Shock and tuberculous enteritis in a non-HIV infected healthy man

We reported a case of shock, diarrhea and tuberculous enteritis in a previously healthy 32-year-old non-HIV infected man. This case presented initially with acute profuse watery diarrhea. The bacterial and virus cultures were negative. Tuberculous enteritis was diagnosed by detecting Mycobacterium tuberculosis on stool culture 52 days after presentation. The symptoms resolved after treatment with intravenous fluids and corticosteroids but was treated with anti- tuberculous medication. Tuberculous enteritis should be included in the differential diagnosis of patients with enteritis and shock.

Mechanism of bactericidal activity of microcin L in Escherichia coli and Salmonella enterica

For the first time, the mechanism of action of microcin L (MccL) was investigated in live bacteria. MccL is a gene-encoded peptide produced by Escherichia coli LR05 that exhibits a strong antibacterial activity against related Enterobacteriaceae, including Salmonella enterica serovars Typhimurium and Enteritidis. We first subcloned the MccL genetic system to remove the sequences not involved in MccL production. We then optimized the MccL purification procedure to obtain large amounts of purified microcin to investigate its antimicrobial and membrane properties. We showed that MccL did not induce outer membrane permeabilization, which indicated that MccL did not use this way to kill the sensitive cell or to enter into it. Using a set of E. coli and Salmonella enterica mutants lacking iron-siderophore receptors, we demonstrated that the MccL uptake required the outer membrane receptor Cir. Moreover, the MccL bactericidal activity was shown to depend on the TonB protein that transduces the proton-motive force of the cytoplasmic membrane to transport iron-siderophore complexes across the outer membrane. Using carbonyl cyanide 3-chlorophenylhydrazone, which is known to fully dissipate the proton-motive force, we proved that the proton-motive force was required for the bactericidal activity of MccL on E. coli. In addition, we showed that a primary target of MccL could be the cytoplasmic membrane: a high level of MccL disrupted the inner membrane potential of E. coli cells. However, no permeabilization of the membrane was detected.

[Clostridium difficile-induced necrotizing enteritis]

BACKGROUND

Clostridium difficile infection usually manifests as pseudomembranous colitis. Infection of the small intestine is rare. C. difficile enteritis has a high mortality rate due to secondary enteric necrosis and perforation.

CASE DESCRIPTION

We describe an 87-year-old woman with abdominal pain, who died from necrotizing enteritis due to a C. difficile infection. This is the first described case of small bowel involvement in the absence of known risk factors for C. difficile enteritis, i.e. bowel surgery and recent use of antibiotics. The described patient was using immunosuppressants, which in this case could have been a risk factor for small bowel colonization with C. difficile.

CONCLUSION

In clinical practice it is important to be prepared for C. difficile infection, as early treatment of this infection will strongly improve the prognosis. Identification of patients at an increased risk of C. difficile infection is of great value in this respect.

Cross-reactive epitopes present in campylobacter jejuni serotypes isolated from enteritis patients

Campylobacter jejuni (C. jejuni) infection frequently triggers autoimmune-mediated neuropathies, especially the Guillain-Barre syndrome (GBS). The molecular mimicry between the core oligosaccharides of bacterial lipopolysaccharides (LPSs) and the human gangliosides presumably results in the production of anti-neural cross-reactive antibodies which are likely to be a contributory factor in the induction and pathogenesis of GBS. The aim of our study was to determine the presence of cross-reactive epitopes in C. jejuni LPSs isolated from enteritis patients and to determine their antigen reactivity. For that purpose we collected stool specimens from 21 patients with enteritis and without neurological symptoms. Seven different serotypes of C. jejuni (0:27; 0:6/0:7; 0:38; 0:3; 0:1/0:44; 0:19; 0:37) were detected using the Penner system. Unexpectedly, one serotype from this group was detected as 0:19, a serotype rarely isolated from enteritis patient and in close association with GBS. Binding studies using cholera toxin-B subunit and peanut agglutinin, showed the presence of ganglioside-like epitopes in C. jejuni strains 0:37, 0:19 and 0:27. Reactivity with sera from patient with GBS, with confirmed previous exposure to C. jejuni and with high a titre of anti-ganglioside antibodies, showed that the same three LPSs from C. jejuni serotypes 0:37, 0:19 and 0:27 bear cross-reactive epitopes in their LPSs structures. Our results confirm the results from previous studies that LPSs from certain C. jejuni serotypes bear cross-reactive ganglioside-like epitopes which might be involved in the induction of GBS after C. jejuni infection.

Acute postinfectious glomerulonephritis associated with Campylobacter jejuni enteritis - a case report and review of the literature on C. jejuni's potential to trigger immunologically mediated renal disease

Kidney disease is a rare complication of Campylobacter jejuni (C. jejuni) enteritis. We here present the case of an 18-year-old male patient with crampy abdominal pain, vomiting, diarrhea, and fever. Three weeks later urinalysis revealed mild proteinuria and hematuria and a marked raise in serum creatinine was observed. Renal biopsy demonstrated acute endocapillary glomerulonephritis with mesangial IgM (immunoglobuline M) deposits. Extensive workup revealed no signs of skin or joint disease, thus excluding Henoch-Schönlein purpura. Due to persistent abdominal discomfort further gastro-enterological tests were performed and eventually Campylobacter jejuni was isolated from the patient's feces. In the absence of other precipitating factors for renal diseases we presumed an association between the bacterial infection and this postinfectious glomerulonephritis. Over a time period of 6 months the patient's kidney function normalized completely. However, long-term prognosis remains unclear. In addition to the case report, we conducted a review of the literature with results underlining Campylobacter jejuni's potential to trigger various types of immune mediated kidney diseases.

Comparison of premier CAMPY enzyme immunoassay (EIA), ProSpecT Campylobacter EIA, and ImmunoCard STAT! CAMPY tests with culture for laboratory diagnosis of Campylobacter enteric infections

Campylobacter enteritis is a food-borne or waterborne illness caused almost exclusively by Campylobacter jejuni and, to a lesser extent, by Campylobacter coli. These organisms produce indistinguishable clinical diseases and together represent the second most common cause of bacterial diarrhea in the United States and the leading cause of enteric infection throughout the world. The conventional approach to the laboratory diagnosis of Campylobacter enteritis is based on the recovery of the organism from a stool specimen, which requires the use of a specialized medium incubated at 42°C for several days in an artificially created microaerophilic environment. Recently, several commercially available enzyme immunoassays (EIAs) have been developed for the direct detection of C. jejuni and C. coli in stool specimens. This study compared conventional culture with three EIA methods, the Premier CAMPY EIA (Meridian Bioscience, Cincinnati, OH), the ProSpecT Campylobacter EIA (Remel, Lenexa, KS), and the ImmunoCard STAT! CAMPY test (Meridian Bioscience, Cincinnati, OH), for the detection of C. jejuni and C. coli in 485 patient stool samples. Discordant results were arbitrated by using an in-house, real-time PCR assay that was developed and validated by a public health reference laboratory. Following analyses of the discrepant specimens by PCR, the sensitivity and specificity of both the Premier CAMPY and ProSpecT Campylobacter EIAs were 99.3% and 98%, respectively, while the ImmunoCard STAT! CAMPY test had a sensitivity of 98.5% and a specificity of 98.2%. By use of the PCR test as the reference standard, culture detected 127 of 135 Campylobacter-positive stool specimens, yielding a sensitivity of 94.1%. These results showed that the three EIAs evaluated in this study provide a rapid and reliable alternative for the laboratory diagnosis of enteric infections with C. jejuni and C. coli and that conventional culture may no longer be recognized as the "gold standard" for diagnosis.

Assessment of 2 Salmonella enterica serovar Typhimurium-based vaccines against necrotic enteritis in reducing colonization of chickens by Salmonella serovars of different serogroups

This study assessed the protective efficacy of oral vaccination with 2 experimental attenuated Salmonella Typhimurium-vectored vaccines for necrotic enteritis in protecting chickens against intestinal colonization by common serovars of Salmonella belonging to the 4 major serogroups affecting chickens. Birds were vaccinated orally with 1 × 10⁸ colony-forming units (CFU) of 1 of the vaccine strains χ9241 and χ9352, which express a plasmid-encoded partial recombinant hypothetical protein gene (tHP) of Clostridium perfringens, at days 1 and 7 of age, and then were challenged at 14 d of age with 10⁶ CFU of Salmonella serovars Anatum, Enteritidis, Heidelberg, Kentucky, or Typhimurium (representative serovars of serogroups B, C, D, and E). Birds were necropsied at 4 wk of age, and samples were collected to determine reduction in tissue and intestinal colonization. The chickens vaccinated with χ9241-tHP showed reduced colonization by Salmonella Enteritidis (serogroup D) and by Salmonella Heidelberg and Salmonella Typhimurium (serogroup B) compared with the control birds. No reduction in colonization was observed in the chickens vaccinated with χ9352-tHP. There was an association between the efficacy of these vaccine strains in protecting against necrotic enteritis, assessed on an earlier occasion, and their efficacy in protecting against Salmonella colonization. Thus, the choice of an attenuated Salmonella Typhimurium vaccine vector for delivery of heterologous antigens to chickens should be based partly on the vaccine's value in protecting against colonization by serovars within serogroups B and D. Such vectors would have the additional benefit of reducing colonization of important Salmonella serovars.

Evidence of cell-mediated immune response and specific local mucosal immunoglobulin (Ig) A production against Lawsonia intracellularis in experimentally infected swine

The purpose of this study was to detect cell-mediated and local humoral immune responses to Lawsonia intracellularis in pigs inoculated with a pure culture of the pathogenic isolate or with an intestinal mucosa homogenate. Twenty-four 5-week-old pigs were inoculated with a pure culture of L. intracellularis (n = 10), an intestinal mucosa homogenate from proliferative enteropathy diseased pigs (n = 10), or a control solution (n = 4). All animals were bled 0, 7, 14, and 20 d post-inoculation (pi). Serum was tested for immunoglobulin (Ig) G against L. intracellularis and for the production of interferon (IFN)-gamma by peripheral blood mononuclear cells (PBMC) after inoculation with L. intracellularis total proteins. Delayed-type hypersensitivity (DTH) reactions were evaluated 24 and 48 h after intra-dermal injection of different concentrations of L. intracellularis antigen 20 d pi. All animals were euthanized on day 22, intestinal lavages of ileum and IgA titrations were done. Weak IFN-gamma production was detected in 1 pig from the pure culture group and 2 pigs from the mucosal homogenate group 14 d pi, and in 2 animals from both groups 20 d pi. All pigs, in both inoculated groups, were seropositive for IgG on day 20. Inoculated pigs from both groups showed very weak dose-dependent DTH reactions, which were more evident at 24 h than 48 h pi. Eight pigs from the pure culture group and 7 from the mucosa homogenate group had detectable IgA titers in the intestinal lavage 22 d pi. In conclusion, specific local intestinal humoral and weak cell-mediated immune responses can be detected in pigs experimentally infected with L. intracellularis.

Non-tuberculous mycobacterial infection localized in small intestine developing after allogeneic bone marrow transplantation

A 33-year-old man with myelodysplastic/myeloproliferative disease underwent allogeneic bone marrow transplantation. Around day 80 post-transplant, he complained of abdominal pain and diarrhea. Colonoscopy and esophagogastroduodenoscopy findings were unremarkable. Double-balloon enteroscopy revealed atrophic villi and mild erosions localized in the small intestine. Histological examination revealed marked proliferation of histiocytes with numerous acid-fast bacilli in their cytoplasm. The specific polymerase chain reaction for Mycobacterium tuberculosis was negative, and a diagnosis of intestinal non-tuberculous mycobacteria (NTM) was made. Physicians should recognize that NTM infection is one of the gastrointestinal infectious complications in immunocompromised patients such as bone marrow transplant recipients, and could localize in the small intestine.

Norepinephrine augments Salmonella enterica-induced enteritis in a manner associated with increased net replication but independent of the putative adrenergic sensor kinases QseC and QseE

Stress has long been correlated with susceptibility to microbial infection. One explanation for this phenomenon is the ability of pathogens to sense and respond to host stress-related catecholamines, such as norepinephrine (NE). In Gram-negative enteric pathogens, it has been proposed that NE may facilitate growth by mediating iron supply, or it may alter gene expression by activating adrenergic sensor kinases. The aim of this work was to investigate the relative importance of these processes in a model in which NE alters the outcome of Salmonella enterica serovar Typhimurium infection. A bovine ligated ileal loop model was used to study the effect of NE on enteritis induced by S. Typhimurium and on the bacterial in vivo replication rate. Mutants lacking putative adrenergic receptor genes were assessed in the loop model, in a calf intestinal colonization model, and in vitro. S. Typhimurium-induced enteritis was significantly enhanced by addition of 5 mM NE. This effect was associated with increased net bacterial replication in the same model. Exogenous ferric iron also stimulated bacterial replication in the medium used but not transcription of enteritis-associated loci. The putative adrenergic sensors QseC and QseE were not required for NE-enhanced enteritis, intestinal colonization of calves, or NE-dependent growth in iron-restricted medium and did not influence expression or secretion of enteritis-associated virulence factors. Our findings support a role for stress-related catecholamines in modulating the virulence of enteric bacterial pathogens in vivo but suggest that bacterial adrenergic sensors may not be the vital link in such interkingdom signaling in Salmonella.

[Toxins of Clostridium perfringens]

Clostridium perfringens is an anaerobic gram-positive spore-forming bacillus. It is one of the pathogens with larger distribution in the environment; it can be isolated from soil and water samples, which also belongs to the intestinal flora of animals and humans. However, on some occasions it can act as an opportunistic pathogen, causing diseases such as gas gangrene, enterotoxemia in sheep and goats and lamb dysentery, among others. In human beings, it is associated to diseases such as food poisoning, necrotic enterocolitis of the infant and necrotic enteritis or pigbel in Papua-New Guinea tribes. The renewed interest existing nowadays in the study of C. perfringens as a veterinarian and human pathogen, together with the advance of molecular biology, had enabled science to have deeper knowledge of the biology and pathology of these bacteria. In this review, we discuss and update the principal aspects of C. perfringens intestinal pathology, in terms of the toxins with major medical relevance at present.

Comparative genotyping of Campylobacter jejuni strains from patients with Guillain-Barré syndrome in Bangladesh

BACKGROUND

Campylobacter jejuni is a common cause of acute gastroenteritis and is associated with post-infectious neuropathies such as the Guillain-Barré syndrome (GBS) and the Miller Fisher syndrome (MFS). We here present comparative genotyping of 49 C. jejuni strains from Bangladesh that were recovered from patients with enteritis or GBS. All strains were serotyped and analyzed by lipo-oligosaccharide (LOS) genotyping, amplified fragment length polymorphism (AFLP) analysis, multilocus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE).

METHODOLOGY/PRINCIPAL FINDINGS

C. jejuni HS:23 was a predominant serotype among GBS patients (50%), and no specific serotype was significantly associated with GBS compared to enteritis. PCR screening showed that 38/49 (78%) of strains could be assigned to LOS classes A, B, C, or E. The class A locus (4/7 vs 3/39; p<0.01) was significantly associated in the GBS-related strains as compared to enteritis strains. All GBS/oculomotor related strains contained the class B locus; which was also detected in 46% of control strains. Overlapping clonal groups were defined by MLST, AFLP and PFGE for strains from patients with gastroenteritis and GBS. MLST defined 22 sequence types (STs) and 7 clonal complexes including 7 STs not previously identified (ST-3742, ST-3741, ST-3743, ST-3748, ST-3968, ST-3969 and ST-3970). C. jejuni HS:23 strains from patients with GBS or enteritis were clonal and all strains belonged to ST-403 complex. Concordance between LOS class B and ST-403 complex was revealed. AFLP defined 25 different types at 90% similarity. The predominant AFLP type AF-20 coincided with the C. jejuni HS:23 and ST-403 complex.

CONCLUSION/SIGNIFICANCE

LOS genotyping, MLST, AFLP and PFGE helped to identify the HS:23 strains from GBS or enteritis patients as clonal. Overall, genotypes exclusive for enteritis or for GBS-related strains were not obtained although LOS class A was significantly associated with GBS strains. Particularly, the presence of a clonal and putative neuropathogenic C. jejuni HS:23 serotype may contribute to the high prevalence of C. jejuni related GBS in Bangladesh.

Detection of beta2 and major toxin genes by PCR in Clostridium perfringens field isolates of domestic animals suffering from enteritis or enterotoxaemia

The production of Clostridium (C.) perfringens toxins in the intestine is an important cause of enteritis and enterotoxaemia in livestock. In the present study, the alpha toxin and the genes encoding beta2 and epsilon toxin could be frequently detected by means of phenotypical and PCR examinations in these bacteria. The C. perfringens isolates originated from 1213 field samples taken from diseased or perished livestock located in the north-eastern administrative districts of Baden-Württemberg (Germany) from 2005 to 2008. The beta2 toxin gene of C perfringens was detected in all animal species examined, comprising pigs, the small ruminants sheep and goats, cattle, horses, rabbits, alpacas and lamas, and fallow deer. Among all the animal species included in this study, pigs attracted attention by a high quota of 74.2% (610 of 822) cpb2-positive C. perfringens isolates in comparison to the other animal species tested, revealing a quota of 20.8% (72 of 346). Beta2 toxigenic isolates could be predominantly cultivated from the faeces of young piglets. The beta toxin gene was detected in isolates from piglets and small ruminants only, amounting to 82.5% (33 of 40) in piglets in combination with the cpb2 gene. In this context, cpb2/cpb-positive C. perfringens isolates of piglets could be clearly detected more often in the intestine of perished animals (18 of 158) than in faeces (15 of 629). Furthermore, cpb2-bearing C. perfringens isolates were detected in cattle, horses, rabbits, alpacas and lamas, and fallow deer to a notable degree. The detection of C. perfringens isolates carrying the epsilon toxin gene was restricted to sheep and goats. Of a total of 242 small ruminants that succumbed to sudden death, 71 (29.3%) harboured epsilon toxin-positive C. perfringens isolates in their intestines. These cases clustered seasonally in the second quarter (April, May, and June) of the year. Neither the isolates bearing the beta2 nor beta toxin gene nor those carrying the epsilon toxin gene showed an annualised accumulation within the sample period. The iota toxin obviously plays a minor role, for in only one case could the encoding toxin gene be detected in an isolate from the intestine of a perished lamb. The need for effective vaccination is discussed, particularly with regard to the beta2 and epsilon toxin. To combat diseases caused by toxin-producing C. perfringens isolates successfully, the implementation of consistent vaccination regimens in combination with controlled feeding is recommended.

Sialylation of Campylobacter jejuni lipo-oligosaccharides is associated with severe gastro-enteritis and reactive arthritis

We used various genotyping methods to identify bacterial genetic markers for development of arthritic symptoms following Campylobacter enteritis. We genotyped a collection of population derived Campylobacter strains, with detailed information on clinical characteristics, including arthritic symptoms. Besides using whole genome screening methods, we focused on the lipo-oligosaccharide (LOS) gene locus in which marker genes for developing post-Campylobacter neurological disease are present. Patients with arthritic symptoms were more frequently infected with Campylobacter jejuni strains with a class A LOS locus. We also found that patients who were infected with a C. jejuni strain containing sialic acid-positive LOS (class A, B or C) more frequently had bloody diarrhoea and a longer duration of symptoms. Furthermore, the IgM antibody response against Campylobacter was stronger in patients with a sialic acid containing LOS. Ganglioside auto-antibodies were observed in a small number of patients following infection with a class C strain. We conclude that sialylation of C. jejuni LOS is not only a risk factor for development of post-infectious symptoms, but is also associated with increased severity of enteric disease.

Pancreas affection in association with enteritis due to Campylobacter fetus ssp. jejuni

A woman with pancreas affection during diarrhoea due to Campylobacter fetus ssp. jejuni is presented. The patient recovered within 8 days without specific treatment. In addition, 5 other cases with pancreas affection associated with Campylobacter infection are cited.

[Choice of probiotic for rational therapy of infection caused by Klebsiella in children]

AIM

To choose lactobacilli-contained probiotic for complex treatment of acute enteric infection caused by Klebsiella in infants.

MATERIALS AND METHODS

On the basis of bacteriological analysis the group consisting of 40 infants with acute enteric infection caused by Klebsiella was formed. Efficacy of three probiotic preparations--lactobacterin, vitaflor, and biobacton--was assessed depending on biological features of causative agents and contents of lactobacilli and bifidobacteria in obligate gut microflora. Intraspecies antagonistic characteristics of manufacturing strains of lactobacilli against 9 clinical isolates of K. pneumoniae and 8 strains of indigenous lactoflora, as well as interspecies antagonism between Klebsiella and probiotic and indigenous strains of lactoflora were studied.

RESULTS

It was shown that complex therapy of Klebsiella infection in infants using vitaflor or biobacton promoted elimination of K. pneumoniae and restoration of indigenous microflora which became apparent in significant increase of titer of lactobacilli. In vitro maximal antagonism to K. pneumoniae was noted for vitaflor, lactobacterin and heteroenzyme autostrains of ill children's lactoflora. Contrantagonism to lactoflora was typical for slowly growing strains of Klebsiella.

CONCLUSION

It is therapeutically rational to use vitaflor, which promotes rapid elimination of infectious agent, in initial phase of acute infection caused by Klebsiella, and biobacton, which increases the titers of indigenous lactoflora, in phase of convalescence.

Acute enteritis associated with pneumococcal bacteremia

We describe an elderly male who had a two day history of fever, abdominal pain and watery loose motions. Clinical examination was positive for abdominal right lower quadrant tenderness and moderate dehydration. Stool examination revealed inflammatory diarrhea. Considering the high prevalence of extended spectrum beta-lactamases (ESBL) producing Gram-negative infections, he was treated with Piperacillin/Tazobactam. Surprisingly, his blood culture which was taken on admission returned positive for Streptococcus pneumoniae after two days, which was coincident with resolution of fever and diarrhea. This patient had no other clinically apparent source of Pneumococcal infection and we believe that he had Pneumococcal enteritis with bacteremia. There are very few reported cases of isolated Pneumococcal enteritis in the literature. Therefore, we report this unusual form of Streptococcus pneumnoniae infection both because of its rarity and its potentially life-threatening but still curable nature.

Evaluation of the humoral immune response and fecal shedding in weanling foals following oral and intra-rectal administration of an avirulent live vaccine of Lawsonia intracellularis

Equine proliferative enteropathy (EPE) caused by Lawsonia intracellularis has recently been recognized as an emerging disease in foals. Whilst the clinical entity, diagnostic evaluation and treatment of affected foals have been well established and described, preventive measures for EPE have remained largely unaddressed. The objectives of this study were to investigate the humoral immune response and onset and duration of fecal shedding in foals after oral and intra-rectal administration of a modified-live vaccine of L. intracellularis. Foals were vaccinated twice, 3 weeks apart, via oral drenching after pre-medication with a proton-pump inhibitor (omeprazole; group 1), intra-rectally (group 2) or orally without any pre-medication (group 3). The health status of the foals was monitored daily, with feces and serum collected at regular intervals for Polymerase Chain Reaction (PCR) and serology. All foals remained healthy and no adverse vaccine reactions were observed. Fecal shedding lasted from 1 to 12 days and was mainly detected in foals receiving the intra-rectal vaccine 11-15 days following the first vaccine administration. Serological responses were measured in the majority of the vaccinated foals. All foals vaccinated intra-rectally seroconverted after the first vaccine, compared to 50% and 0% of foals in groups 1 and 3, respectively. Pre-medication with omeprazole prior to oral vaccination in group 1 foals led to an earlier and stronger detectable humoral response compared to non pre-medicated foals.

Campylobacter enteritis in children in northern Taiwan--a 7-year experience

BACKGROUND AND PURPOSE

Campylobacter infection is recognized as a major cause of acute enteritis in humans. The clinical characteristics may vary in different countries. This study investigated the clinical manifestations of pediatric Campylobacter enteritis in a medical center in northern Taiwan.

METHODS

This was a retrospective review of Campylobacter enteritis infections at National Taiwan University Hospital, Taipei, Taiwan, from January 2000 to December 2006. All children who tested positive for Campylobacter, isolated from stool samples, were included in the study. Data collected and evaluated included the species of Campylobacter, age, gender, underlying disease, travel history, clinical manifestations and laboratory data.

RESULTS

A total of 104 patients had enteric campylobacteriosis. Campylobacter coli was grown from 24 patients (23.1%), while Campylobacter jejuni was found in 80 patients (76.9%). More than half of the infections (60.6%) occurred in children less than 5 years old. The male-to-female ratio was 2.46:1. Fifteen patients had underlying diseases (14.4%), such as hematologic malignancy, solid organ transplantation and liver cirrhosis. Watery diarrhea (93.2%), abdominal pain (92.0%), fever (81.2%), and vomiting (46.1%) were the most common clinical manifestations. Three episodes of campylobacteriosis appeared to be imported from Southeast Asia and 3 were acquired nosocomially. One patient, who did not have any underlying disease, developed Campylobacter bacteremia. No Guillain-Barre syndrome was noted in our patients and none of our patients died due to campylobacteriosis. While both diseases had similar clinical manifestations, infections caused by C. coli seemed to be more severe than those caused by C. jejuni, as evidenced by a higher incidence of decreased activity and pus cells in the stool in patients infected with C. coli.

CONCLUSION

Even in patients with bacteremia or underlying disease, enteric campylobacteriosis usually runs a benign course regardless of treatment with antimicrobial agents in children in northern Taiwan.

Microbiology of salt rising bread

Salt rising bread (SRB) is an Appalachian traditional bread made without yeast, using a starter derived from flour, milk and potatoes. The "rising agent" has been identified as Clostridium perfringens, not salt, and is presumably derived from the environment. Although no cases of illness have been attributed to SRB, C. perfringens type A is a common cause of food poisoning from meats and gravies. Other C. perfringens isolates may cause enteritis necroticans (pig-bel disease) and gas gangrene. Past research documents that pathogenic strains derived from wounds may be used to produce bread and that bacteria isolated from this bread retain their pathogenicity. SRB starter samples were cultured at the University of Pittsburgh and abundant C. perfringens, type A grew out of all samples. However none of the cultures were positive for enterotoxin and thus would be unlikely to cause human food borne disease. While this does not preclude the possibility of other starter mixes containing enteropathogenic strains, the baking process appears to reduce bacterial contamination to safe levels and SRB has not been implicated in causing any human disease.