Guillain-Barre syndrome and Campylobacter jejuni infection. A study on the etiological characteristics of Guillain-Barre syndrome in China

Fecal culture for Campylobacter jejuni with the method of Skirrow and serum class specific antibodies (IgG, IgM, IgA) against Campylobacter jejuni using a solid phase enzyme linked immunosorbent assay were performed in 17 cases of Guillain-Barre Syndrome, 17 other neurological disease controls, and 33 normal controls. The results revealed: 1. the incidence of Campylobacter jejuni infection, especially the recent one in Guillain-Barre Syndrome was much higher than in the other two groups; 2. the recent incidence of infection in those below 30 years old and those within the period of summer and autumn was higher than that above 30 years old and that in the other seasons. The results suggested that Campylobacter jejuni infection might be one of the important precipitating factors of Guillain-Barre syndrome and might play an important role in the epidemiological pattern of Guillain-Barre Syndrome in China.

[Five cases of Campylobacter jejuni enteritis accompanied with Guillain-Barré syndrome]

17 cases of Guillain-Barré syndrome (GBS) were admitted to The First Hospital of Beijing Medical University and Baoding Hospital from July, 1991 to October, 1992. Five patients had diarrhea before the onset of GBS and showed positive reaction for serum IgM antibodies to Campylobacter jejuni. They were considered to have Campylobacter jejuni enteritis as well. This incidence of Campylobacter jejuni enteritis in GBS patients was higher than in those with other neurological diseases and in normal controls. These five patients were all from countryside and had their onset in the summer and autumn. Moreover, four of them were below twenty-four years old. The epidemiological pattern was quite similar to that of Campylobacter jejuni enteritis in China. Our data showed the close association between GBS and Campylobacter jejuni enteritis and the possible mechanism was discussed.

[A case of Campylobacter fetus subspecies fetus meningitis]

A 40-year-old male with no history of underlying disease was admitted to Hokusho Central Hospital on May 25, 1991, complaining of high fever and headache. Physical examination on admission revealed a temperature of 38.5 degrees C, a pulse rate of 84 beat/min (relative bradycardia) and no abnormal findings for the chest or abdomen. Slight neck stiffness without Kernig's sign was observed at neurological examination. Laboratory data were: ESR 11 mm/lh, WBC 12000/mm3, C-reactive protein positive. Lumbar puncture showed an initial pressure of 230 mmH2O; CSF revealed a cell count of 2633/3 mm3 with mononuclear pleocytosis, total protein of 76 mg/dl and sugar of 54 mg/dl (CSF:blood glucose ratio 0.47). We initially suspected tuberculous or cryptococcal meningitis, but Campylobacter fetus subsp. fetus (C. fetus) was isolated from the CSF and venous blood on the 27th hospital day. IPM/CS 1 g/day, MINO 200 mg/day and FOM 4 g/day were intravenously administered. This antibiotic therapy was very effective: the patient was soon afebrile, and gradually all signs and symptoms were resolved. C. fetus was sensitive to IMP/CS, MINO, KM, GM, EM, OFLX, CP. The patient was discharged with no complication. He has eaten raw beef frequently before admission, but stool culture for C. fetus was negative.

[Hematologic manifestations in Campylobacter coli septicemia. Apropos of a case]

We report the case of a 71-year old male patient with a chronic lymphoid leukaemia of 10 years' duration who abruptly suffered deterioration of this general condition and haematological disturbances suggesting worsening of this blood disease (Richter's syndrome). Blood cultures demonstrated a Campylobacter coli septicaemia. Treatment with antibiotics resulted in a return to the previous clinical and biological situation. The various visceral manifestation of the infection are discussed.

[Detection of Campylobacter species by using polymerase chain reaction and nonradioactive labeled DNA probe]

We have detected Campylobacter species which are now recognized as major pathogens of acute diarrheal disease in humans using polymerase chain reaction (PCR) and a nonradioactive labeled DNA probe. Diagnosis of Campylobacter enteritis without doing culture from stool samples is of great benefit in the laboratory. Two oligonucleotide primers (20 mer) complementary to a unique sequence of the DNA encoding ribosomal RNA (rRNA) of Campylobacter jejuni for PCR were synthesized by solid-phase phosphoamidite method. Amplified target DNA of 275 base pairs could be resolved on ethidium bromide-stained gels, and hybridized with an oligodeoxynucleotide probe (28 mer) conjugated to alkaline phosphatase. In identification experiments, it was shown that the nonradioactive probe was hybridized to clinical strains of C. jejuni (104), C. coli (5), C. laridis (5), C. hyointestinalis (1) and C. fetus subsp. fetus (1) with an accuracy of 99-100%, while it was not for Helicobacter pylori. Further, there was no evidence of amplification in strains of K. pneumoniae, S. marcescens and E. coli. Using direct detection to stool specimens, this method could be performed in C. jejuni in 39 of 43 culture-positive specimens (91%), and in 19 of 141 culture-negative specimens (13.5%), respectively. The results of this comparative study suggested that the DNA probe assay became a rapid and reliable technique to confirm culture of Campylobacter species.

A case of intrauterine fetal death associated with maternal Campylobacter coli bacteraemia

Campylobacter species are known to cause infectious abortion in domestic animals. In humans, Campylobacter are an important cause of enteritis, an occasional cause of systemic infection and have had a rare association with abortion and perinatal infection. A case history of spontaneous abortion, at 26 weeks' duration, associated with maternal bacteraemia, due to Campylobacter coli is presented. Transmission, pathogenesis, treatment, and the need for further investigation are discussed.

Neonatal Campylobacter fetus meningitis: a report of an unusual case

Campylobacter fetus is a rare cause of meningitis in the pediatric age group and, in particular, among neonates. The clinical presentation of campylobacter meningitis in high-risk neonates is not well-described. A review of campylobacter meningitis by Lee et al in 1985 reported nine cases occurring in neonates, of which only one case was caused by C. fetus. In the ensuing six years only three more confirmed cases of neonatal meningitis caused by C. fetus have been reported. We here report another confirmed case of C. fetus meningitis in a neonate.

Pyogenic arthritis of the hip due to Campylobacter fetus--a case report

Septic arthritis of the hip caused by Campylobacter fetus subsp. fetusis very rare. The authoris isolated C. fetus subsp. fetus from a specimen of the left hip. The patient was a 53-year old man with a history of heavy drinking, diabetes, and chronic hepatitis, and had been suffering from avascular necrosis of both femoral heads. It was considered that the organism invaded already damaged tissue of the joint. The patient was treated with intravenous antibiotics and later received successful total hip replacement.

Campylobacter spondylodiscitis and deficiency of cellular immunity

We describe a case of spondylodiscitis caused by Campylobacter fetus in a previously healthy patient. This is the first report of this agent causing discovertebral infection, which generated cellular immune deficiency, reversible with the cure.

Electron microscopic appearance of the chronic Campylobacter jejuni enteritis of mice

Campylobacter jejuni is a major cause of human enteritis which mimics the inflammatory bowel disease (IBD). In this study, microstructural changes on the surfaces of the murine gastrointestinal tract persistently colonized by Campylobacter jejuni, strain GJ-S131, were investigated by using scanning electron microscopy (SEM) and transmission electron microscopy (TEM). The results revealed that the appearance of the gastrointestinal mucosa in both BALB/C and KM mice resembled that in human with inflammatory bowel disease. Under SEM, the mucosa of the jejunum and ileum, with broken or distorted villi had a "worm eaten" look; crypts were irregular in shape and size, and the mucosa showed atrophy, especially in the colon. Epithelial junctions demonstrated furrows, clefts or deep crevasses, with exudates containing a large number of leukocytes. Cytologic appearances were characterized by microvilli dysplasia and/or atrophy, patchy erosions or necrosis and pelade-like appearance due to absence of microvilli, which were similar to the findings under TEM.

[Campylobacter enterocolitis complaining of melena]

A 38-year-old man was admitted to our hospital complaining of 5 episodes of melena without abdominal pain or diarrhea. No abnormalities were noted through an upper gastrointestinal endoscopy, but a proctoscopy revealed a large amount of coagulated blood within the rectum immediately before his admission. A colonoscopy revealed spotty redness with dark-red coagulation in the region from the splenic flexure down to the rectum except oral colon beyond the transverse colon. A presumptive diagnosis of campylobacter enterocolitis was made by a microscopy performed on the stool specimen, then an oral administration of erythromycin was started. A colonoscopy done on the 5th hospital day proved improvement on the mucosal changes. The final diagnosis of campylobacter enterocolitis was made by the stool culture. The patient took a satisfactory course of hospitalization and was discharged on the 10th day. Bacteriological examination of stool specimen together with endoscopy has been confirmed to be useful for the diagnosis of melena cases without manifestation of infectious enterocolitis.

Surveillance of patients attending a rural diarrhoea treatment centre in Bangladesh

In May 1983, a surveillance system was set up at a rural diarrhoea treatment centre of the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B) to study a 20% systematic sample of all admissions. Between May 1983 and April 1984, 2,635 patients were studied. A recognized enteric pathogen was detected in 69% of the patients screened, 15% of whom had a mixed infection. Vibrio cholerae 0: 1 was the most common enteropathogen detected (39%), followed by enterotoxigenic Escherichia coli (ETEC) (14%), Shigella spp. (11%), and Campylobacter jejuni (11%). Detection of C. jejuni was highest in infants, Shigella spp. in children between 1-4 years and V. cholerae 0:1 in children between 3-9 years of age. 75% of patients presented with watery diarrhoea, a presentation that was significantly more common in patients infected with V. cholerae 0:1 (94%) and ETEC (88%). Bloody diarrhoea was the presenting complaint in 18% of all patients, but in 65% of patients in whom Shigella spp. was isolated. Although 91% of patients reported that they had prior experience of use of oral rehydration therapy (ORT), 54% of the patients came to the treatment centre with no or mild dehydration and more than half of them did not use ORT before coming to the treatment centre. Most of these patients could have been safely treated at home if ORT could be made available and acceptable.

[Campylobacter fetus ssp fetus septicemia associated with a colonic abscess]

Campylobacter is considered to be an opportunistic agent. The authors relate an unusual case with Campylobacter fetus ssp fetus (CF) septicemia and colic abscess. Human Campylobacteriosis is presumed to be a food-born disease related to contaminated animal products such as milk or meat. In some cases CF may be transmitted by drinking water or by fecal soiling via the hands. Conventional treatment uses macrolides with decrease the duration of diarrhea and reduce the fecal excretion of CF. Macrolides are ineffective in CF septicemias. In such cases aminoglycosides seem to be the drug of choice.