Campylobacter infection in urban and rural populations in Scotland

A review of campylobacter infection in Scotland over five years (1978-82), during which 7808 human isolates were recorded (mean annual isolation rate of 30 per 100000), revealed differences in the epidemiology of the disease between rural and urban populations which were not apparent in the national data. The incidence of infection in the two rural areas studied was greatest in the early months of the year, whereas that in the two urban areas showed a third-quarter predominance. In both urban and rural populations, age-specific infection rates were highest in children less than 5 years old, but this trend was more pronounced in rural than urban populations. Conversely, secondary peaks in age-specific infection rates observed in young adults were more pronounced in the urban than rural populations. It is postulated that rural children were being infected by campylobacters at an early age by drinking contaminated raw milk which was not normally available to city residents. The lower incidence in adults in the rural populations is interpreted as indicating more widespread immunity, resulting from greater exposure to infection during childhood. The effect of compulsory heat treatment of milk sold in Scotland, introduced in August 1983, is currently being studied.     

Campylobacter infection in urban and rural populations in Scotland.

A review of campylobacter infection in Scotland over five years (1978-82), during which 7808 human isolates were recorded (mean annual isolation rate of 30 per 100000), revealed differences in the epidemiology of the disease between rural and urban populations which were not apparent in the national data. The incidence of infection in the two rural areas studied was greatest in the early months of the year, whereas that in the two urban areas showed a third-quarter predominance. In both urban and rural populations, age-specific infection rates were highest in children less than 5 years old, but this trend was more pronounced in rural than urban populations. Conversely, secondary peaks in age-specific infection rates observed in young adults were more pronounced in the urban than rural populations. It is postulated that rural children were being infected by campylobacters at an early age by drinking contaminated raw milk which was not normally available to city residents. The lower incidence in adults in the rural populations is interpreted as indicating more widespread immunity, resulting from greater exposure to infection during childhood. The effect of compulsory heat treatment of milk sold in Scotland, introduced in August 1983, is currently being studied.     

Immunoglobulin A antibodies directed against Campylobacter jejuni flagellin present in breast-milk.

We studied the relationship between IgA anti-campylobacter flagellin antibodies in breast milk samples and protection of breastfed infants living in a rural Mexican village from campylobacter infection. There were fewer episodes of campylobacter infection (symptomatic and asymptomatic combined) in infants breastfed with milk containing specific anti-flagellin antibodies (1.2/child/year, 95% CI 0.6-1.8) versus non-breastfed children (3.3/child/year, 95% CI 1.8-4.8; P < 0.01). Infants breastfed with milk that was anti-flagellin antibody negative by ELISA also had fewer episodes of infection compared with non-breastfed children, but the difference did not reach statistical significance (1.8/child/year, 95% CI 0.7-3.0 versus 3.3/child/year, 95% CI 1.8-4.8, P > 0.05). Breastfeeding has a protective effect against campylobacter infection and is associated with the presence of specific antibodies directed against campylobacter flagellin.     

A demographic survey of campylobacter, salmonella and shigella infections in England. A Public Health Laboratory Service Survey

Five laboratories serving a population of 1.5 million participated in a 2-year survey of campylobacter, salmonella and shigella infections in patients suffering from gastrointestinal symptoms. In total, 33,857 faecal specimens were examined of which 5.5% yielded campylobacters, 3.4% salmonellas and 0.8% shigellas; incidence of infection (per 100,000 population per year) was 58, 38 and 9 respectively. Peak incidences occurred at different ages for each organism: campylobacter, 1-4 years (183); salmonella, less than 1 year (181); shigella, 1-4 years (17). There was a secondary peak in campylobacter incidence in patients aged 15-24 years (87), which was not seen with salmonella or shigella infections. By recording the age and sex of all patients submitting faecal specimens, it was shown that sampling rates were disproportionately high in infants aged less than 1 year (12:1 relative to other ages). Thus the percentage of faecal samples positive in infants--in sharp contrast to incidence values--was the lowest of any age group for all three organisms. By taking the numbers of faecal specimens tested as denominators in this way, the highest campylobacter isolation rates were in young adults, with a notable male predominance in the 15-24 year (1.7:1) and 45-54 year (1.6:1) age groups. This male predominance was accentuated during the summer (2.1:1) when incidence was generally high. The maximum percentage isolation recorded by any laboratory was 32.5% in males aged 15-24 years in June. The reasons for this pattern of campylobacter infection are unknown, but the similarity of the results between laboratories and the regularity of the seasonal fluctuations recorded over the last 6 years indicate that the sources and routes of infection are geographically similar and stable, yet different from those of salmonellosis.     

A cohort study of enteric campylobacter infection in children from birth to two years in Bangui (Central African Republic)

A cohort of 111 children from Bangui, Central African Republic, was followed for enteric campylobacter infection from birth until the age of 2 years. Stools were examined at each episode of diarrhoea, and bi-weekly up to the age of 6 months irrespective of the presence of diarrhoea. 349 episodes of diarrhoeal illness were recorded (1.6 per child-year). Campylobacters were isolated from 41 (11.7%) of the 349 episodes, but in half of them another enteric pathogen was also isolated. Campylobacters were statistically associated with diarrhoea only before the age of 6 months. Bi-weekly sampling up to this age detected 75 infections (1.3 per child-year), yet only 12 (16%) were associated with diarrhoea. Campylobacter coli was isolated slightly more often (51%) than C jejuni (49%); biotyping and serogrouping showed that no strain was especially associated with disease. Fewer children who had campylobacter infection before the age of 6 months suffered campylobacter diarrhoea between 6 and 24 months of age than those who did not, but the difference did not reach statistical significance. A significantly higher rate of isolation was found in the homes of infected children (human and animal contacts) than of non-infected children. Campylobacter infections were statistically associated with the presence of live poultry and the lack of piped water in homes.     

A survey of Campylobacter in animals

A survey of Campylobacter species in the faeces or rectal contents of domestic animals was carried out using direct and enrichment culture methods. Campylobacters were isolated from 259 (31%) of 846 faecal specimens. The highest isolation rate was found in pigs (66%); lower rates were found in cattle (24%) and sheep (22%). In pigs all the isolates were C. coli, in sheep and cattle about 75% were C. jejuni. Only five isolations of C. fetus subsp. fetus were made, all from cattle. More pigs with diarrhoea had C. coli in their faeces than healthy pigs (77% vs 47%), but such a clear difference in isolation rate between sick and healthy animals was not seen in cattle or sheep. The enrichment method increased the total isolation rate of C. jejuni and C. coli by 33%, but for cattle specimens it increased it by 69% (from 6.5% to 21%). However, the enrichment method failed to detect 16% of positive specimens (mainly C. coli), so direct and enrichment methods should be used for the culture of campylobacters from animal faeces. The results show that cattle, sheep and pigs constitute a large potential source of campylobacter infection for man.     

A survey of Campylobacter in animals.

A survey of Campylobacter species in the faeces or rectal contents of domestic animals was carried out using direct and enrichment culture methods. Campylobacters were isolated from 259 (31%) of 846 faecal specimens. The highest isolation rate was found in pigs (66%); lower rates were found in cattle (24%) and sheep (22%). In pigs all the isolates were C. coli, in sheep and cattle about 75% were C. jejuni. Only five isolations of C. fetus subsp. fetus were made, all from cattle. More pigs with diarrhoea had C. coli in their faeces than healthy pigs (77% vs 47%), but such a clear difference in isolation rate between sick and healthy animals was not seen in cattle or sheep. The enrichment method increased the total isolation rate of C. jejuni and C. coli by 33%, but for cattle specimens it increased it by 69% (from 6.5% to 21%). However, the enrichment method failed to detect 16% of positive specimens (mainly C. coli), so direct and enrichment methods should be used for the culture of campylobacters from animal faeces. The results show that cattle, sheep and pigs constitute a large potential source of campylobacter infection for man.     

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.     

Campylobacter enteritis in Saudi Arabia.

A 12-month survey on the incidence of campylobacter infection in 1217 patients with diarrhoea was carried out in Jeddah, Saudi Arabia. Campylobacters were isolated from 55 (4.5%) patients, second in prevalence to salmonellas (6.2%). Shigellas were isolated from 4.2% of patients. Campylobacter isolation rates were high in children of all ages, as well as in young adults (36.5% of all isolates were from adults aged 20-39 years). Isolation rates peaked in September and November. Analysis of the results showed that 69% were Campylobacter jejuni (mostly biotype IV) and 31% C. coli. Serogroups 5 and 23 (Penner scheme) and phage type 125 (Preston scheme) were most frequently isolated. Resistance to erythromycin and tetracycline was observed in 7.3 and 32.7% of the isolates. Campylobacters are an important cause of bacterial enteritis in Saudi Arabia, both in adults and in children, and should be sought routinely.     

Campylobacter diarrhoea and an association of recent disease with asymptomatic shedding in Egyptian children

A hospital-based case-control diarrhoea survey was conducted in Cairo, Egypt to determine the age-specific frequency of campylobacter infection among diarrhoeic and non-diarrhoeic children aged new born to 5 years. Campylobacter was the most common bacterial enteropathogen isolated from diarrhoeic stools. The overall prevalence of campylobacter isolations was 25.9% from stools of 143 diarrhoeic children compared to 15.2% of 132 non-diarrhoeic control children (P = 0.028) during the 4-month period of study. Children less than 1 year of age were at greatest risk of campylobacter infection with 32.6% of diarrhoeic patients culture positive, compared to 14.3% of controls. Asymptomatic shedding in controls was positively associated with a recent diarrhoeal episode (P = 0.019) and may be an important source of new infections.     

Escherichia coli O157: comparing awareness of rural residents and visitors in livestock farming areas

This research compared public opinions about Escherichia coli O157 (an increasing environmental hazard associated with livestock) in two farming areas with contrasting incidence of E. coli O157 disease. A questionnaire was administered in rural Grampian (10·8 cases/100,000 population per year) and North Wales (2·5 cases/100,000 population per year). Awareness was highest among farmers in Grampian (91%) and lowest among visitors to both areas (28%). Respondents were more likely to indicate vomiting (76%) than bloody diarrhoea (48%) as a common symptom. Undercooked meat and contact with farm animal faeces were identified by 60% of all respondents as risk factors who described 'basic hygiene' for risk reduction indoors. Visitors view E. coli O157 as a food hazard, not an environmental hazard that produces vomiting not dysentery. Efforts to reduce human infections in livestock farming areas could be improved with proximate reminders for visitors of the environmental pathway of E. coli O157 infection.     

Invasive group A streptococcal infection and vaccine implications, Auckland, New Zealand

We aimed to assess the effect of invasive group A streptococcal (GAS) infection and the potential effects of a multivalent GAS vaccine in New Zealand. During January 2005-December 2006, we conducted prospective population-based laboratory surveillance of Auckland residents admitted to all public hospitals with isolation of GAS from normally sterile sites. Using emm typing, we identified 225 persons with confirmed invasive GAS infection (median 53 years of age; range 0-97 years). Overall incidence was 8.1 cases per 100,00 persons per year (20.4/100,000/year for Maori and Pacific Islanders; 24.4/100,000/year for persons >65 years of age; 33/100,000/year for infants <1 year of age). Nearly half (49%) of all cases occurred in Auckland's lowest socioeconomic quintile. Twenty-two persons died, for an overall case-fatality rate of 10% (63% for toxic shock syndrome). Seventy-four percent of patients who died had an underlying condition. To the population in our study, the proposed 26-valent vaccine would provide limited benefit.     

Bacteremia in Charleston County, South Carolina

To describe the epidemiology of bacteremia in a large, well defined population, the authors reviewed medical records for residents of Charleston County, South Carolina, who had bacteria isolated from blood in the period 1974 to 1976. The incidence was 80 cases per 100,000 population per year. The most common organisms were Escherichia coli, Staphylococcus aureus, Klebsiella, and Streptococcus pneumoniae. The incidence was highest for neonates, infants, and those 70 years of age and older with annualized attack rates of 1,864,250, and 446 cases per 100,000 population, respectively. The incidence was 3.2 times higher for blacks than for whites and, within races, appeared to be independent of family income. Twenty-five per cent of patients had no clinically apparent focus of infection, 26% had urinary tract infection, and 17% had pneumonia. Thirty-nine per cent of cases were nosocomial, and 30% of patients died.     

Prospective study of diarrhoeal disease in a cohort of rural Mexican children: incidence and isolated pathogens during the first two years of life

Colonization of the intestine by putative pathogens was followed longitudinally in a cohort of 56 infants born during one calendar year in a rural Mexican village with faecal cultures taken every fortnight and every time a child had diarrhoea. The frequency of isolation of pathogens during episodes of diarrhoea was compared with that of matched controls from the same cohort. Incidence of diarrhoea during the first year of life was 98%, diminishing to 93% during the second year. The incidence curves for each year were not significantly different (P greater than 0.1). Isolation of enteropathogenic Escherichia coli, enterotoxigenic Escherichia coli producing heat-stable (ST) and/or heat-labile (LT) enterotoxins and rotaviruses was significantly higher in infants with diarrhoea during the first 2 years of life. In the case of shigella, although no significant differences were found by semester of life, 13 of 16 children in which these strains were found had diarrhoea. Isolation of Salmonella spp., Campylobacter spp. and protozoa were not significantly different in the two groups during the period studied. Strains showing localized adherence to HEp-2 cells or the presence of colonization factor antigens I or E8775 were found with significantly higher frequency in children with diarrhoea. Eighty-two percent of ST+ or LT+ ETEC strains isolated produced one of the three known colonization factors.     

Campylobacter infections: the emerging national pattern.

In the United States, 8,837 Campylobacter isolates and eight outbreaks of Campylobacter infections were reported in 1984, a national isolation rate of 4.9/100,000. C. jejuni represented 99 per cent of reported isolates. Age-specific incidence was highest among infants (11/100,000), and young adults (8/100,000); infants in the second month of life were at highest risk. An unexplained nationwide November peak, not observed in previous years, occurred in all age groups and suggests there is an homogeneous nationwide source for this infection.     

The importance of Campylobacter coli in human campylobacteriosis: prevalence and genetic characterization

The primary aim of this study was to detect and genotype Campylobacter coli strains from humans over a period of one year from November 2002 to October 2003. Campylobacter spp. were isolated from patients with symptoms of enteric infection. Amplified fragment length polymorphism (AFLP) analysis was used to identify the genetic diversity of C. coli strains by cluster analysis. A total of 18.6% of all Campylobacter isolates were identified as C. coli. These data show, that C. coli is indeed of importance to human campylobacter infections. Heterogeneous patterns were detectable among the human C. coli pool by AFLP analysis suggesting different sources of infection. A continuous seasonal shift of genotypes was detectable.     

Campylobacter enteritis-an in-patient study

During the first eight months of 1978, 26 patients were admitted to the Communicable Diseases Unit at King's Cross Hospital, Dundee with a diagnosis of campylobacter enteritis. The variety of clinical features encountered is described. Although diarrhoea occurred in all cases, it was preceded or accompanied by abdominal pain in the majority of cases and by fever in over half of the patients. The article emphasises the need to consider campylobacter infection in patients presenting with bloody diarrhoea, acute abdominal pain or pyrexias of unknown origin.     

Epidemiology of campylobacteriosis in a cohort of rural population near Calcutta

Over a 2-year period, 25 families comprising of 181 individuals of all ages were longitudinally observed for the excretion of Campylobacter species. Faecal samples were taken from all persons with diarrhoea. Specimens were also taken from apparently healthy individuals and from domestic animals living within the confines of the study families at monthly intervals. The overall diarrhoea attack rate was 19 episodes per 100 person-years with peak incidence in the 1- to 4-year-old age group (76/100 person-years). Eight (11.5%) of the total episodes were campylobacter-associated and the overall rate of campylobacter positive diarrhoeal episodes were 2.2 per 100 person-years. Of the 1002 stool samples from healthy individuals 32 (3.2/100 samples) were positive for campylobacter. The organism was most frequently isolated from children under 1 year of age both during diarrhoeal episodes (11.5 per 100 person-years) and non-diarrhoeal (11.1 per 100 samples). Multiple infections in a family were rare. In 19.4% of the occasions one or more animals were campylobacter positive. However, only in 7.7% of these occasions was a human infection recorded within 1 month after the animal was found to be positive. The study showed that the epidemiology of campylobacteriosis in this community was distinct compared to that observed in developed countries.     

Vero cytotoxin-producing Escherichia coli, particularly serogroup O 157, associated with human infections in the United Kingdom: 1989-91.

This survey reports the results of investigations performed by the Laboratory of Enteric Pathogens (LEP), to identify evidence of human infection with Vero cytotoxin-producing Escherichia coli (VTEC) in the UK during the period 1989-91. Bacterial isolates, faecal specimens and serum samples were received from patients suffering from diarrhoea, bloody diarrhoea and haemolytic uraemic syndrome. Using serotyping, Vero cytotoxin gene probing and an ELISA for serum antibodies to E. coli O 157, evidence of infection was detected in 232, 428 and 615 individuals in 1989, 1990 and 1991 respectively. Of these individuals, 15% were reported as having HUS. Vero cytotoxin-producing E. coli O 157 was the most frequently encountered serogroup, with isolations from a total of 1092 individuals over the 3-year period. The incidence of VTEC infection increased from 0.41/100,000 in 1989 to 1.07/100,000 in 1991. The area with the highest rate of infection in each year was Scotland, increasing from 1.37/100,000 in 1989 to 3.97/100,000 in 1991.     

Campylobacter enteritis in general practice.

The incidence and clinical features of campylobacter enteritis were studied in a defined general practice population over a period of three years. Specimens of faeces were cultured from a representative sample of patients suffering from acute enteritis. Of 168 patients submitting a specimen to the laboratory 34 (20.2%) were positive for thermophilic Campylobacter species. The projected campylobacter infection rate varied from 5.4% per annum in infancy to 0.3% per annum in the 5- to 14-year-olds with a mean of 1.1% per annum for the whole study population. During the same period campylobacters were isolated from 484 (14.9%) of 3250 patients suffering from acute enteritis whose general practitioners had sent faecal specimens to the laboratory, confirming the importance of this organism in the aetiology of acute enteritis in the community.