Campylobacter jejuni in acute diarrhoea in infancy and its relation to faecal leucocytic count.

A prospective study was carried out to identify the relative risk of Campylobacter jejuni infection in 50 infants with acute diarrhoea, 24 infants with acute resistant diarrhoea and 25 healthy normal infants as a matching control group. Faecal samples were collected from the three groups and were cultured on both selective media for Campylobacter and other media for isolation of other organisms. Direct stool smears, stained with methylene blue, were examined for detection of faecal leucocyte in all samples. Campylobacter jejuni were isolated from 4 cases (8.0%) of the acute diarrhoeal group and 4 cases (16.6%) of acute resistant diarrhoeal group. The other bacterial pathogens isolated from our cases were Salmonella, Shigella, E. Coli, Proteus mirabilis, Vibrio Parahaemolytious Klebsiella, Streptococcus faecalis and Candida albicans. All cases from whom Campylobacter was isolated were bottle fed and their ages were below 6 months. Smears for faecal leucocytes were positive in 100% of Campylobacter isolated cases, 60% of Salmonella, 50% of Shigella, 14% of E. Coli and 100% were negative in all other cases. Thus it can be recommended that any case presenting with acute diarrhoea should be initially screened by faecal leucocytic counting, positive cases should be cultured for Campylobacter jejuni detection in addition to cultures for other organisms detection.     

Acute diarrhoeal disease in Nigeria: detection of enteropathogens in a rural sub-Saharan population

A retrospective study was carried out to obtain epidemiological data concerning the relative risk of Shigella, Salmonella, Campylobacter jejuni and Vibrio cholerae infection in several rural population groups. Faecal samples (rectal swab specimens) were cultured from 914 selected children with acute diarrhoeal disease and from a matched control group of 984 non-diarrhoeal children. Shigella were more frequently isolated than the other enteropathogens from both the diarrhoeal (12.7%) and control children (6.6%). S. flexneri was the predominant species; S. sonnei and V. cholerae were not detected. Salmonella was isolated from 19 diarrhoeal (2.1%) and 16 control children (1.6%). C. jejuni was obtained from 34 diarrhoeal (3.7%) and 6 control children (0.6%). Most Shigella isolates were obtained during the peak agricultural periods (March/April and August/September) and from diarrhoeal children 0-5 months and 3-5 years of age. The highest infection rates with Salmonella and C. jejuni were observed during February and August, in diarrhoeal children aged 0-5 months and 6-11 months of age respectively. Up to 6 months of age, infection rates with Shigella, Salmonella and C. jejuni were markedly higher in bottle-fed than in breast-fed infants.     

The aetiologic agents of bacterial diarrhoea in the children of the former East Central State of Nigeria

A total of 1015 single stool specimens were collected from under 5-year-old children suffering from diarrhoea, who were seen as out-patients or admitted into some of the hospitals in the former East Central State of Nigeria. These stools were investigated to determine the bacterial aetiology of their diseases. During the same period, 401 single stool specimens were collected from children under 5 years old, who were seen as out-patients or admitted into these hospitals with diagnosis other than diarrhoea, and also investigated for the presence of these bacteria. From the diarrhoea patients, enteropathogenic E. coli were detected in 12.0% (122/1015) of the children; Salmonella sp. in 3.1% (31/1015), Shigella sp. in 2.1% (21/1015), Campylobacter jejuni in 2.5% (25/1015), Y ersinia enterocolitica in 0.4% (4/1015), Vibrio parahaemolyticus in 1.0% (10/1015) and Vibrio cholerae in 0.0% (0/1015). Thus, aetiologic agents were identified in 21.0% (213/1015) of all the diarrhoea cases enteropathogenic Escherichia coli and Campylobacter jejuni were detected in 2.7% and 1.2% respectively of the control stools and swabs. All the Vibrio parahaemolyticus isolates were Kanagawa positive.     

Campylobacter species and drug resistance in a north Indian rural community

Campylobacter species are known as agents of enteritis worldwide. However, rural community-based studies on Campylobacter infections are lacking. We carried out a prospective case-control study from July to December 2002 to investigate the prevalence and socio-epidemiological determinants of Campylobacter infection in a rural community in north India and the drug resistance of Campylobacter strains isolated from the community. Stool specimens from 348 subjects with diarrhoea and 351 age- and gender-matched asymptomatic controls were cultured for Campylobacter, Salmonella and Shigella. All Campylobacter strains were identified and tested for antibiotic susceptibility. Campylobacter species were isolated from 47 (13.5%) subjects with diarrhoea and 2 (0.6%) asymptomatic controls respectively (P<0.001). Campylobacter infection was significantly higher in children aged less than 5 years, families engaged in agriculture and persons who did not wash their hands with soap after peri-anal washing following defaecation. Campylobacter infections were more frequent than combined Salmonella and Shigella infections (47/348 vs. 15/351; P<0.001) in subjects with diarrhoea. Only two Campylobacter-infected individuals with diarrhoea had bloody stools. Antibiotic resistance of Campylobacter species was as follows: ampicillin 81.6%, ciprofloxacin 71.4%, tetracycline 26.5%, furazolidine 14.3%, gentamicin 10.2% and erythromycin 6.1%; 30.6% of strains were multidrug resistant. Increased quinolone resistance and multidrug resistance pose major risks for treatment failure.     

Isolation and antibiotic susceptibility of Salmonella, Shigella, and Campylobacter from acute enteric infections in Egypt

While Campylobacter, Salmonella, and Shigella remain major contributors to acute enteric infections, few studies on these pathogens have been conducted in Egypt. From January 1986 to December 1993, 869 Salmonella, Shigella and Campylobacter strains were isolated from stool specimens from 6,278 patients, presenting to the Abbassia Fever Hospital, Cairo, Egypt, with acute enteric infections. Salmonella predominated, totalling 465 isolates, followed by Shigella with 258 isolates, and Campylobacter with 146 isolates. Of the Shigella isolates, 124 were Shigella flexneri, 49 were S. sonnei, 47 were S. dysenteriae (mainly serotype 1, 2, and 3), and 38 were S. boydii. Campylobacter spp. comprised 92 Campylobacter jejuni and 54 C. coli isolates. Isolation of Salmonella was highest during the months of February-March, June-July, and October-November, while that of Shigella was maximal from July to October. Isolation of Campylobacter increased during May-June and again during August-October. Although Salmonella was sensitive to amikacin, aztreonam, ceftriaxone, and nalidixic acid, it was, however, resistant to erythromycin, streptomycin, ampicillin, chloramphenicol, and tetracycline. Shigella (> 80%) was sensitive to amikacin, ceftriaxone, cephalothin, sulphamethoxazole-trimethoprim (except S. sonnei), aztreonam, and nalidixic acid. Resistance (> 50%) was noted only for ampicillin, chloramphenicol, and tetracycline. C. jejuni and C. coli were resistant to cephalothin, aztreonam, and streptomycin. Some of the above antibiotics were employed to characterize the Egyptian isolates, but did not have any clinical utility in the treatment of diarrhoea. Significant differences (p < 0.05) were observed in the resistance profiles of Shigella and Salmonella between late 1980s and early 1990s. The results suggest the use of fluoroquinolones or a third-generation cephalosporin as an empirical treatment of enteric diseases. However, alternative control strategies, including the aggressive development of broadly protective vaccines, may be more effective approaches to curbing morbidity and mortality due to acute enteric infections.     

Can erythema nodosum and reactive arthritis be a sequel to Shigella flexneri gastroenteritis?

Erythema nodosum and seronegative arthritis associated with diarrhoea was previously regarded as implying the presence of inflammatory bowel disease. Recently, however, erythema nodosum has been described as a sequel to diarrhoea caused by infection with Salmonella typhimurium, Yersinia enterocolitica and Campylobacter jejuni. We report two patients in whom erythema nodosum and reactive arthritis followed acute Shigella flexneri gastroenteritis, a rare association.     

Faecal carriage rate of Yersinia species

A total of 1,203 unselected routine faecal samples from 1,006 patients were cultured for Yersinia species by a cold enrichment technique. Seventy-five specimens (6.1%) from 63 patients were culture-positive for Yersinia spp. Fifty-two were Yersinia enterocolitica, 22 Yersinia frederiksenii and 1 Yersinia intermedia. The predominant Y. enterocolitica isolates belonged to biotype 1 - serotype 0:6, 30 or serotype 0:5, 27. Y. frederiksenii strains were non-typable. Forty isolates were recovered from 33 patients with gastroenteritis. During the study period 83 Salmonella spp. from 33 patients, 17 Shigella sonnei from 13 patients and 13 Campylobacter jejuni from 12 patients were cultured. Yersinia spp. was isolated in association with salmonella on three occasions, twice with rotavirus and once each with Shigella sonnei, Campylobacter jejuni and Trichuris trichiura.     

Isolation and characterization of Campylobacter jejuni from acute diarrhoeal cases in Calcutta

During a seven-month survey, Campylobacter jejuni was isolated from 9.6% of the 116 acute diarrhoeal cases admitted to the Infectious Diseases Hospital, Calcutta. In six of the 11 cases, C. jejuni occurred together with V. cholerae biotype El Tor (Ogawa) while in one case it was found in association with Shigella sonnei. No age or sex specific incidence was observed. A distinct clinical profile in cases suffering from Campylobacter enteritis was not discernible. Biochemically all strains isolated in this study conformed to the typical reported characteristics of C. jejuni. Survival of the organism in positive stool samples held at 4 degrees C without any transport medium was limited. This preliminary study indicates that C. jejuni is an important aetiological agent of acute diarrhoea and must be routinely monitored in enteric laboratories in India.     

Faecal carriage rate of Yersinia species.

A total of 1,203 unselected routine faecal samples from 1,006 patients were cultured for Yersinia species by a cold enrichment technique. Seventy-five specimens (6.1%) from 63 patients were culture-positive for Yersinia spp. Fifty-two were Yersinia enterocolitica, 22 Yersinia frederiksenii and 1 Yersinia intermedia. The predominant Y. enterocolitica isolates belonged to biotype 1 - serotype 0:6, 30 or serotype 0:5, 27. Y. frederiksenii strains were non-typable. Forty isolates were recovered from 33 patients with gastroenteritis. During the study period 83 Salmonella spp. from 33 patients, 17 Shigella sonnei from 13 patients and 13 Campylobacter jejuni from 12 patients were cultured. Yersinia spp. was isolated in association with salmonella on three occasions, twice with rotavirus and once each with Shigella sonnei, Campylobacter jejuni and Trichuris trichiura.     

Aetiology of diarrhoea in a birth cohort of children aged 0-2 year(s) in rural Mirzapur, Bangladesh

The incidence of aetiology-specific diarrhoea and the pathogenicity of infectious agents in a birth cohort (n=252) in rural Bangladesh were determined. Stool specimens or rectal swabs were collected from diarrhoeal cases over two years and routinely on a monthly basis. Stool samples from children with diarrhoea were compared with stool samples from children without diarrhoea to calculate rates of isolation and pathogenicity of agents. In total, 1750 stool specimens from diarrhoea patients and 5679 stool specimens from children without diarrhoea were tested. An infectious agent was identified in 58% of the stool specimens from diarrhoea patients and 21.6% of the stool specimens from children without diarrhoea. The most commonly-isolated pathogens from all specimens were enterotoxigenic Escherichia coli (ETEC), enteroadherent E. coli, Shigella, Campylobacter jejuni, Giardia, and rotavirus. ETEC (ST and LT-ST toxin), enterotoxigenic Bacteroides fragilis, Shigella, and rotavirus were associated more with disease than with asymptomatic infections. Aetiology-specific infections were associated with acute episodes. The isolated enteropathogens were essentially the same as those found in other tropical rural settings. Enterotoxigenic B. fragilis was also identified as a pathogen. Ongoing vaccine efforts focusing on Shigella, rotavirus, and ETEC would be useful.     

Diarrhoeagenic bacterial pathogens in HIV-positive patients with diarrhoea in rural communities of Limpopo Province,South Africa

Potential enteric bacterial pathogens in 60 HIV-positive patients with chronic diarrhoea in rural communities of the Limpopo Province, South Africa, were identified using standard microbiological methods. The Kirby-Bauer disk-diffusion method was employed to determine antibiograms of isolated bacteria. Results revealed that diarrhoeagenic bacterial agents were isolated from 48 (80%) of the 60 HIV-positive patients with diarrhoea. Forty-four (73.3%) and 16 (26.7%) of the 60 patients were female and male respectively in the age range of 17-55 years with a mean of 34 years. Bacterial pathogens isolated comprised Campylobacter species (20.0%), Plesiomonas shigelloides (16.6%), Aeromonas species (13.3%), and Escherichia coli, Shigella and Salmonella species (10.0% each). No attempts were made to isolate parasites, fungi, or viruses. Antibiotic susceptibility profiles revealed resistance of the isolates to ampicillin, cephalothin, chloramphenicol, erythromycin, and streptomycin. However, all (100%) of P. shigelloides and Salmonella species were sensitive to nalidixic acid and ciprofloxacin. Most isolates were susceptible to nalidixic acid, ciprofloxacin, and gentamicin, indicating the usefulness of these drugs, although antibiograms may not always correlate with clinical usefulness.     

2009-2011年无锡市部分腹泻患者病原学检测资料分析

[目的]了解腹泻病人的病原学分布,并提出相应的预防措施。[方法]收集2009～2011年无锡市12家医院消化科和小诊所食源性致病菌所致腹泻病例的粪便标本,进行致病菌检测。[结果]检测腹泻病人粪便标本1205份,检出腹泻致病菌1083份,检出率为89．88％。检出腹泻致病菌8种,菌株1127株,其中沙门菌占27．77％,志贺菌占7．28％,副溶血性弧菌占3．02％,阪崎肠杆菌占9．94％,空肠弯曲杆菌占11．89％,金黄色葡萄球菌占10．03％,单核细胞增生李斯特菌占9．14％,肠出血性大肠杆菌0157：H7占20．94％。夏季食源性致病菌阳性标本占43．37％,秋季占24．75％。[结论]食源性致病菌感染是造成腹泻的主要原因,且在夏季分布最多。     

Salmonella and Shigella gastroenteritis at a public teaching hospital in Nairobi, Kenya.

OBJECTIVE: To measure the proportion of nosocomial diarrhea cases associated with Salmonella and Shigella species. DESIGN: Prospective 6-month survey. SETTING: Tertiary care center in a developing country. PATIENTS: Pediatric and adult patients admitted with the previous 24 hours and all consenting adult or pediatric medical patients with nosocomial diarrhea. OUTCOME MEASURES: Prevalence of Salmonella and Shigella species isolated from rectal swabs at admission and among subjects with nosocomial diarrhea. RESULTS: Salmonella species and Shigella species were isolated from 3.0% and 2.5%, respectively, of 667 patients screened on admission. All admission Salmonella isolates were identified in children under 13 years of age; Shigella prevalence was similar for children and adults. Children with Salmonella at admission were significantly older and more likely to have diarrhea, fever, and some indicators of malnutrition than those from whom Salmonella was not isolated. Salmonella and Shigella were isolated from rectal cultures in 36 (10%) and 9 (2.5%) of 360 nosocomial gastroenteritis cases, respectively. Nosocomial cases occurred equally in adults and children. In adults, nosocomial Salmonella acquisition was associated with sharing a room with a diarrhea patient and previous institutionalization. In children, it was associated with recent antimicrobial therapy, crowding at home, and age between 6 months and 6 years. Nine (41%) of 22 nosocomial Salmonella cases in adults occurred in patients with human immunodeficiency virus-type 1 (HIV-1) infection, while none of 79 HIV-1-positive patients had Salmonella isolated at admission. CONCLUSIONS: Salmonella is a frequent cause of nosocomial gastroenteritis in this tertiary care institution in a developing country. Risk factors appear to differ for children and adults, and HIV-1-infected subjects may be at increased risk of acquisition. Control measures feasible for the limited resources available to such institutions require evaluation.     

Campylobacter enteritis in Portugal: Epidemiological features and biological markers

From 1984 to 1989, stool samples from 2811 gastroenteritis cases were examined for the presence ofCampylobacter jejuni andC. Coli, Salmonella, Shigella andYersinia species. Isolation rates were:Campylobacter jejuni andC. Coli, 5.3%,Salmonella spp., 14.8%,Shigella spp., 4.6% andYersinia enterocolitica, 1.1%. Age group distribution analysis shows a higherCampylobacter isolation rate in children under one year of age. Seasonal distribution revealed a peak incidence in winter as in other Meditteranean countries. Predominant biotypes wereC. jejuni I (51%),C. jejuni II (21.5%) andC. coli I (18.8%). Antimicrobial susceptibility testing did not reveal resistance to erythromycin. Thirty of the strains harboured plasmids with 7 different profiles.     

Frequency and characteristics of selected enteropathogens in fecal and rectal specimens from childhood diarrhea in Trinidad, 1998-2000.

OBJECTIVE: To determine the prevalence and characteristics of selected enteric pathogens in diarrheic children in six counties of the island of Trinidad. METHODS: This cross-sectional study was conducted from April 1998 through March 2000. Fecal or rectal swab specimens from children (<12 years) were collected and then processed, using standard methods, to detect Salmonella spp., Shigella spp., enteropathogenic Escherichia coli (EPEC), Campylobacter spp., Yersinia spp., Cryptosporidium parvum, and parasite ova. The antibiograms of the enteropathogens were determined using the disk diffusion method. RESULTS: A total of 236 samples were processed; 86 samples originated directly from 17 heath centers in two counties (St. George East and St. George West), while 150 samples were obtained from the Trinidad Public Health Laboratory, having been submitted by private practitioners and personnel from six counties in Trinidad. Of the 236 samples, 33 (14.0%) were positive for Shigella, 4 (1.7%) for Salmonella, and 1 (0.4%) for EPEC. Two of the samples (0.8%) were positive for Campylobacter jejuni, while 1 sample (0.4%) was positive for hookworm ova. All the samples were negative for Cryptosporidium parvum and Yersinia spp. With the 86 samples collected directly from the health centers, in St. George East County the frequency of Shigella was 20.0% (12 of 60), compared with 26.9% (7 of 26) for samples from St. George West County, but the difference was not statistically significant (P>0.05 with the chi-square test). For the 150 samples from the six counties that had been submitted directly to the Trinidad Public Health Laboratory, 14 of them (9.3%) were positive for Shigella, a figure statistically significantly lower than that found with the samples sampled directly from the health centers (P<0.05 with the chi-square test). Sh. sonnei was the predominant serotype detected, accounting for 28 of the 33 Shigella isolates (84.8%) recovered from the 236 samples. Overall, the frequency of detection of enteropathogens had no seasonal pattern nor relationship to the county of origin. Of the 37 isolates of Salmonella and Shigella tested for antimicrobial sensitivity, all of them were sensitive to ciprofloxacin, gentamicin, and cefotaxime. In terms of resistance, 3 of the 37 isolates (8.1%) exhibited resistance to ampicillin, 1 (2.7%) to chloramphenicol, and 1 (2.7%) to sulfamethoxazole/ trimethoprim. CONCLUSION: Of the enteropathogens for which assays were done, Shigella sonnei was the most prevalent, and it has the highest probability of being an important etiological agent of childhood diarrhea in Trinidad.     

Campylobacter bacteraemia in England and Wales, 1981-91.

Routine surveillance of infection in England and Wales detected 394 cases of campylobacter bacteraemia in 11 years. This represented an average incidence of 1.5 per 1000 intestinal campylobacter infections, with a range of 0.3/1000 in children aged 1-4 years to 5.9/1000 in patients aged 65 years or more. Definitive identification of 257 isolates showed that 89% were Campylobacter jejuni or C. coli; other species were C. fetus (8.6%), C. lari (0.8%), C. upsaliensis (0.8%), Helicobacter (Campylobacter) fennelliae (0.8%), and Helicobacter (Campylobacter) cinaedi (0.4%). Most (71%) of the C. jejuni/C. coli bacteraemias were in patients with acute enteritis. Of the patients with C. fetus bacteraemia only 27% had diarrhoea; they were older than patients with C. jejuni or C. coli bacteraemia (54.1 v. 45.9 years) and proportionally more of them were male (M:F ratio 2.7:1 v. 1.9:1); 41% had endovascular pathology or cellulitis. There was a higher proportion of C. jejuni serogroup O 4 (Penner) and O 18 strains among blood than faecal isolates, which suggests that they were unusually serum resistant and/or invasive.     

Bacterial contamination of Vhuswa--a local weaning food and stored drinking-water in impoverished households in the Venda region of South Africa

Bacterial contaminants of Vhuswa--a traditional maize-based weaning food, and domestic drinking-water stored in impoverished rural households in Venda of Limpopo province, South Africa, were determined. One hundred and twenty-five samples of Vhuswa fed to children aged less than five years were assessed for Escherichia coli, Campylobacter jejuni, Salmonella, and Shigella. The microbiological quality of 125 drinking-water samples was also evaluated using total coliforms, faecal coliforms, and faecal streptococci as indicators. The frequency of isolation of E. coli, Salmonella, Shigella, and C. jejuni from the Vhuswa samples was 70%, 5%, 5%, and 2% respectively. The geometric mean counts of total coliforms, faecal coliforms, and faecal streptococci in tap-water stored in household containers ranged from 4.9x10(2) to 5.8x10(3) cfu 100 mL(-1), 2.6x10(2) to 3.7x10(3) cfu 100 mL(-1), and 3.1x10(3) to 5.8x10(3) cfu 100 mL(-1) respectively, and for stored spring water it was 5.1x10(3) cfu 100 mL(-1), 3.2x10(3) cfu 100 mL(-1), and 5.1x10(3) cfu 100 mL(-1) respectively. The frequent contamination of water and food samples in this study has important implications for the health of children from impoverished communities.     

Bacterial pathogens associated with diarrhoea on the island of Crete

Stool specimens from 3,600 diarrhoeal patients from the island of Crete, Greece, were examined for bacterial pathogens, during a three-year period (1992–1994). One or more pathogens were identified in 826 patients (22.9%), more often from children. Salmonella spp. were the most frequently isolated organisms in 13.6% of the patients, followed by Campylobacter in 4.7%, and enteropathogenic Escherichia coli (EPEC) in 3.9%. Yersinia enterocolitica was found in 0.7%, Shigella spp. in 0.7% and Aeromonas hydrophila in 0.05%. Vibrio spp. and enterohaemorragic E. coli were not identified in the stools tested. Resistance to ampicillin was observed in 36% of the Salmonella, 62% of the Shigella, and 27% of the EPEC isolates. Cotrimoxazole resistance was observed in 42% of the Shigella and 12% of the EPEC isolates, while tetracycline and the quinolones were inactive against almost half and erythromycin against 20% of the Campylobacter isolates. This is the first study investigating bacterial pathogens associated with diarrhoea on the island of Crete.     

Campylobacter jejuni infection in Colorado: unexplained excess of cases in males

Between January 1, 1981, and December 31, 1982, the Colorado Department of Health received reports of 1,185 culture-confirmed cases of Campylobacter jejuni infection. Incidence rates were highest among infants less than 1 year old and among persons aged 20-29 years. The distribution of cases by sex showed a predominance among males at all ages except 40-59 years, the most marked predominance occurring in infants under 1 year. The higher rates for males were also significant for all ages combined, for ages 10-19 years, and for ages 5-9 years. Neither Salmonella nor Shigella infections reported in Colorado during the same period showed the preponderance among males found for C. jejuni infections. Giardia infections, however, showed a weak male predominance, especially among children less than 10 years old. The preponderance of C. jejuni cases among males disclosed by this study was remarkable. The reasons for this phenomenon are not clear and need further research.     

Aeromonas species as cause of diarrhea and infections outside the gastrointestinal tract in The Netherlands

In a national survey in the period May 1986-December 1987, Aeromonas was isolated from 277 out of 16,857 (1.6%) samples of watery, bloody or mucous stool, from patients with diarrhoea. There was a clear seasonal pattern (less than 1% in winter, up to 3% in summer). A. caviae was isolated most frequently (49%), followed by A. sobria (35%) and A. hydrophila (15%). Some non-identifiable strains were isolated as well. Aeromonas were isolated in particular from faeces of patients aged over 70 years (predominantly A. sobria) or under 5 years (predominantly A. caviae). In 67% Aeromonas was isolated as the only possible bacterial cause of diarrhoea, but in 33% other enteropathogenic bacteria were found as well (17% Campylobacter, 14% Salmonella, 2% Shigella). In addition, all Aeromonas isolates were collected which were obtained in normal diagnostic activities in the participating laboratories, among others from blood, from pus or wound fluid, from faecal samples which did not meet the above mentioned criteria. A. caviae was the dominant species in 'other' faeces and 'various' body sites but was not isolated from blood. The results of this study do not indicate that routine examinations for Aeromonas in faeces of patients with diarrhoea are necessary.