Campylobacter enteritis: clinical and epidemiologic features

Detection of pathogenic Campylobacter species in blood culture systems

Because differences in recognition of Campylobacter fetus and Campylobacter jejuni in systemic infections may be due partially to differences in the ability to cultivate these organisms, we studied their growth characteristics in two widely used blood culture systems. In the Roche Septi-Chek system (Hoffman-La Roche, Inc., Nutley, N.J.), over a broad range of inocula all strains were detected in broth within 2 days and on paddles within 3 days. In the BACTEC 6B aerobic bottles (Johnston Laboratories, Inc., Towson, Md.), C. jejuni and C. fetus took a median of 5 and 3 days, respectively, to reach the growth index threshold. However, in the BACTEC 7D anaerobic bottles, C. fetus required a median of 2 days to reach the growth index threshold, whereas for C. jejuni the median was greater than 10 days. The poor performance of C. jejuni in both BACTEC systems may have been due to unfavorable incubation atmospheres and may partially explain why C. jejuni bacteremia is so infrequently detected. Overall, the Roche Septi-Chek system was excellent for detecting Campylobacter strains in blood cultures.

Evaluation of a blood-free, charcoal-based, selective medium for the isolation of Campylobacter organisms from feces

A blood-free, charcoal-based selective medium (CSM) consisting of a Columbia agar base, activated charcoal (4 g/liter), hematin (0.032 g/liter), sodium pyruvate (0.1 g/liter), cefoperazone (32 mg/liter), vancomycin (20 mg/liter), and cycloheximide (100 mg/liter) supported the growth of Campylobacter jejuni and C. coli with colony counts equivalent to those obtained on antibiotic-free horse blood agar. CSM was compared to Skirrow medium (SKM) for the recovery of C. jejuni and C. coli from stools of patients with diarrhea, the media being incubated for 2 days under reduced oxygen tension at 43 degrees C. These campylobacters were isolated from 35 (2.9%) of 1,227 stools tested (29 on both media, 5 on CSM alone, and one on SKM alone). Whenever C. jejuni and C. coli were recovered, growth was pure on 29 CSM cultures (85%), but on only 11 SKM cultures (37%). Complete suppression of "contaminating" flora occurred in 704 CSM cultures (57%) compared with 426 SKM cultures (35%). CSM more effectively suppressed contaminating pseudomonads, gram-positive organisms, and yeasts than did SKM; both media failed to suppress members of the family Enterobacteriaceae in about a quarter of the samples. Studies on 20 representative Enterobacteriaceae contaminants showed that susceptibility to cefoperazone and growth on CSM were markedly dependent on inoculum size; 12 strains were inhibited by cefoperazone (32 mg/liter) at inoculum sizes of 5 X 10(2) and 5 X 10(4) but not 5 X 10(6) organisms, indicating that the frequency of contaminants on CSM could probably be reduced further by ensuring that stools were not inoculated too heavily on CSM. Our findings confirm that charcoal is an effective substitute for blood in media for growing campylobacters, and that CSM is a highly effective blood-free selective medium for isolating C. jejuni and C. coli from stools.

Methods for isolating Campylobacter jejuni from low-turbidity water

Membrane filtration methods were developed and evaluated for the quantitative recovery of Campylobacter jejuni from environmental waters of low turbidity. The best procedure studied involved passaging the test water through a filter (pore size, 0.45 micron) and plating it facedown on Campylobacter-selective agar. The filter was removed after overnight incubation, and the plate was streaked for isolation and then reincubated. This method, with or without prefiltration through 5.0- and 0.6-micron-pore-size membranes consistently resulted in the recovery of 30 C. jejuni CFU/250 ml of seeded natural waters. The other methods, plating the final filter face-up or preincubation of the filter in an enrichment medium, were not as sensitive. The technique described above could be useful in the routine monitoring of finished waters for C. jejuni or during investigations of suspected waterborne outbreaks for water of low turbidity.

Toxic megacolon due to Campylobacter colitis

Campylobacter jejuni is a common cause of acute infectious diarrhoea. Most patients recover in less than a week, but 20 per cent may have a prolonged or severe illness [1]. We describe a patient who developed a fulminant toxic dilatation of the colon necessitating a subtotal colectomy.

Roentgenologic changes of the colon in Campylobacter infection

A double-contrast examination of the colon was performed during diarrheal illness in 5 patients with Campylobacter infection. The findings in these 5 patients were aphthoid ulcers and stippled appearance. In 1 patient with stool culture positive for Campylobacter, double-contrast study of the colon 9 days later showed no abnormalities. In a 12-year-old boy lymphoid hyperplasia could be observed as well as the aphthoid ulcers. All the abnormalities were segmental, more often localized in the rectosigmoid. No changes were found in the ascending colon. Histopathologic studies of the biopsy specimens taken endoscopically in 3 patients showed a nonspecific inflammatory reaction.

Studies on the identification of Campylobacter species using biochemical tests and high-performance liquid chromatography

A total of 56 strains of Campylobacter jejuni (C. jejuni) isolated from diarrhoeal patients were characterized by biochemical tests. The following reactions were performed: hydrolysis of hippurate, reduction of nitrate and nitrite, activity of deoxyribonuclease, hydrolysis of Tween(R) 40, 60 and 80. Including the hydrolysis of the different Tweens(R), 14 biotypes could be distinguished. 19 out of the 56 strains of C. jejuni and the nomenclatural type strains of C. jejuni, C. coli, C. laridis, C. fetus subsp. fetus, subsp. venerealis, C. faecalis, C. sputorum subsp. sputorum, subsp. mucosalis, subsp. bubulus were examined for the production of volatile (VFA) and non-volatile (NVFA) short-chain fatty acids using high performance liquid chromatography (HPLC) with a column for organic acids (Aminex HPX-87 H). A standard mixture of 21 short-chain fatty acids was taken as reference. By this method 5 biotypes of C. jejuni could be characterized. The most frequent biotype was type 1 (78.9%). All the biotypes produced succinic, acetic and butyric acids. Differences existed in the production of pyruvic, malonic, formic and isobutyric acids. C. jejuni could rapidly and clearly be distinguished from C. coli, C. fetus subspp. and catalase-negative Campylobacter species. No qualitative differences were found between the subspecies of C. fetus, C. sputorum subsp. sputorum and subsp. bubulus, C. sputorum subsp. mucosalis and C. faecalis were characterized by presence of fumaric and malonic acid, respectively.

Evaluation of an enzyme-linked immunosorbent assay (ELISA) for the detection of Campylobacter jejuni antibodies, and comparison with a complement fixation test (CFT)

An enzyme-linked immunosorbent assay (ELISA) was developed for the detection of total anti-Campylobacter immunoglobulins in human sera. In this assay disintegrated Campylobacter bacteria were used as the antigen. Absorption tests including other possibly enteropathogenic bacterial species showed that the ELISA system displayed a high immunological specificity for Campylobacter. Using this ELISA it was found that in about 80% of Campylobacter patients these Campylobacter antibodies are produced to almost maximal levels within 8 days after onset of disease, and that they may persist for at least 4 months. Indeed, Campylobacter antibodies were demonstrated at low levels in a large number of control sera. However, accepting an antibody titre of 1:640 as indicative of Campylobacter infection, the statistical sensitivity of the ELISA system was 77% and the specificity 95%. In an epidemiological survey a high association was demonstrated between the severity of Campylobacter-related symptoms and antibody titre values. Assessment of Campylobacter antibody titres by means of this ELISA and by a complement fixation test in 92 sera from index patients and contacts with and without symptoms showed a high association of results.

Inhibition of Campylobacter coli and Campylobacter jejuni by antibiotics used in selective growth media

The ability of Campylobacter coli and Campylobacter jejuni to grow in the presence of antibiotics used in selective growth media was compared. MIC data for C. coli indicated that some strains were more susceptible to the antibiotics than were the C. jejuni strains tested. A reduction of greater than 1 log cycle in the numbers of cells growing on plates containing antibiotics was considered to be a marked level of inhibition. Only one of nine of the antibiotic combinations studied did not markedly inhibit most of the C. coli strains tested. Although one C. coli strain was not inhibited by any of the antibiotic combinations, the other six strains were inhibited for up to 7 log cycles. The addition of blood or growth supplements reduced but did not eliminate the inhibitory effect. The inhibition of laboratory strains of C. coli on media developed for the isolation of Campylobacter spp. indicates that the incidence of C. coli may be underestimated.

Efficacy of media and methods for detecting and enumerating Campylobacter jejuni in refrigerated chicken meat

A study was undertaken to compare several enrichment and direct isolation media for their suitability to detect and enumerate five strains of Campylobacter jejuni in refrigerated (5 degrees C) chicken meat. The influence of CO2 on survival at 5 degrees C was also investigated. Selective enrichment media evaluated included Preston broth (PB), selective semisolid brucella medium (SSBM), Campylobacter enrichment broth (CEB), VTP brucella-FBP broth (VTP), Rosef and Kapperud Campylobacter enrichment broth (RKCEB), and Doyle and Roman enrichment broth (DREB). Direct isolation agars included Campy brucella agar (CBAP), blood-free Campylobacter medium (BFCM) and modified Butzler agar (MBA). Comminuted chicken meat was inoculated with C. jejuni, sealed under atmospheric gas or CO2, and stored at 5 degrees C for up to 21 days. Viable population was determined by the most-probable-number technique (PB, SSBM, CEB, VTP, and RKCEB, followed by plating on CBAP, BFCM, and MBA), enrichment on DREB, followed by plating on CBAP, BFCM, and MBA, and direct isolation on CBAP, BFCM, and MBA. Without exception, direct plating of samples was superior to the most-probable-number technique for enumerating C. jejuni; MBA was inferior to CBAP and BFCM, and DREB performed at least as well as other enrichment media evaluated. Carbon dioxide afforded protection against death of three of the five strains of C. jejuni tested.

Pathogenic properties of Campylobacter jejuni: assay and correlation with clinical manifestations

The pathogenic properties of 20 strains of Campylobacter jejuni isolated from persons with clearly defined clinical manifestations were determined. Cell-free broth filtrates were examined for (i) enterotoxin production by Chinese hamster tissue culture assay and an enzyme-linked immunosorbent assay (ELISA) employing GM1 ganglioside and affinity-purified antiserum to Escherichia coli heat-labile toxin, (ii) cytotoxin production by Vero and HeLa cell tissue culture lines, and (iii) their ability to cause fluid secretion in rat ligated ileal loops. Viable bacteria were examined for invasive properties by an ELISA with the immunoglobulin fraction of antiserum to Formalin-killed bacteria of an invasive strain, and by their effect on fluid secretion and morphology in rat ligated ileal loops. None of the eight isolates obtained from asymptomatic carriers had any detectable pathogenic properties. All six strains isolated from persons with bloody invasive-type diarrhea elaborated a cytotoxin; their viable bacteria had high titers in the ELISA for invasive properties and caused fluid secretion in ligated ileal loops, although consistent morphologic abnormalities and evidence of mucosal invasion, examined by immunofluorescence techniques, were not detected. All six strains isolated from persons with watery secretory-type diarrhea produced an enterotoxin, one elaborated a cytotoxin, and broth filtrates of all strains caused fluid secretion in ligated ileal loops; viable bacteria had low titers in the ELISA for invasive properties and evoked fluid secretion in ligated loops by means of enterotoxin production. These observations show (i) that a correlation exists between the pathogenic properties of the infective C. jejuni strain and gastrointestinal manifestations in the infected host, and (ii) that these pathogenic properties can be identified by in vitro assays, including ELISAs.

Community-wide surveillance of Campylobacter jejuni infection. Evaluation of a laboratory-based method

Surveillance of infections due to Campylobacter jejuni is needed to further define the epidemiology of this disease in the U.S. We assessed one potential method of community-wide surveillance, a laboratory-based reporting network. Six microbiology laboratories that routinely culture fecal specimens for C. jejuni reported all isolates to Seattle-King County Health Department for an 18-month period. Further investigations on 476 cases reported from this broadly based network revealed that C. jejuni enteritis affected primarily children and young adults, occurred sporadically (with a summer-fall predominance), led to hospitalization in 13% of cases, was found negligibly in patients hospitalized or immunocompromised, and produced no fatalities. Comparative statistics showed that C. jejuni was reported more frequently than Salmonella and Shigella combined in individuals served by reporting laboratories. Because one participating laboratory was that of a 280,000-member health maintenance organization, it was possible to calculate age-specific incidence rates for bacterial enteric infections in that population. C. jejuni and Salmonella had high attack rates among 0-4 year-old children: 184 cases/100,000 enrollees per year and 126/100,000 per year, respectively. C. jejuni showed another peak at 20-29 years (108/100,000 per year) that was absent in salmonellosis. This study demonstrates that a laboratory-based reporting system is a feasible approach to community-wide C. jejuni surveillance.

In vitro susceptibilities of Campylobacter-like organisms to twenty antimicrobial agents

We determined MICs of 20 antimicrobial agents for 50 representative strains of four subgroups of Campylobacter-like organisms (CLOs) by agar dilution. Ampicillin, gentamicin, doxycycline, tetracycline, ceftriaxone, rifampin, spectinomycin, nalidixic acid, and chloramphenicol were active against all strains of CLOs. Most CLO strains (83%) were inhibited by 4 micrograms of sulfamethoxazole per ml and by 8 micrograms of trimethoprim-sulfamethoxazole per ml. Of type 1 strains, 28% were resistant to 8 micrograms of erythromycin per ml. In addition, cross resistance between erythromycin and clindamycin was always present. Type 1 strains exhibited a broad distribution of MICs of metronidazole and streptomycin, whereas all type 2 strains were uniformly susceptible to metronidazole and resistant to streptomycin. Unlike type 1 and 3 strains, type 2 CLOs were susceptible to cephalothin and penicillin G and highly resistant to streptomycin. The type 3 strain was uniquely resistant to cefazolin. The majority of strains were not inhibited by cefoperazone; and all were resistant to trimethoprim. In contrast to Campylobacter jejuni and Campylobacter fetus subsp. fetus, all CLOs tested were susceptible to 0.5 microgram of rifampin per ml.

Occurrence of Campylobacter jejuni and Giardia species in muskrat (Ondatra zibethica)

A total of 189 muskrat fecal samples were surveyed for Campylobacter and Giardia species. Campylobacter jejuni was recovered from 47.5% of these samples, and Giardia species were detected in 82.5%. These findings indicate that muskrat may be of importance to the health both of humans and of domestic animals.

The occurrence and significance of Campylobacter jejuni in man and animals

Campylobacter jejuni, which is now recognized as a discrete species, is a gram negative, microaerophilic, thermophilic, nalidixic acid sensitive, hippurate positive pathogen requiring special selective media for propogation. The organism is widely distributed in avian species, experimental and companion animals and in humans. Mammalian campylobacteriosis is characterized by an enterocolitis of variable severity. The prevalence of the condition is relatively high in young individuals, in underdeveloped countries and in subjects with diarrhea. Food animals, especially poultry, are reservoirs of the organism and infection occurs following consumption of untreated surface water, unpasteurized milk, incompletely cooked meat or other contaminated food products. Close contact with infected immature companion animals is a significant cause of campylobacteriosis in children and direct intrafamilial transmission and occupational infection have been documented. Campylobacteriosis attributable to C. jejuni is a condition of emerging significance which arises principally from deficiencies in hygiene inherent in the environment and in the food chain which extends from domestic animals to the consumer.

Development of a bacteriophage typing system for Campylobacter jejuni and Campylobacter coli

A bacteriophage typing system for Campylobacter jejuni and Campylobacter coli was developed with phages isolated from poultry feces. Data for phage selection were generated from a set of isolates of C. jejuni and C. coli from humans in Illinois. Selection of 14 phages from the 47 phages available was assisted by determination of the Sneath-Jaccard similarity coefficients and subsequent unweighted pair-group arithmetic averaging cluster analysis. The typing set was reproducible and stable in the 255 isolates from Illinois. Of these isolates, 94.5% were typable, with 46% represented by the four most common phage patterns. In a set of 51 isolates from humans outside of Illinois, 88.1% of the C. jejuni isolates were typable. Phage typing for C. jejuni and C. coli has excellent epidemiologic potential and should serve as a useful adjunct or alternative to serotyping systems in current use.

A quantitative study of immunoglobulin containing cells in the differential diagnosis of acute colitis

In colonic biopsies of 33 patients with acute colitis caused by campylobacter, salmonella, or shigella immunoglobulin containing cells were determined quantitatively using an indirect immunoperoxidase technique and morphometry with a graphic tablet. The findings were compared with those of 10 patients without histological abnormalities, 10 patients with Crohn's disease of the colon, and 10 patients with ulcerative colitis. Biopsies of patients with acute infectious colitis had increased numbers of IgA containing cells and to a lesser extent IgM containing cells but not IgG containing cells compared with controls. Compared with the patients with active chronic idiopathic inflammatory bowel disease the patients with acute colitis showed significantly lower relative and absolute numbers of IgG containing cells. We therefore conclude that quantitative assessment of immunoglobulin containing cells in colonic biopsies may be useful in the differential diagnosis of acute infectious colitis and chronic idiopathic inflammatory bowel disease.

Antibiotic and deoxycholate resistance in Campylobacter jejuni following freezing or heating

The surviving populations of Campylobacter jejuni serotypes following freezing or heat were found to be more sensitive to rifampicin and sodium deoxycholate on subsequent culture. Thus while control cultures had an IC50 of greater than 20 micrograms/ml rifampicin those of injured cells were less than 5 micrograms/ml. Treatment with EDTA caused almost identical changes in resistance suggesting that the altered resistance pattern of injured cells was due to loss of the barrier properties of the bacterial outer membrane.

Cadmium chloride susceptibility, a characteristic of Campylobacter spp

We report a simple diagnostic characteristic useful in the presumptive identification of Campylobacter jejuni and Campylobacter coli. Filter paper disks impregnated with cadmium chloride were placed on streaked agar medium. Zones of growth inhibition for Campylobacter spp. occurred at 1.25 micrograms per disk. Other enteropathogens (Salmonella spp., Shigella spp., Vibrio cholerae, Vibrio parahaemolyticus, Escherichia coli, and Yersinia enterocolitica) were resistant to at least 40 micrograms per disk, with the exception of a strain of Shigella flexneri, which showed first susceptibility at 10 micrograms per disk. Most of the 52 Campylobacter strains, which were isolated from human clinical and animal sources, showed zones of inhibition greater than 10 mm with 2.5 micrograms of cadmium chloride per disk. At 20 micrograms per disk, Campylobacter isolates from clinical sources were significantly (P less than 0.01) more susceptible to cadmium chloride inhibition than were those from meat samples.

Serotyping of Campylobacter jejuni isolated from sporadic cases and outbreaks in northern Norway

In the northern regions of Norway, 123 cases of Campylobacter jejuni gastroenteritis were either sporadic infections or due to five separate outbreaks during 1980-83. Using a serotyping scheme based on thermostable antigens and the passive haemagglutination technique, 92 isolates were serotyped. Excluding duplicates from the outbreaks, the serotype distribution based on 79 isolates showed that serotypes 6, 7 and 12, 40 were the most frequent in occurrence. Each included 11 (13.9%) of the isolates and each serotype was also identified twice as the epidemic strain in four different outbreaks. A fifth outbreak strain was serotype 13, 16, 50. The number of isolates that reacted in one or more antisera of the cross reacting group of serotypes 4, 13, 16, 43 and 50 was 21 (26.6%). The other 23 isolates fell into 19 other serotypes and 13 (16.5%) were untypable.

Campylobacter colitis: differentiation from acute inflammatory bowel disease

We describe 10 patients with campylobacter colitis who gave a characteristic history of an acute diarrhoeal illness, rectal bleeding and colicky abdominal pain. For the majority of patients the clinical and sigmoidoscopic features differentiated campylobacter colitis from acute inflammatory bowel disease. Where doubt remained, evidence of a specific antibody response to campylobacter enabled a presumptive clinical diagnosis to be confirmed.

Comparison of enrichment methods and atmosphere modification procedures for isolating Campylobacter jejuni from foods

A comparison was made of enrichment broths for recovery of Campylobacter jejuni from food by the methods of Doyle and Roman (Appl. Environ. Microbiol. 43:1343-1353) and of Park et al. (Can. J. Microbiol. 27:841-842). No significant differences were found between the results obtained with the two broths. Recovery was greater, however, with a constant gas flow into the broths than with an evacuation-replacement method.

Serotyping and serology studies of campylobacteriosis associated with consumption of raw milk

A community outbreak of 15 cases of gastroenteritis was traced to consumption of unpasteurized milk produced at one commercial dairy. Using two different testing schemes, we found that a Campylobacter jejuni isolate from an ill patient and an isolate from a sick cow were the same serotype. Bacteriological studies suggested that a single epidemic strain of Campylobacter jejuni caused this outbreak.

Economical, simple method for production of the gaseous environment required for cultivation of Campylobacter jejuni

Campylobacter jejuni is an enteric pathogen recognized worldwide as a cause of diarrhea. Its isolation from stool samples requires a microaerophilic environment that heretofore has been expensive and cumbersome to create. An economical, portable, and simple method is described which involves the production of appropriate concentrations of oxygen and carbon dioxide. Inside a plastic bag are placed two cups, one containing fine steel wool (grade 0) previously soaked in a 2.5% aqueous solution of copper sulfate and the other containing an Alka-Seltzer tablet in tap water. As suggested by Jurgensen et al. (Rev. Bras. Pat. Clin. 18:58-63, 1982), we used the effervescent antacid to generate CO2. By plate counts, we found this method to be as reliable in the cultivation of 20 isolates of C. jejuni in pure and mixed fecal culture as the reference gas method (85% N2, 10% CO2, and 5% O2). Analyses of the gas mixture inside the bag after up to 24 h of incubation confirmed the creation of an atmosphere of reduced O2 and increased CO2 concentrations. This method is eminently suitable for field situations in which more costly supplies are not available.

Identification of Campylobacter coli isolates from animals and humans by bacterial restriction endonuclease DNA analysis

Ninety-nine Campylobacter coli isolates were examined by bacterial restriction endonuclease DNA analysis (BRENDA) with HindIII. Isolates from poultry from the same environment had identical patterns, patterns of isolates carried by suckling piglets were generally the same as those of isolates recovered from their dams, and one human patient yielded the same BRENDA type when sampled 6 weeks later. The 14 human isolates examined produced 11 distinct BRENDA types. Forty-three C. coli isolates from pigs were represented by 20 BRENDA types. Ten C. coli isolates from the feces of gulls yielded five different BRENDA types. Thirty-two C. coli isolates from live chickens and processed chicken yielded five different BRENDA types. Three human isolates had identical DNA patterns; two were from brothers living in the same house, and the third was from a human with no apparent relationship to the brothers. Another human isolate was identical to a poultry isolate. None of the pig strains had DNA patterns resembling those of human strains, nor were the DNA patterns like those of any strains recovered from poultry or gulls. Four C. coli isolates were subcultured onto agar 23 times over a period of 45 days, and their BRENDA patterns were preserved. BRENDA shows great promise for use in epidemiological studies of C. coli.

Properties of crude Campylobacter jejuni heat-labile enterotoxin

The amount of crude Campylobacter jejuni enterotoxin present in culture products was quantitated by comparing the response of these preparations with that of pure Escherichia coli heat-labile toxin (LT) in the Chinese hamster ovary assay and in enzyme-linked immunosorbent assays that used GM ganglioside or antisera to LT or both. Maximum C. jejuni enterotoxin production was achieved by growth at 42 degrees C for 24 h under agitation in supplemented GC medium. Adding polymyxin separately to either the broth supernatant or the cells enhanced the recovery of toxin; the yield from cell lysates was much lower. The quantity of C. jejuni enterotoxin produced by clinical isolates obtained locally or provided from Mexico varied widely, over a spectrum from none to large amounts; quantitative values for the amount of C. jejuni enterotoxin determined by the Chinese hamster ovary and enzyme-linked immunosorbent assays correlated with the degree of secretory potency of this material in ligated rat ileal loops. The cytotonic activity of C. jejuni enterotoxin in Chinese hamster ovary cells was abolished by heating at 96 degrees C for 10 min and by preincubation either with GM ganglioside or with LT or cholera toxin antisera. The secretory activity of C. jejuni enterotoxin in ligated rat ileal loops was passively neutralized by antiserum to LT, and immunizing rats with either LT or its B subunit significantly (P less than 0.001) reduced fluid response to active challenge with C. jejuni enterotoxin in ligated ileal loops. These observations indicate that strains of C. jejuni vary in their capacity to elaborate a heat-labile enterotoxin that has close immunological homology with LT and cholera toxin.

Systematic investigation of enrichment media for wild-type Campylobacter jejuni strains

Of the media examined, thioglycolate broth supplemented with 5% lysed sheep blood, Butzler antibiotic mixture, and 0.1% lauryl sulfate was the most sensitive enrichment medium for recovery of wild-type strains of Campylobacter jejuni from cecal contents of chickens and chicken livers. It allowed the retrieval of 1 CFU as did solid media but permitted the screening of 50-times larger volumes. Double-strength enrichment medium required 5 to 10 CFU for growth. Omission of lauryl sulfate reduced the sensitivity. Replacement of Butzler antibiotic mixture with Blaser antibiotic mixture increased overgrowth and, therefore, decreased retrieval of C. jejuni.

Campylobacter enteritis. A 3-year experience

Campylobacter jejuni was isolated from 135 infants and children seen at the Oklahoma Children's Memorial Hospital over a 3-year period. The comparative frequency of isolation of C. jejuni, Salmonella, and Shigella were 1.5 percent, 2.2 percent, and 3.1 percent, respectively. Campylobacter enteritis was most prevalent during the warm months from May to October, peaking in July. Seventy percent of the afflicted children were 2 years old or younger; only 13 percent were older than 5 years. There were the usual clinical presentations (acute onset of diarrhea, fever, abdominal pain, and bloody stools) of Campylobacter enteritis, but other, less common, patterns also were seen. These included chronic diarrhea without significant systemic manifestations; asymptomatic bloody stools, particularly in neonates; and fever and abdominal pain without diarrhea. Severe complications included hemolytic-uremic syndrome, sepsis associated with septic arthritis and osteomyelitis, and failure to thrive.

Infection due to Campylobacter jejuni: a report of 524 outpatients

Within a three-year period 712 patients with Campylobacter jejuni infection were diagnosed at our laboratory in Helsinki and 524 (72%) were treated as outpatients. More than half (57%) of the patients became infected when abroad, chiefly during holiday trips in the Mediterranean and in East European countries. The risk of acquiring infection was about 250 times greater abroad than in Finland, and it differed considerably from country to country, being highest in Morocco and Tunisia. Among domestic cases the incidence of infection was significantly higher (p less than 0.001) during the summer and autumn months than during winter or spring. Animal contact prior to infection was reported in 59% of domestic and 31% of imported cases, and previous consumption of poultry in 28% and 42% of those from whom information was obtained. Besides diarrhoea (98%), the main symptoms included abdominal pain (87%), fatigue (81%), fever (78%), malaise (70%) and headache (51%). Arthralgia was observed in 19% and arthritis in 2% of patients. The mean duration of diarrhoea was 10.8 days, of fever 2.8 days.

Early initiation of weaning foods and proliferation of bacteria in Nigerian infants

Ninety-five children, age range from 1 to 18 months, were followed for the types of weaning foods. Forty-five of the 95 children were evaluated for intestinal bacteria colonization. The most frequently isolated pathogens were enteropathogenic Escherichia coli (EPEC) and Staphylococcus aureus. Children who were not subjected to early initiation of weaning and supplementary foods had lower bacteria counts than their counterparts.

Campylobacter-caused diarrhea. Who is at risk? What to watch for

Campylobacter jejuni is now recognized as one of the most common causes of human infectious diarrhea. Avian species and mammals are the chief reservoirs, although the organism has been isolated from contaminated drinking water and unpasteurized milk. Transmission usually occurs by the fecal-oral route through ingestion of contaminated food or water or by direct contact with feces of infected humans or animals. Persons affected have abdominal pain, watery or bloody diarrhea, fever, and constitutional symptoms. Diagnosis is established by demonstrating the organism in Gram stains of stool or by stool or blood culture. Erythromycin is the drug of choice if specific therapy is needed.

Procedure for increased recovery of Campylobacter jejuni from inoculated unpasteurized milk

Different treatments were applied to Campylobacter jejuni-inoculated unpasteurized milk to identify means of enhancing the survival of the organism in refrigerated (4 degrees C) samples. The greatest survival occurred in milk supplemented with 0.01% sodium bisulfite and held under an atmosphere of 100% nitrogen (bisulfite-nitrogen), in most instances allowing isolation of C. jejuni from highly contaminated milk 15 or more days longer than from unsupplemented milk held in air (21% oxygen). Although a larger amount of Campylobacter was consistently recovered from milk treated with bisulfite-nitrogen, similar isolation rates (qualitative) resulted from milk stored in air and supplemented with 0.01% sodium bisulfite and 0.15% sodium thioglycolate when analyzed within 12 days after sampling. Milk samples to be transported and assayed at a later date would best be held refrigerated (4 degrees C) and supplemented with 0.01% sodium bisulfite and either 0.15% sodium thioglycolate or an atmosphere of 100% nitrogen.

Campylobacter jejuni diarrhea model in infant chickens

To study the pathogenic mechanisms of Campylobacter jejuni infection, 36- to 72-h-old chickens were fed 10(3) to 10(6) live cells, using strains isolated from 40 patients with watery diarrhea and 6 with bloody mucoid diarrhea from whom no other known enteropathogen was detected. Chickens of Starbro strain were more likely to develop C. jejuni-induced diarrhea than were White Leghorn chickens. Diarrhea was defined on the basis of amounts of gut fluid in 288 chicks fed with live C. jejuni versus 183 saline-fed control as an accumulation greater than or equal to 0.4 ml of fluid in the guts (excluding ceca) of chickens. Twenty-five percent of the chickens developed diarrhea on day 2, 49% on day 4, and 81% on day 5. The intestines, including ceca, were distended with watery fluid. The majority of the strains, irrespective of whether they were isolated from watery or bloody mucoid enteritis patients, caused watery diarrhea in chickens, and a few caused mucoid diarrhea. No correlation was observed between the source of a strain and the outcome in the experimental model. Bloody diarrhea was never observed in chickens. The peak incidence of diarrhea on day 5 coincided with the mean of maximum fluid accumulation. The organisms multiplied by 3 to 4 logs in all parts of the intestine, with a steady increase in number until day 5. Systemic invasion occurred frequently: C. jejuni could be recovered from the spleen in 47% of the chickens on day 5, in 25% from the liver on day 6, and in 11% from heart blood on day 4. Histopathological examination of gut tissue of the chickens having watery diarrhea did not reveal any abnormality except slight submucosal edema. However, in chickens with mucoid diarrhea, the organisms were found to adhere to brush borders and penetrate into the epithelial cells with formation of a breach in continuity of the brush border lining. The electrolyte composition of the intestinal fluid from chickens infected with C. jejuni and from saline-fed controls did not show significant differences, except for depletion of K+ in the test group. The results obtained in this highly reproducible chicken diarrhea model indicate that (i) most chickens develop nonexudative watery diarrhea 2 to 5 days after oral feeding of 10(3) to 10(6) live cells of C. jejuni; (ii) the organism multiples in all parts of a chicken intestine, (iii) systemic invasion is common, and (iv) local invasion is sometimes observed.

Association of Campylobacter jejuni with laying hens and eggs

Laying hens were individually caged at 20 weeks of age and tested for fecal excretion of Campylobacter jejuni (minimum level of detection was 100 cfu/g) during a 42-week period. Peak rates of C. jejuni isolation (approximately 25% of hens positive) occurred at two different times, in October and in late April to early May. Before being segregated in late September, birds were allowed to consume fecal matter, litter, and communal drinking water, all likely sources of C. jejuni. The increased excretion rate in late April may have been due to a climatic change. A small portion (8.1%) of the hens chronically excreted (positive less than 30% of the sampling times) the organism, whereas C. jejuni was not detected in 33% of the hens, even though birds were likely exposed to the organism before being segregated. No correlation could be made between rates of C. jejuni excretion and egg production. Of 266 eggs from hens fecally excreting C. jejuni, the organism was isolated from two shell surfaces but no egg contents. Egg penetration studies revealed that the organism would not penetrate into the contents of the eggs but could be isolated occasionally from the inner shell and membranes of refrigerated eggs.

Is enrichment culture necessary for the isolation of Campylobacter jejuni from faeces?

The role of enrichment culture for the isolation of Campylobacter jejuni from faeces is discussed. It is concluded that enrichment culture is only necessary for those specimens where it is anticipated that the number of organisms is likely to be low. In a trial of a blood free enrichment broth (CCD broth) and the modified Preston enrichment broth the latter gave significantly superior results.

Simple adult rabbit model for Campylobacter jejuni enteritis

We tested the usefulness of the Removable Intestinal Tie Adult Rabbit Diarrhea model to establish Campylobacter jejuni infection in rabbits. The procedure involved ligation of the cecum, placement of a slip knot at the terminal ileum, and injection of the test inoculum into the mid-small bowel. The ends of the slip knot were externalized, and the tie was released 4 h later. Fifty-five rabbits received C. jejuni, and 16 received uninoculated medium as controls. Daily rectal swabs were positive for 2 weeks in infected rabbits. The diarrheal attack rate was 64% in infected rabbits and 0% in controls. Diarrhea was characterized by loose, mucus-containing stools after an incubation period ranging from 24 h to 6 days. When blood was obtained daily for culture from 30 rabbits for 4 days post-challenge, bacteremia was present in 96.3% 24 h after challenge but diminished to 5 of 19 (26.3%) at 96 h. Death occurred in 53% of rabbits and was always preceded by diarrhea. No control animal died. Only 5 of 35 animals experiencing diarrhea recovered. An indirect whole-cell enzyme-linked immunosorbent assay was used to determine serum immunoglobulin G responses. Mean titers rose from 1:198 preoperatively to 1:9,087 on day 28. Necropsy on eight infected and two control animals showed inflammatory lesions with ulceration in 62.5% and goblet cell hyperplasia in 75% of infected rabbits. We conclude that the Removable Intestinal Tie Adult Rabbit Diarrhea procedure is a simple, effective method to establish C. jejuni infection which mimics human disease.

Isolation and enumeration of Campylobacter jejuni from poultry products by a selective enrichment method

A direct selective enrichment procedure was developed for the isolation of Campylobacter jejuni from poultry products. The selective enrichment medium (ATB) consisted of (per liter) tryptose (20 g), yeast extract (2.5 g), sodium chloride (5 g), FBP supplement (ferrous sulfate [0.25 g], sodium metabisulfite [0.25 g], sodium pyruvate [0.25 g]), bicine (10 g), and agar (1 g). Hematin solution (6.25 ml; prepared by dissolving 0.032 g of bovine hemin in 10 ml of 0.15 N sodium hydroxide solution and autoclaving at 0.35 kg/cm2 for 30 min), rifampin (25 mg), cefsulodin (6.25 mg), and polymyxin B sulfate (20,000 IU) were added after the medium was sterilized. The pH was adjusted to 8.0. Samples were enriched in the above medium at 42 degrees C for 48 h under an atmosphere of 5% O2, 10% CO2, and 85% N2. Enrichment cultures were streaked on a plating medium composed of Brucella agar, hematin solution, FBP supplement, and the above antibiotics. Plates were incubated under the same conditions as above. Suspect colonies from the plates were confirmed to be C. jejuni by morphological examination, growth characteristics, and biochemical tests. The above method yielded 25 isolates of C. jejuni from 50 samples of retail cut-up chicken and chicken parts, whereas a more complex method involving filtration, centrifugation, selective enrichment under a flowing atmosphere, and membrane filtration yielded only 6 positives from the same samples. The new isolation procedure was particularly effective in isolating C. jejuni in the presence of large numbers of Pseudomonas aeruginosa.(ABSTRACT TRUNCATED AT 250 WORDS)

Evaluation of filters for recovery of Campylobacter jejuni from water

Campylobacter jejuni has been incriminated in several large waterborne outbreaks, but it has rarely been isolated from water itself. Better methodology is needed for the isolation of C. jejuni from water. We evaluated three types of 0.45-micron microporous filters and three different pore sizes of positively charged depth filters for their ability to recover C. jejuni from seeded, sterile tap and surface water. The microporous filters tested were Millipore HA, Gelman GN6, and Zetapor. Three pore sizes of Zeta Plus depth filters (05S, 30S, and 50S) were evaluated by using an adsorption-elution technique. The overall percent recovery in both tap and surface water by microporous filters was: Zetapor, 66%; Millipore HA, 33%; and Gelman GN6, 33%. Adsorption-elution with Zeta Plus 50S allowed 89% recovery of C. jejuni. These data suggest that both the positively charged Zetapor microporous filter and the Zeta Plus 50S depth filter are effective filters for the recovery of C. jejuni from water.

Hydrogenase activity in catalase-positive strains of Campylobacter spp

A rapid hydrogenase assay has been developed which may be useful in separating the species Campylobacter jejuni and C. coli from the subspecies C. fetus subsp. fetus and C. fetus subsp. venerealis. This assay employs the impermeant redox dye benzyl viologen, and positive determinations can be made within 20 min. All strains of C. jejuni and C. coli were found to be strongly hydrogenase positive. All strains of C. fetus subsp. fetus and C. fetus subsp. venerealis were negative for hydrogenase when the assay was performed at a benzyl viologen concentration of 2 mM and an incubation temperature of 30 degrees C. Some strains of C. fetus had low levels of hydrogenase as determined with cell extracts but were hydrogenase negative by the benzyl viologen assay. Since there are few rapid diagnostic tests available for screening Campylobacter isolates, we hope that the rapid hydrogenase assay will prove useful.