the outpatient department of Hanyang University Hospital in Seoul, Korea, were evaluated during a 14-month period. Stools were cultured for bacterial pathogens, including enterotoxigenic (heat-labile and heat-stable enterotoxin-producing) and enteroadherent organisms. Only those stools obtained from patients with diarrhea were examined for rotavirus. All Escherichia coli isolates were screened for Shiga-like toxin (SLT) I, SLT-II, enterohemorrhagic E. coli fimbriae, and enteroinvasiveness by colony hybridization. One or more pathogens were identified in 75.8% of the children with diarrhea. Rotavirus was the most frequently identified pathogen, accounting for 47% of the cases. Other major enteropathogens were enterotoxigenic E. coli (22%), Clostridium difficile (16%), enteroadherent E. coli (15%), and enteropathogenic E. coli (6%). Shigella spp., Campylobacter jejuni, Salmonella spp., SLT-I-and enterohemorrhagic-E. coli-fimbria-probe-positive E. coli serotype O26:H11 and enteroinvasive E. coli were isolated from only a few patients. Aeromonas hydrophila and E. coli O157 were not isolated. Compared with those of the controls, the isolation rates of heat-stable-enterotoxin-producing E. coli (P less than 0.05), C. difficile (P less than 0.025), and enteroadherent E. coli (P less than 0.05) were significantly higher in the patients with diarrhea. The greatest number of rotavirus, enterotoxigenic E. coli, and C. difficile cases were identified during the cool, dry months of October and November.     

Incidence of pathogenic Escherichia coli in acute infantile diarrhea in Dakar

We have studied the incidence of enteropathogenic (EPEC), enteroinvasive (EIEC) and enterotoxigenic (ETEC) Escherichia coli associated with infant acute diarrhoeal disease in Dakar during a period of one year. We report 405 strains of Escherichia coli suspected to be the etiologic agent of the diarrhoea and isolated from 405 diarrheic stools of 0-5 years old children. We have isolated 119 pathogenic Escherichia coli with 63 EPEC (15.5%), 3 ETEC (0.7%) and 53 ETEC (13.1%) including 23 strains releasing heat-labile enterotoxin (LT+) and 30 strains releasing heat-stable enterotoxin (ST+). No ST+/LT+ strain was isolated. Escherichia coli with colonization factor antigens were isolated from 62 children. Almost all of them are CFAI+. Only one strain is CFAII+ and another one agglutinates with both CFAI and CFAII antisera. Among these CFA+ strains 5 belong to the EPEC group, 29 are enterotoxigenic (25 ST+ and 4 LT+) and 28 do not belong to any known etiopathologic group. Near 70% of the pathogenic Escherichia coli are from infants less than one year old, with a highest frequency between 7 and 12 months. Prevalence of ETEC is higher during the raining season. The existence of a great number of strains that belong to none of the 3 groups of etiopathologic Escherichia coli emphasis the need to search other factors of pathogenicity.     

Rate of Campylobacter spp. isolation in three regions of Ontario, Canada, from 1978 to 1985.

Isolation rates of Campylobacter spp. were analyzed for an 8-year period, 1978 through 1985. Three laboratories of the Ontario Ministry of Health examined 146,842 human feces samples for bacterial pathogens, including Campylobacter jejuni and Campylobacter coli. Campylobacter spp. were isolated from 5,580 specimens (3.8%), with monthly isolation rates ranging from 1.1 to 7.4%. The data showed a seasonal distribution of isolations, with peaks during the summer months (June to September). Most infections were in children, adolescents, and young adults. More males were infected than females; this finding was most pronounced in the age groups under 25 years. In Northern and Central Ontario, a strikingly higher incidence was observed among farm residents than among rural nonfarm or urban residents. Of 89 farm residents, 63 had consumed raw milk (61 bovine, 2 goat) within 72 h before becoming ill.     

Distribution and serotypes of Campylobacter jejuni and Campylobacter coli in enteric Campylobacter strains isolated from children in the Central African Republic.

One hundred eighty-five enteric Campylobacter strains isolated from diarrheic or healthy children in Bangui (Central African Republic) were studied to determine their species and serotypes. C. coli was identified in 38.9% of all strains and in 43.9% of strains from diarrheic children. By the hemagglutination technique for heat-stable antigens, 73.5% of the strains could be serotyped. Of the typeable strains, 75% were distributed among 13 more frequent serotypes. C. coli serotype Pen 37,56 was the most common serotype from diarrheic children.     

Campylobacter jejuni and Campylobacter coli serotypes isolated from chickens, cattle, and pigs

A total of 191 Campylobacter jejuni and 125 Campylobacter coli were isolated from the intestinal content of 398 chickens, 421 cattle, and 203 pigs. All 108 chicken isolates and 73 of 80 cattle isolates were C. jejuni, but 115 of the 118 pig isolates were C. coli. A total of 84% of the C. jejuni and 64% of the C. coli isolates were typed on the basis of thermostable antigens with 20 antisera prepared against frequently occurring serotypes in Campylobacter enteritis in man (15 C. jejuni, 6 C. coli serotypes). A total of 96% of the chicken isolates and 67% of the cattle isolates belonged to 11 C. jejuni serotypes that occur most frequently in human cases of enteritis (serotypes 1, 2, 3, 4, 5, 13/16, 18, 21, 23, 31, and 36). Serotype 8, a relatively common human isolate, was not recovered. The C. coli isolates from pigs belonged to serotypes uncommon among human isolates.     

Biotype and Lior serogroup distribution of enteric Campylobacter isolated from children in Bangui (Central African Republic), and comparison with Penner serotypes

The new extended biotyping scheme of Lior as well as the slide agglutination technique were applied to 209 strains of enteric Campylobacter isolated from children in Bangui (Central African Republic). Three biotypes of C. jejuni and 2 biotypes of C. coli were identified among the strains; 31.1% were C. jejuni I, 11% C. jejuni II, 2.4% C. jejuni III, 44% C. coli I and 11.5% C. coli II. We were able to serotype 71.3% of the strains with 20 immune sera prepared against strains of Campylobacter isolated previously; 63% of the strains were distributed among the ten most common serogroups. No significant difference was observed in the distribution of biotypes or serogroups between strains from healthy and diarrhoeic children. Comparison of Lior serogroups with Penner serotypes showed that different Penner serotypes may correspond to a Lior serogroup and vice versa.     

Significance of Cryptosporidium in acute diarrhoea in North-Eastern India.

In a hospital-based study, stool samples from 2095 patients of all ages were examined for different fungal, protozoal and bacterial enteropathogens over a period of 2 years (July 1994-June 1996). Cryptosporidium was detected in 151 specimens (7.2%) and was the third commonest pathogen found. The highest prevalence of this organism was in the group aged 16-45 years and during the rainy months (July-Oct.). Diarrhoea caused by the protozoon was of mild to moderate severity and features of dysentery were absent. Amongst other enteropathogens, Candida albicans was the most frequently isolated, followed by enteropathogenic and enterotoxigenic Escherichia coli, Salmonella spp., Campylobacter jejuni, Entamoeba histolytica, Giardia duodenalis (lamblia), Shigella spp., Vibrio cholerae and Aeromonas spp.     

Campylobacter fetus subsp. jejuni as a cause of gastroenteritis in Jakarta, Indonesia.

Campylobacter fetus subsp. jejuni was isolated from the feces of 15 out of 144 (10%) children (0 to 9 years old) and 4 out of 251 (2%) adults with gastroenteritis and was found together with another enteric pathogen in 2 of the children and in all 4 adults. It was isolated from 2 out of 7 (28%) children and 3 out of 160 (2%) adults with suspected typhoid fever. The bacterium was recovered from 3 out of 4 orphanage children with diarrhea and from 1 without symptoms and was isolated from only 1 child in a control group of 221 persons.     

Enteric campylobacteria and RNA viruses associated with healthy and diarrheic humans in the Chinook health region of southwestern Alberta, Canada

The presence of Campylobacter species and enteric RNA viruses in stools from diarrheic (n = 442) and healthy (n = 58) humans living in southwestern Alberta was examined (May to October 2005). A large number of diarrheic individuals who were culture negative for C. jejuni (n = 54) or C. coli (n = 19) were PCR positive for these taxa. Overall detection rates for C. jejuni and C. coli in diarrheic stools were 29% and 5%, respectively. In contrast, 3% and 0% of stools from healthy humans were positive for these taxa, respectively. Infection with C. jejuni was endemic over the study period. However, there was no difference in infection rates between individuals living in urban or rural locations. Stools from a large number of diarrheic (74%) and healthy (88%) individuals were positive for Campylobacter DNA. The prevalence rates of C. concisus, C. curvus, C. fetus, C. gracilis, C. helveticus, C. hominis, C. hyointestinalis, C. mucosalis, C. showae, C. sputorum, and C. upsaliensis DNA were either not significantly different or were significantly lower in stools from diarrheic than from healthy individuals. No C. lanienae or C. lari DNA was detected. Stools from 4% and 0% of diarrheic and healthy humans, respectively, were positive for rotavirus, sapovirus, or norovirus (GI/GII). Our results showed a high prevalence of diarrheic individuals living in southwestern Alberta who were infected by C. jejuni and, to a lesser extent, by C. coli. However, other Campylobacter species, norovirus, rotavirus, sapovirus, and bovine enteric calicivirus were either inconsequential pathogens during the study period or are not pathogens at all.     

Occurrence of plasmids and antibiotic resistance among Campylobacter jejuni and Campylobacter coli isolated from healthy and diarrheic animals.

Serologically defined strains of Campylobacter jejuni and Campylobacter coli from healthy and diarrheic animals were examined for the occurrence of plasmid DNA in association with the antibiotic susceptibility of the bacterial host and the health status of the animal host. Of all campylobacter organisms surveyed, 53% (116 of 200) contained plasmid DNA. A plasmid occurrence rate of 73.8% was obtained for C. coli from healthy pigs, contrasted by lower plasmid occurrence rates for C. coli from diarrheic pigs (30%) and from all diarrheic animals (21.4%). For C. jejuni, in contrast, only 13.6% of healthy cattle contained plasmid DNA, contrasted by a higher plasmid occurrence rate of 31.2% from diarrheic cattle. A high plasmid occurrence rate of 75.8% was observed for C. jejuni from healthy chickens. Campylobacter plasmids ranged in size from less than or equal to 1 to 86 megadaltons. Antibiotic susceptibility for 52 animal isolates (excluding chickens) indicated that most isolates were susceptible to kanamycin, erythromycin, gentamicin, tetracycline, and compound sulfonamide, whereas few were susceptible to bacitracin (19.2%); approximately half were susceptible to ampicillin (55.8%) and streptomycin (51.9%), and no isolates were susceptible to penicillin G. More isolates containing plasmids were resistant to ampicillin, tetracycline, and gentamicin than were isolates not carrying plasmids, there being a statistically significant difference for tetracycline and gentamicin, which suggested that these two antibiotics were probably plasmid mediated. The antibiotic susceptibility patterns of 21 chicken isolates of C. jejuni, by contrast, were different in that most were susceptible to ampicillin in addition to kanamycin, erythromycin, and gentamicin, whereas few wer susceptible to compound sulfonamide, streptomycin, and tetracycline in addition to penicillin G and bacitracin. A 30- or 39-megadalton plasmid, or both, common to many of the chicken isolates was usually associated with tetracycline resistance.     

Detection and species identification of Campylobacter in stool samples of children and animals from Vellore, south India

Campylobacter spp. are an important cause of bacterial gastroenteritis frequently isolated from animal, poultry and environmental samples. In this study, we investigated the zoonotic potential of Campylobacter spp. by comparing prevalence rates and species in 394 children with diarrhoea and 652 animals in Vellore using PCR-based tools. Eighteen children (4.5%) had campylobacteriosis, a majority of whom had co-pathogens (15/18) and most were infected with Campylobacter jejuni (16/18). A few C. coli and mixed infections with both species were also seen. Among the animal samples, 16/25 chicken samples (64%) were positive and all were found to be C. jejuni.     

Two-year survey of etiologic agents of diarrheal disease at San Lazaro Hospital, Manila, Republic of the Philippines.

The prevalence of bacterial pathogens and rotavirus in 2,908 patients with diarrhea who were admitted to San Lazaro Hospital in Manila in 1983 and 1984 was determined. One or more enteric pathogens were isolated or detected in samples from 1,698 (58.4%) patients. Isolation rates for the various enteropathogens were as follows: rotavirus, 30.6%; Shigella spp., 11.6%; Salmonella spp., 9.2%; enterotoxigenic Escherichia coli (1983 only), 7.8%; Vibrio cholerae biotype eltor, 3.8%; non-O1 V. cholerae, 2.8%; Vibrio parahaemolyticus, 1.7%; other Vibrio spp., 1.1%; Campylobacter jejuni, 3.0%; Aeromonas hydrophila, 1.3%; and Plesiomonas shigelloides 1.1%. Giardia lamblia and Entamoeba histolytica were detected in 0.6 and 0.1%, respectively, of stool samples examined. Determination of the etiologic role of isolates was complicated by one or more of the following factors: isolation of multiple enteric pathogens (302 cases); isolation of Salmonella spp., enterotoxigenic E. coli, and C. jejuni from a similar proportion of asymptomatic control patients and patients with diarrhea; and isolation of a high proportion of certain pathogens (especially Salmonella spp.) only from enrichment broth, suggesting infection with a small number of organisms. Isolation of V. cholerae eltor was seasonal, with the majority of cases occurring in the rainy months. In addition, the number of patients with diarrhea increased with the onset of the monsoon rains and peaked during the months of maximum rainfall. Rotavirus infection occurred in both children and adults throughout the year and was the most frequently identified cause of diarrhea in children under 5 years of age. Shigella spp. were the most common agents of diarrhea in adults.     

Campylobacter species in broiler chickens

The incidence of Campylobacter spp. in broiler chickens in Northern Ireland was determined by examining three groups of birds. These included: (1)12 flocks of broilers monitored at regular intervals from their introduction into commercial units until the time of slaughter; (2) 21 batches of unsolicited birds submitted to the laboratory for postmortem examination; and (3) 13 batches of chicks under 36 hours old. Most birds became infected but Campylobacter spp. were not usually isolated during the first 2 weeks of life. C. jejuni biotype 1 was the predominant species isolated although C. coli and an atypical strain were also isolated. At least five distinct serotypes were present (Penner sero-types 1,3,5,9 and 11) of which serotypes 1 and 9 were most common. In birds older than 2 weeks of age, an association was sometimes observed between the sudden occurrence of wet litter and the presence of C. jejuni in all or the majority of the birds sampled. Infection of broilers under 2 weeks of age was accompanied by mortality.     

Immune response to Campylobacter jejuni and Campylobacter coli in a cohort of children from birth to 2 years of age.

A cohort of 111 children from Bangui, Central African Republic, was surveyed for enteric Campylobacter infections from birth to the age of 2 years; stools were examined biweekly in these children until 6 months of age and at least four times per year thereafter until 2 years of age and after each diarrheal episode. Blood samples were obtained at birth and at 3, 6, 9, 12, 18, and 24 months of age. Antibodies against glycine-extracted membrane antigens, purified flagella, and cholera toxin (CT) were assayed by an enzyme-linked immunosorbent assay. The results showed that titers of antibody against the three tested antigens increased in children between 6 and 12 months of age and that nearly all children were immunized by the age of 2 years. A significant fall in anti-flagellum (P less than 0.001) and anti-glycine extract antibodies (P less than 0.001) occurred between birth and age 3 months, and children who had Campylobacter infections during the first 6 months of life had significantly (P less than 0.02) less anti-flagellum antibodies at birth than did those who did not have Campylobacter infections during that time. Three-month-interval stratification showed that CT antibody titers at birth were significantly lower in children who developed Campylobacter infection than in controls (P = 0.05). Comparison of the immune response to a single Campylobacter episode showed that 46.6% of children with asymptomatic carriage did not respond to CT while only 5% of children with diarrhea-producing infection did not respond to CT (P less than 0.01), compared with 30% (P = 0.065) and 56% (P less than 0.01), respectively, of the age-matched controls. Antibodies to flagella seem to protect against enteric colonization by Campylobacter jejuni and Campylobacter coli.     

Prospective study of enteric Campylobacter infections in children from birth to 6 months in the Central African Republic.

A survey of enteric Campylobacter infections was performed in Bangui, Central African Republic, with a cohort of 127 children from birth to 6 months of age by biweekly culture of stools; 82 infections were observed, and 41.7% of the children presented at least 1 infection before 6 months of age. Only 15.9% of the infected children had a diarrheic syndrome; moreover, 61.5% of these diarrheic children had another enteropathogen associated with Campylobacter species. In about half the cases, Campylobacter spp. were excreted for more than 4 days. More than half of the children had at least one diarrheic episode, for which an enteropathogen was identified in one third of the cases, before 6 months of age.     

Detection of enteric campylobacteriosis in children.

Campylobacter fetus subsp. jejuni was recovered as the sole bacterial pathogen from 31% of 0- to 8-month-old children with acute gastroenteritis and from 5% of asymptomatic children (P less than 0.05). In children 8 to 24 months old, the respective recovery rates were 38 and 40%. With the exception of one case of simultaneous bacteremia, the clinical course of the symptomatic infection was benign and rarely lasted more than a week. The isolates were sensitive to most commonly used antibiotics. Several isolates shared antigenic determinants with C. fetus subsp. intestinalis. A bacteriophage specific for C. fetus subsp. jejuni lysed 73% of the strains. Several phage-resistant isolates carried a phage that lysed the stock strain of C. fetus subsp. jejuni (NADC 917).