Studies on enteric campylobacteriosis in Tikur Anbessa and Ethio-Swedish children's hospital, Addis Ababa, Ethiopia

Between February 1992 and January 1993 different Campylobacter spp. were isolated from 86 (13.7%) of 630 patients with diarrhoea at Tikur Anbessa and Ethio-Swedish Children's Hospital, Addis Ababa, Ethiopia. In the same study population, Shigella spp. were found in 11.7% and Salmonella spp. in 3.8%. Campylobacter spp. were found in all age groups, but the majority were isolated from children less than five years of age (68.6%). Only 2 (0.9%) of 220 controls had campylobacter in their stools. Of the campylobacters that were differentiated at species level, Campylobacter jejuni accounted for 82.4% and Campylobacter coli for 17.6% of the isolates. Yersinia enterocolitica was not isolated from any tested stool specimen. More patients (53.1%) presented for investigation of diarrhoea during the months of April through July than during other parts of the year but there was no significant difference in the frequency of isolation of the three enteric pathogens studied during this period as compared to other months of the year. In 12 of the patients infected with Campylobacter spp., Shigella spp. or Salmonella spp. was concomitantly isolated from their stools. The most common symptoms and signs in both adults and children were watery diarrhoea in 82.4%, low grade fever in 78.4% and frequent vomiting in 45.9%. Dehydration ranging from mild to severe was observed in 25.4% of the 55 children with campylobacter infections. Of the 55 children 67.2% had signs of malnutrition and most of them (47.2%) were underweight. This study indicates that Campylobacter spp. are an important cause of diarrhoea both in adults and children in Addis Ababa, and should be considered routinely in the diagnosis of patients with diarrhoea.

The seasonal variation of thermophilic campylobacters in beef cattle, dairy cattle and calves

The epidemiology of clinical cases of campylobacter in temperate climates shows a striking seasonality. In the search for a seasonal environmental reservoir changes in the carriage rate and population size of campylobacters in bovine hosts with time have been measured. Most probable number (MPN) methodology was used to enumerate thermophilic campylobacters in samples taken from the small intestines of beef cattle at slaughter and the fresh faeces of four dairy herds and new-born calves. Statistical analyses revealed significant evidence for seasonal periodicity in the data from dairy herds (P = 0.044). Not only was there a departure from constancy within a 12-month interval but these data revealed a true seasonality, that is, the same periodicity in numbers from one year to the next. Each herd had two peaks per year, in approximately spring and autumn. Peaks coincided in herds on neighbouring farms but those on farms in the north preceded those on farms in the south by 2 and 1 months, respectively (P = 0.0057). Intestinal carriage by beef cattle at slaughter was 89.4% (n = 360) with an average MPN campylobacters per gram fresh weight (MPN gfw-1) of 6.1 x 10(2). Average MPN gfw-1 in faeces from the dairy herds and calves were 69.9 (S.D. 3) and 3.3 x 10(4) (S.D. 1.7 x 10(2)). There was no evidence of seasonal periodicity in the size of the campylobacter population in beef cattle at slaughter. Calves were campylobacter free at birth but became colonized with a few days.

Lectin-binding sites in uterus and oviduct of normal and Campylobacter fetus subspecies venerealis-infected heifers

This study was carried out to investigate the effect of infection with Campylobacter fetus subsp. venerealis (Cfv) on the pattern of lectin binding in the uterus and oviduct of heifers. Cfv persistence was demonstrated by bacterial isolation and immunofluorescence. Infected animals showed variations in the lectin binding pattern when compared with control animals. Cfv-infected heifers showed an increased expression of galactose and N-acetyl-galactosamine in the endometrial glands (PNA and SBA binding, respectively). The oviductal epithelium of infected heifers was strongly positive for Con A, which indicated the presence of alpha-D-mannose and alpha-D-glucose. The results of this study showed that Cfv-infection modifies the lectin binding pattern in the reproductive system of heifers. Modifications in glycoconjugates may be involved in failures of fertility and/or implantation.

Primary Campylobacter jejuni infection in different mice strains

Campylobacter jejuni is one of the most frequent causes of diarrhoea in man. Extra-intestinal manifestations may also occur, particularly in immunocompromised individuals. However, because of the lack of appropriate animal models the pathophysiology and immunological response of the host to C. jejuni infection are still poorly understood. In our laboratory an experimental infection of adult BALB/c, C57BL/6 and DBA/2 mice has been established. After intraperitoneal injection of 0.5-1x10(9) cfu of C. jejuni none of the infected mice showed clinical symptoms of illness, but bacterial spreading and tissue invasion were achieved. We have concentrated our studies on the duration of primary infection, recovery of bacteria from livers and spleens of infected animals and pathohistological changes of these organs. Our results showed differences in the course of systemic infection among the tested mice strains. BALB/c mice were most sensitive, resulting in the most pronounced pathohistological changes in the examined organs. The duration of the primary liver infection was the longest in BALB/c mice while the duration of the splenic infection also differed among the tested mice strains. Nevertheless, the experimental model used in this study can be efficiently used in further analysis of the pathogenesis of this bacterial infection. However, the strain differences should be taken into account depending on the parameters to be followed.

Infected subdural effusion associated with resolving subdural hematoma--case report

A 70-year-old male presented with rapid neurological deterioration and fever 3 months after suffering a closed head trauma. He underwent craniotomy for possible subdural empyema based on computed tomography and clinical findings. Dural incision revealed an outer membrane typical of chronic subdural hematoma which covered a clear, yellowish fluid containing Campylobacter fetus. Histological examination confirmed the capsule of the hematoma, with a necrotic focus infiltrated by neutrophils. Administration of intravenous imipenem and topical tobramycin and cefalothin achieved total resolution of his neurological deficits. Development of the infected subdural effusion was probably secondary to bacterial infection in the pre-existing chronic subdural hematoma in the resolving stage. The presence of the hematoma capsule always carries the risk of development of an infectious focus.

Histological and bacteriological evaluation of digital dermatitis in cattle, with special reference to spirochaetes and Campylobacter faecalis

Tissue samples from the feet of slaughtered cattle exhibiting different stages of digital dermatitis were sectioned and stained with haematoxylin and eosin and silver staining techniques. Three morphological variations of spirochaetes were observed, whereas control samples from feet which were macroscopically negative for digital dermatitis were also negative for spirochaetes. In an immunofluorescence test, Campylobacter faecalis was found to be abundant on superficial wound smears from the classical ulceration of digital dermatitis.

Intracellular Campylobacter-like organisms associated with rectal prolapse and proliferative enteroproctitis in emus (Dromaius novaehollandiae)

Rectal prolapse was the presenting clinical finding in a group of juvenile emus (Dromaius novaehollandiae). Gross findings included severely thickened and rugose distal rectal mucosae. Histologically, there were thickened villi, enterocyte hyperplasia, dilated glands filled with mucus and heterophils, and a dense infiltrate of heterophils, macrophages, lymphocytes, and plasma cells in the lamina propria. Examination of Warthin-Starry silver-stained sections revealed numerous apically located comma-shaped intracytoplasmic bacteria approximately 1 x 3 microns in size. Campylobacter-like organisms morphologically compatible with ileal symbiont intracellularis now known as Lawsonia intracellularis were seen via electron microscopy. Bacteria were further characterized by indirect immunofluorescence using monoclonal antibody specific for the 25-27-kd outer membrane protein of L. intracellularis.

Seasonality of thermophilic Campylobacter populations in chickens

The small intestines and caeca of chickens were monitored for seasonal variation of thermophilic campylobacters over a 12-month period. There was a significant seasonal fluctuation in the carriage rate which correlated with the following environmental parameters: sunshine hours (P = 0.0003) and minimum (P = 0.007) and maximum temperatures (P = 0.003). The number of campylobacters in the small intestine and caeca also showed significant seasonal variation (P = 0.0008); however, the periodicity in the caeca was significantly different from that in the small intestine (P = 0.007). The numbers of Campylobacter in the caeca were significantly higher than those in the small intestine (P = 0.001). No significant correlation was found between the numbers of campylobacters in the caeca and small intestines and the environmental parameters monitored.

Comparative histopathology of intestinal infections

Intestinal infections are characterized by a range of histologic changes. Some examples (moving progressively deeper into the tissue from the intestinal lumen) are: 1) Enterotoxigenic E. coli infections are characterized by layers of E. coli adherent to villous epithelium, usually with little or no apparent structural damage to the mucosa. 2) The term enteropathogenic E. coli infection designates a disease characterized by E. coli attached intimately to the epithelial cell surface membrane with effacement of brush border microvilli. 3) Rotavirus infections are characterized by destruction of villous epithelial cells. Parvovirus infections are characterized by destruction of crypt epithelial cells. 4) Some intracellular infections with Campylobacter-like organisms are characterized by epithelial cell hyperplasia. 5) Hemorrhagic colitis in humans, caused by enterohemorrhagic E. coli strains, is characterized by mucosal hemorrhage and edema indicative of vascular necrosis. 6) Most of these lesions are accompanied by some degree of inflammation. Neurophils and lymphocytes mediate some of the structural and functional changes characteristic of these infections. Some changes are mediated directly by microbial products. Additional examples of the complexity of these diseases are: 1) Edema disease of swine is characterized both by adherent E. coli and vascular necrosis (each process mediated by a different bacterial virulence attribute). 2) Rotavirus infections are characterized both by destruction of villous epithelial cells and compensatory hyperplasia of crypt epithelial cells. 3) There is suggestive evidence that enterohemorrhagic E. coli infections may involve: a) destruction of epithelial brush border by attaching-effacing E. coli, b) neutrophil mediated epithelial cell destruction, c) Shiga-like toxin mediated epithelial cell destruction and d) Shiga-like toxin mediated vascular necrosis which in turn causes ischemic damage to epithelium.

Isolation of paramyxovirus serotype 7 from ostriches (Struthio camelus)

Paramyxovirus serotype 7 (PMV-7) was isolated from pooled intestinal contents of two 5-month-old ostriches (Struthio camelus). The pathogenicity of the virus was comparable with lentogenic strains of Newcastle disease virus (PMV-1) in chicken and chicken embryo pathogenicity tests. The relationship of the virus to the observed pathology of proliferative nonsuppurative enteritis is unknown; the Campylobacter jejuni isolated was presumably the primary pathogen. To our knowledge, this is the first report of an isolation of PMV-7 from ostriches.

Experimental Campylobacter jejuni infection in the chicken: an animal model of axonal Guillain-Barré syndrome

OBJECTIVE

To develop and characterise an animal model of paralytic neuropathy after Campylobacter jejuni infection. Campylobacter infection precedes development of many cases of Guillain-Barré syndrome and is particularly associated with cases having prominent axonal degeneration. Understanding the pathogenesis of Guillain-Barré syndrome after C jejuni infection has been slowed by the lack of animal models.

METHODS

A spontaneous paralytic neuropathy is described that developed in chickens from the farms of four patients with Guillain-Barré syndrome. The production of paralytic neuropathy in chickens experimentally fed Campylobacter jejuni isolated from one of these patients is reported. The sciatic nerves of the spontaneously paralysed chickens were examined pathologically in teased fibres, in plastic embedded sections, and by electron microscopy. Two large groups of chickens were then fed cultures of a C jejuni (Penner type O:19) isolated from one of these patients.

RESULTS

The chickens with spontaneous paralysis had pathologically noninflammatory neuropathy. Pathology in the sciatic nerves ranged from no detectable changes to severe Wallerian-like degeneration. In the experimentally inoculated groups, an average of 33% of the chickens became paralysed. The median time after inoculation to paralysis was 12 days. The lesions found in the first few days of paralysis included nodal lengthening and paranodal demyelination. In those animals that survived for several days after onset of weakness, the pathology was dominated by extensive Wallerian-like degeneration. Animals that survived for weeks with no clinically apparent neuropathy had paranodal remyelination in some teased nerve fibres, reflecting earlier paranodal demyelination.

CONCLUSION

Experimental inoculation with C jejuni may provide a new model for understanding some forms of Guillain-Barré syndrome.

Infection of cesarean-derived colostrum-deprived 1-day-old piglets with Arcobacter butzleri, Arcobacter cryaerophilus, and Arcobacter skirrowii

Neonatal piglets have been used as models to study human campylobacteriosis and helicobacteriosis. The purpose of this study was to determine the relative pathogenicities, on the basis of the duration of fecal shedding and colonization of tissues, of three Arcobacter species in 1-day-old cesarean-derived colostrum-deprived piglets. Two experiments were conducted. In experiment 1, two piglets each were infected per os with either Arcobacter butzleri ATCC 49616, Arcobacter cryaerophilus 1B ATCC 43159, Arcobacter skirrowii CCUG 10374, or the three field strains of A. butzleri (approximately 5 X 10(9) CFU per piglet). Rectal swab samples were taken prior to infection and daily thereafter for up to 7 days. Arcobacter spp. were detected at least once in rectal swab samples of all but one of the experimentally infected piglets but not in the control. At necropsy, A. butzleri was recovered from the lung, kidney, ileum, or brain tissues of the four infected piglets which had received either the field strain or the ATCC type strain of A. butzleri. A. cryaerophilus 1B was detected in rectal swab samples for up to 7 days postinfection but was not cultured from tissues at necropsy. Arcobacters were detected in the rectal swab sample of the A. skirrowii-infected piglet only on day 3 postinfection; no isolates were obtained from tissues at necropsy. No gross pathological lesions were consistently noted in the experimentally infected piglets. In experiment 2, two piglets each were infected per os with A. butzleri ATCC 49616, A. cryaerophilus 1A ATCC 43158, A. skirrowii CCUG 10374, or the single A. butzleri field strain Yard J/c (approximately 5 X 10(9) CFU per piglet). Arcobacter spp. were cultured from rectal swab samples of all but one of the experimentally infected piglets at least once. At necropsy Arcobacter spp. were cultured from the liver, kidney, ileum, or brain tissues of two of the four A. butzleri-infected piglets. However, no severe gross pathology was noted. These data suggest that Arcobacter spp., especially A. butzleri, can colonize neonatal pigs.

Experimental hepatitis induced by Campylobacter jejuni infection in Japanese quail (Coturnix coturnix japonica)

To establish an experimental model for vibrionic hepatitis caused by Campylobacter jejuni, Japanese quails (Coturnix coturnix japonica) were inoculated with C. jejuni strains isolated from chicken hepatitis (BL107) and human diarrhea (HP5113). Necrotic liver lesions were formed by intra-pancreaticoduodenal vein injection by which the bacteria reached the liver directly via the portal vein, but not by intra-gastric infection. These liver lesions were observed from day 1 to 7 after the infection. The pathological changes were weak and no clinical signs were observed throughout the experimental period. By immunohistochemistry, the bacterial antigens were detected in the hepatocytes, and intercellular spaces between the hepatocytes, and in the macrophages during the early stage of the infection. When focal hepatocyte necrosis was formed, the antigen was detected more frequently in the intact hepatocytes at the periphery of the lesions than within necrotic foci. The bacteria were not detected from the liver, spleen or blood according to raising the serum agglutination titer. In contrast, the bacteria immediately invaded the bile in 5 min post-infection and were retained in the gallbladder for long periods. The present study showed that necrotizing hepatitis was formed by intra-pancreaticoduodenal vein infection of the quail with C. jejuni.

Pathology of the motor-sensory axonal Guillain-Barré syndrome

The concept of a severe motor-sensory neuropathy of acute onset caused by an immune attack on the axon ("axonal" Guillain-Barré syndrome) has been advanced primarily based on electrodiagnostic and limited pathological data, but remains controversial. At autopsy some cases demonstrate unusually severe inflammatory demyelinating neuropathy. There are conflicting data about whether antecedent Campylobacter jejuni infection is associated with "axonal" Guillain-Barré syndrome. We report 4 individuals from Hebei Province, China, who died 7, 7, 18, and 60 days after onset of a syndrome diagnosed clinically as Guillain-Barré syndrome. High titers of antibodies recognizing C. jejuni, consistent with recent infection, were found in the 2 patients tested. At autopsy the 3 with early disease had ongoing wallerian-like degeneration of fibers in the ventral and dorsal roots and in the peripheral nerves, with only minimal demyelination or lymphocytic infiltration. All 3 had numerous macrophages in the periaxonal space of myelinated internodes, and rare intraaxonal macrophages as well. Examination of the patient having the syndrome for 60 days confirmed the extensive loss of large fibers in the spinal roots and nerves, and the paucity of demyelination and remyelination. These observations confirm predictions that some patients with severe motor-sensory Guillain-Barré syndrome, as defined clinically, have predominantly axonal lesions of both motor and sensory fibers, even in the early stages of the disease, and that axonal Guillain-Barré syndrome can follow C. jejuni infection. The pathology supports the possibility that such cases of motor-sensory axonal Guillain-Barré syndrome represent the most severe end of a spectrum of immune attack directed toward epitopes on the axon.

[Septic abortion in Campylobacter jejuni infection]

Case report of a 24 year old woman II G/I P with enterocolitis and septicaemia caused by Campylobacter jejuni (C.) in the following time abortion at 16 weeks of gestation. Diagnostics, therapy, review of literature.

[Acute Campylobacter colitis]

Biopsies of colon mucous membrane obtained at colonofibroscopy of 16 adult patients with colon campylobacteriosis were studied. Acute diffuse colitis was found in all cases. Exudative inflammation with hemorrhagic component and microerosion formation was found up to day 10 of the disease. Catarrhal inflammation was observed from day 10-16 during the period of convalescence. Abundant infiltration of tunica propria with eosinophylic leucocytes is a peculiar feature of colon campylobacteriosis. This, together with a diffuse character of inflammation, makes a difference with Shigella colitis. Complete normalization of the mucosa does not occur within 16 days.

Campylobacter jejuni enterocolitis causing peritonitis, ileitis and intestinal obstruction

Patients with Campylobacter enterocolitis may come to laparotomy due to the severity of abdominal symptoms and signs, although only two patients with intestinal inflammation have been described and in neither was the histopathology documented. A case of a 52-year-old male who had a typical diarrhoeal illness of Campylobacter enterocolitis diagnosed on stool culture is reported. Despite appropriate treatment he developed signs and symptoms consistent with small intestinal obstruction. Laparotomy revealed peritonitis and thickened distal ileum with transmural inflammatory changes on histopathology. These changes were shown to have completely resolved at a second laparotomy, required for persistent obstruction due to adhesions. Recurrent adhesions culminated in a third laparotomy. The clinical, operative and histopathological findings may be confused with Crohn's disease.

Granulomatous enteritis and Campylobacter bacteremia in a horse

A 10-month-old Standard-bred colt was examined because of weight loss, fever, and extensive subcutaneous edema of the ventral aspects of its trunk. Diagnosis of granulomatous enteritis was based on D-xylose malabsorption, hypoproteinemia, and rectal mucosal biopsy. Campylobacter fetus subsp fetus was cultured from jugular venous blood when the horse was admitted to the hospital and 24 hours later. Appropriate antimicrobial agents and glucocorticoids failed to effect clinical remission. After euthanasia, granulomatous enteritis was confirmed at necropsy but C fetus subsp fetus was not isolated from tissues.

Newborn piglet model for campylobacteriosis

An in vivo model system for human campylobacteriosis has been developed in which colostrum-deprived newborn piglets are orally challenged with an invasive strain of Campylobacter jejuni. Piglets developed clinical symptoms and histopathological lesions similar to those observed in humans infected with C. jejuni. Gross lesion examination at autopsy revealed the presence of edema, hyperemia, and mucus. Histopathologic examinations by light and transmission electron microscopy demonstrated damage to surface epithelial cells with the presence of intracellular bacteria, mainly in the large intestine. Similar lesions were not demonstrated in control piglets.

Early colonic damage and invasion of Campylobacter jejuni in experimentally challenged infant Macaca mulatta

Experimental challenge studies with Campylobacter jejuni were conducted in 3.5-month-old infant Macaca mulatta. One infant monkey (92-1) was challenged with 2.7 x 10(10) cfu of strain 78-37. A second infant was infected intentionally by natural transmission. The infants developed diarrhea 32 h after challenge of infant 92-1. Electron microscopic observations indicate that cell invasion is the primary mechanism of colon damage and diarrheal disease caused by C. jejuni. Intracellular C. jejuni were located in membrane-bound vacuoles and were free in the cytoplasm. Damaged epithelial cells exhibited premature apoptosis and were exfoliated into the lumen of the colon. C. jejuni were also located extracellularly in the mucosa and submucosa. Some cells had dilated endoplasmic reticulum, indicating possible alteration in ion and water transport.

Pathological changes in the rabbit ileal loop model caused by Campylobacter jejuni from human colitis

Four strains of Campylobacter jejuni isolated from children with inflammatory diarrhoea were assayed in the rabbit ileal loop model of infectious diarrhoea. All caused inflammatory reactions with severe macroscopic and microscopic damage in infected rabbit ileal tissue similar to that observed in the patients by endoscopy and histological analysis of colonic biopsies. Haemoglobin and other proteins were observed in loop fluids, consistent with leakage of serum from damaged mucosa. Loop fluids also contained significant bicarbonate concentrations, indicative of an active secretory component similar to that in control loops inoculated with cholera toxin. However, although three of the four clinical strains produced small amounts of a protein immunologically related to cholera toxin in vitro, none such was detected in either tissues or fluids of infected ileal loops. We propose instead that host-derived mediators of secretion may be important in pathogenesis. A mutant strain of C. jejuni with impaired motility, obtained from the National Collection of Type Cultures, did not induce tissue damage or fluid secretion in rabbit ileal loops.

Salmonella, Campylobacter and Shigella in HIV-seropositive patients

OBJECTIVE

To study the incidence, clinical features, treatment and outcome of patients with Salmonella, Shigella or Campylobacter infection.

DESIGN

Retrospective analysis.

SETTING

Two dedicated HIV units within a London teaching hospital.

METHODS

All patients with Salmonella, Shigella or Campylobacter infection were reviewed retrospectively by correlating the records of the gastrointestinal and microbiology departments with the computerized records of all HIV-positive patients attending the two clinics.

RESULTS

Between July 1985 and June 1991, 56 episodes of Salmonella, 37 of Campylobacter and eight of Shigella infection were documented in HIV-seropositive patients. Shigella was most likely to occur early in HIV disease, whilst patients with Campylobacter or Salmonella were more likely to have had a previous AIDS diagnosis. Septicaemica was most common in patients with Salmonella and was especially likely to occur in individuals with an AIDS diagnosis. Relapse of infection was common in patients with Salmonella, especially in those with low CD4 lymphocyte counts, those with an initial septicaemic illness and those not treated with ciprofloxacin.

CONCLUSIONS

Patients with Salmonella who have low CD4 lymphocytes counts and/or a septicaemic illness should be considered for life-long secondary prophylaxis with ciprofloxacin because of the high rate of relapse observed. Administration of zidovudine or cotrimoxazole as prophylaxis against Pneumocystis carinii pneumonia may prevent the development of salmonellosis: significantly fewer patients with this infection were taking these drugs than patients with Campylobacter.

Mononuclear cell response in the liver of mice infected with hepatotoxigenic Campylobacter jejuni

Intragastric inoculation with hepatotoxigenic strains of Campylobacter jejuni led to the death of mice during the late phase of infection. Histological study disclosed a massive infiltration of mononuclear cells in the liver, mimicking intrahepatic hypersensitivity. Neither enterotoxigenic nor enteroinvasive Escherichia coli induced such a lesion. However, the same histopathological change was induced by injecting the hepatotoxic factor of hepatotoxigenic C. jejuni intravenously on two occasions separated by 14 days. Neither a single injection of an increased dose of the hepatotoxic factor nor two injections, the second of which was heat-inactivated, induced this change. Pre-treatment with rabbit antibody to the hepatotoxic factor inhibited the development of the hepatic lesion. These results suggest that C. jejuni-induced hepatic lesions in mice may be caused, at least in part, by the active moiety of the hepatotoxic factor. The possible mechanisms by which the toxic factor induces hepatitis as a consequence of hypersensitivity are discussed in relation to Guillain-Barré syndrome and Reiter's syndrome associated with C. jejuni enteritis.