Campylobacter enteritis: clinical and epidemiologic features

Respiratory physiology and energy conservation efficiency of Campylobacter jejuni

A study of the electron transport chain of the human intestinal pathogen Campylobacter jejuni revealed a rich complement of b- and c-type cytochromes. Two c-type cytochromes were partially purified: one, possibly an oxidase, bound carbon monoxide whereas the other, of high potential was unreactive with carbon monoxide. Respiratory activities determined with membrane vesicles were 50- to 100-fold higher with formate and hydrogen than with succinate, lactate, malate, or NADH as substrates. Evidence for three terminal respiratory components was obtained from respiratory kinetic studies employing cyanide, and the following Ki values for cyanide were determined from Dixon plots: ascorbate + reduced N,N,N', N'-tetramethyl-p-phenylenediamine, K1 + 3.5 muM; malate, K1 = 55 muM; and hydrogen, K1 = 4.5 muM. Two oxidases (K1 = 90 muM, 4.5 mM) participated in the oxidation of succinate, lactate, and formate. Except with formate, 37 muM HQNO inhibited respiration by approximately 50%. Carbon monoxide had little inhibitory effect on respiration except under low oxygen tension (less than 10% air saturation). The stoichiometry of respiratory-driven proton translocation (H+/O) determined with whole cells was approximately 2 for all substrates examined except hydrogen (H+/) = 3.7) and formate (H+/O = 2.5). The higher stoichiometries observed with hydrogen and formate are consistent with their respective dehydrogenase being located on the periplasmic face of the cytoplasmic membrane. The results of this study suggest that the oxidation of hydrogen and formate probably serves as the major sources of energy for growth.

Campylobacter Enteritis

Campylobacter jejuni (previously called "related vibrio") has recently become recognized as an important cause of acute diarrhoeal disease in many countries. As with other intestinal pathogens, the clinical picture of C. jejuni infection varies from symptomless excretion to severe disease. The incubation period averages two to five days. Fever, abdominal pain and bloody diarrhoea are the usual symptoms of campylobacter enteritis. Although it is normally a self-limiting disease, complications such as cholecystitis, peritonitis, septicaemia and meningitis occasionally arise. The small intestine is thought to be the main site of infection, but the colon is also regularly involved. The disease might be more accurately described as an enterocolitis. Campylobacters, like salmonellae and yersiniae, are thought to be pathogenic by virtue of their invasive ability. Chemotherapy is usually effective. Erythromycin is commonly used for patients ill enough to require specific treatment. Although the infection can be transmitted from person to person, it is mainly a zoonosis with many possible routes of infection. Poultry is a potential source of infection, dogs may also transmit the disease and there have been major outbreaks of campylobacter enteritis from the consumption of untreated or inadequately treated milk and water. Further epidemiological work is hampered by the lack of suitable typing techniques.

Campylobacter enteritis presenting with convulsions

A 14-month old boy presented to the hospital having had a convulsion. Initial work-up was essentially negative except for the presence of a temperature of 40 C. On the second hospital day, the patient began to have diarrhea and Campylobacter jejuni was isolated. This case illustrates that Campylobacter infection may be associated with febrile convulsions, and that these may precede the diarrheal phase of the illness.

Double-blind placebo controlled trial of erythromycin for treatment of Campylobacter enteritis

Although most strains of Campylobacter jejuni are susceptible in vitro to erythromycin and the drug has been recommended for treatment of campylobacter enteritis, prospective controlled trials have not been done. Erythromycin (250 mg 6-hourly for adults and 40 mg/kg daily for children) has been compared with placebo in a double-blind trial of 5-day therapy for acute campylobacter enteritis. The mean number of days of illness at onset of therapy was 5.6 for the treatment group (n = 15) and 6.5 for the placebo group (n = 14). There were no differences in temperature, symptoms, and stool characteristics between the two groups. The mean duration of unformed stools after treatment was 4.1 days in the erythromycin group and 3.5 days in the placebo group. Fever, when present, abated within 48 h in all but two patients in each group. Follow-up faecal cultures 2 days after completion of therapy, however, were negative in all 15 of the erythromycin-treated patients compared with 6 out of 14 controls. Thus erythromycin promptly eradicates C. jejuni from the faeces but does not alter the natural course of uncomplicated campylobacter enteritis when therapy begins 4 or more days after the onset of symptoms.

Enteric diseases of homosexual men

Certain enteric ailments are particularly common among homosexual men. They are primarily infectious diseases and include not only such common venereal diseases as gonorrhea and syphilis but also infections not usually regarded as being sexually transmitted. Among the latter are shigellosis, salmonellosis, giardiasis, and amebiasis. Patients' symptoms are non-specific and seldom helpful in diagnosing particular diseases. The practitioner must be prepared to identify a number of infections with similar presentations that may occur singly or together in gay men. Gonorrhea is probably the most common bacterial infection in gay men. Carriage rates as high as 50% have been reported, and extra-genital carriage is common; this necessitates culturing the urethra, rectum, and pharynx. Procaine penicillin G is the treatment of choice for most patients; spectinomycin is probably the drug of choice in penicillin-sensitive patients. In contrast to other venereal diseases, syphilis may have a characteristic protoscopic presentation. Benzathine penicillin G is the treatment of choice for most patients. Lymphogranuloma venereum causes penile lesions and inguinal lymphadenitis in heterosexual men, whereas homosexual men are more prone to proctitis. The disease may mimic Crohn's disease. Recommended treatment includes tetracycline or sulfamethoxazole-trimethoprim. Shigellosis usually presents as an acute diarrheal illness. Patients generally require only supportive treatment with fluids. Herpes simplex viral infection is difficult to diagnose and has several different presentations, including lumbosacral radiculomyelopathy. Symptomatic treatment with sitz baths, anesthetic ointment, and analgesics is recommended. Venereal warts are believed to be caused by the same virus that causes verrucous warts; they are usually found in the anal canal or around the anal orifice. They are commonly treated with 25% podophyllin solution. Parasitic infections include giardiasis, amebiasis, and pinworm infections. Metronidazole may be used in the treatment of symptomatic giardiasis and amebiasis, but it is not approved for the former indication; quinacrine is approved for giardiasis. Pinworm infestation may be treated with pyrantel pamoate or mebendazole. Cure of enteric diseases in homosexual men must be documented.

Enrichment medium and control system for isolation of Campylobacter fetus subsp. jejuni from stools

Enrichment culture with a semisolid medium increased by 6% the isolation rate of Campylobacter fetus subsp. jejuni. The semisolid enrichment medium was also used successfully as a transport medium for Campylobacter isolates. A blood agar plate streaked with Pseudomonas aeruginosa, Clostridium perfringens, and a laboratory strain of Campylobacter was a good control system for the microaerophilic atmosphere. Good growth of all three organisms indicated satisfactory conditions for culturing Campylobacter.

Comparison of atmospheres of incubation for primary isolation of Campylobacter fetus subsp. jejuni from animal specimens: 5% oxygen versus candle jar

An atmosphere with reduced oxygen tension is required for the primary isolation of Campylobacter fetus subsp. jejuni. Therefore, we compared use of the conventional atmosphere of 5% oxygen and 8% carbon dioxide with use of a candle jar (17% oxygen and 3% carbon dioxide) for primary isolation of C. fetus subsp. jejuni from 263 positive canine, cattle, and turkey fecal or cecal specimens. At an incubation temperature of 42 degrees C, the atmosphere with 5% oxygen resulted in more Campylobacter colonies per plate (P less than 0.005) and consistently larger Campylobacter colonies (P less than 0.005) than did the candle jar, whereas the growth of interfering flora was similar. Overall, 96% of the 263 specimens were positive for C. fetus subsp. jejuni with 5% oxygen, and 90% were positive with the candle jar (P less than 0.02). More striking differences in isolation rates were seen when both the temperature and the atmosphere were varied: 5% oxygen at 42 degrees C enabled recovery of 93% of the isolates from 70 positive specimens, versus 46% recovery with the candle jar at 37 degrees C. Results with 5% oxygen at 37 degrees C were intermediate. The addition of FBP supplement (0.25% each of ferrous sulfate, sodium metabisulfite, and sodium pyruvate) to Campy-BAP selective medium made no improvement over unsupplemented medium at 42 degrees C (whether in 5% oxygen or in the candle jar), but there was significant improvement over unsupplemented medium when both media were incubated at 37 degrees in the candle jar.

Evaluation of the CampyPak II gas generator system for isolation of Campylobacter fetus subsp. jejuni

The CampyPak II (BBL Microbiology Systems, Cockeysville, Md.) method for isolating Campylobacter fetus subsp. jejuni was evaluated with clinical specimens by comparison with an evacuation replacement procedure. Of 757 specimens, 26 (3.4%) were positive for C. fetus subsp. jejuni. All 26 were recovered by both systems. No difference was found in the time necessary for isolation, except with one isolate that required 3 days for isolation with CampyPak II and 2 days with the established procedure. Although the average colony size was slightly smaller for colonies incubated in the CampyPak II system (P less than 0.02 by a paired t test), this is probably of no practical consequence. In terms of technical performance, therefore, the CampyPak II system appears to be an excellent alternative method for establishing microaerophilic conditions necessary for isolating C. fetus subsp. jejuni. The only difference between the two systems was the cost of using the CampyPak II envelopes. Excluding the initial equipment costs, CampyPak II envelopes cost approximately $0.74 per specimen, whereas the standard Torbal jar technique cost about $0.10 per specimen.

Hippurate hydrolysis by and triphenyltetrazolium tolerance of Campylobacter fetus

A rapid test of hippurate hydrolysis and a test of tolerance to triphenyltetrazolium chloride (TTC) were studied in 315 strains of Campylobacter fetus subsp. jejuni to determine their usefulness for biotyping this organism and for distinguishing it from C. fetus subsp. intestinalis. Of the 315 strains tested, 84% hydrolyzed hippurate and 97% were resistant to TTC. Ability to hydrolyze hippurate was seen in 99% of 155 human isolates, 75% of 60 avian isolates, 100% of 41 cattle and dog isolates, 84% of 31 zoo mammal isolates, and none of 28 hog isolates. Resistance to 400 micrograms of TTC per ml was seen in 97% of the human isolates, 95% of the avian isolates, and 100% of the mammalian isolates (other than human). In no case did any of the 315 isolates of C. fetus subsp. jejuni show both lack of ability to hydrolyze hippurate and sensitivity to TTC. In contrast, all 18 strains of C. fetus subsp. intestinalis failed to hydrolyze hippurate and were sensitive to TTC. These two tests may be useful to distinguish between C. fetus subsp. jejuni and subsp. intestinalis and also to biotype strains of C. fetus subsp. jejuni.

Principles of antibiotic therapy

Many host factors influence both the presentation and response to therapy of clinical infections. Since the selection of an appropriate antibiotic depends significantly upon results of in vitro susceptibility testing, great care should be taken to obtain suitable specimens for culture and susceptibility studies. The likelihood that antibiotic therapy will be successful depends upon whether the drug will reach the infected site at the desired concentration and for an optimal duration of time. Local factors such as pH, oxygen tension, and the presence of inactivating substances may affect antibiotic activity. At present, many of our recommendations for dose, dosage intervals, and duration of therapy are largely empiric. Enhanced understanding of the pharmacokinetics of antimicrobial agents should provide the basis for more rational therapy in the future. The remainder of this symposium will present the data from which such recommendations can be drawn.

Campylobacter colitis: a common infectious form of acute colitis

A case of acute ulcerating colitis due to Campylobacter fetus is presented. The radiographic and endoscopic findings are indistinguishable from those of idiopathic acute ulcerative colitis. The clinical and bacteriological data relating to Campylobacter are discussed.

Effect of moisture content of the medium on colony morphology of Campylobacter fetus subsp. jejuni

Reduction in the moisture content of the medium produced a profound effect on the colony morphology of Campylobacter fetus subsp. jejuni. Fresh medium produced flat, grayfish, spreading colonies with an irregular shape and variety appearance. Plates that were incubated at 30 degrees C for 48 h produced round, convex, butyrous colonies with an entire edge. Plates incubated at 30 degrees C for 24 h before inoculation produced colonies of an intermediate nature; they were round and raised, but not convex, and slightly water or mucoid in nature. This marked effect produced by moisture content of the medium was reproducible and may account for the variation in colonies observed by other investigators.

Campylobacter fetus subsp. jejuni: experience in a large Chicago medical center

From January 1979 through December 1979, 2069 stool specimens received by our laboratory for enteric culturing were additionally examined for the presence of Campylobacter fetus subsp. jejuni. The study population included inpatients, outpatients and hospital food handlers. Patients were included regardless of symptoms. Enteric pathogens were identified as follows: Salmonella, 27 isolates; Campylobacter fetus subsp. jejuni, 26 isolates; and Shigella, 11 isolates. Twenty-five of 26 patients with stool cultures positive for Campylobacter fetus subsp. jejuni had an acute diarrheal illness. Diarrhea, fever and chills were the most common symptoms. In most patients the disease was self-limited, requiring only supportive therapy. A seasonal variation was noted, with 14 of the 26 patients presenting between July and September.

Clinical and serological studies in patients with Campylobacter fetus ssp. jejuni infection: I. Clinical findings

Stool samples from 775 patients with diarrhoea referred to a hospital over an 18-month period were cultured for Campylobacter fetus ssp. jejuni, and in 55 patients (7.1%), infections were identified. In addition, one asymptomatic patient had a positive stool sample and serological evidence of a current infection. The patients were aged between 11 and 76 years, the majority being in the age group 15 to 39 years. The symptoms included diarrhoea (in almost 100%), fever (in 80%) and abdominal tenderness (in 35%). Almost half the patients vomited. The total leucocyte count was usually normal, but half the patients showed increased numbers of juvenile neutrophils. Eosinopenia and high serum C-reactive protein were frequently seen in the acute phase of the illness. Complications included haematemesis, pancreatic affection, carditis, reactive arthritis, urticaria, and transient malabsorption in one patient who had had a previous Billroth II operation. Invasive disease was occasionally suggested by clinical manifestations of extensive mesenteric lymphadenitis, septicaemia and focal bone necrosis.

Clinical and serological studies in patients with Campylobacter fetus ssp. jejuni infection: II. Serological findings

The serological responses of 53 patients with Campylobacter fetus ssp. jejuni enteritis were determined with formalinized, boiled and autoclaved antigen suspensions of four reference strains and the autologous isolate. Agglutinin titres of 400 or greater were found against both formalinized and boiled reference antigens in 64% of the patients. Using boiled reference antigens five seropositive patients were found who had not been detected with the formalinized reference antigens, and vice versa. Autoclaved antigens were less useful. The use of paired sera permitted the demonstration of a serological response in some additional patients, although their maximal titre did not exceed 200. The total number of patients with serological responses to reference antigens was thus 48 (91%). The use of autologous antigens detected only one further patient.

Evaluation of media for isolation of Campylobacter fetus subsp. jejuni from fecal specimens

Isolation rates of Campylobacter fetus subsp. jejuni from human fecal specimens were equivalent after broth enrichment (thioglycolate medium containing antibiotics) and direct inoculation on two brucella blood agar media containing ferrous sulfate, sodium metabisulfite, and sodium pyruvate, identical concentrations of vancomycin and trimethoprim, and different concentrations of polymyxin B and cephalothin. Studies with clinical isolates of C. fetus subsp. jejuni demonstrated temperature-dependent activity of polymyxin E (colistin) and substantial inhibition of growth on Thayer-Martin and Martin-Lewis media.

Experimental Campylobacter diarrhea in chickens

An animal model for Campylobacter fetus subsp. jejuni enteritis was developed in 3-day-old chickens. Diarrhea was induced in 88% (22 of 25) of chickens inoculated with 9 X 10(7) bacteria given orally. The mean incubation time was 45 h (range, 24 to 72 h). Considerable weight loss was observed in the experimental group compared with the control group. Ninety bacteria was the minimal infective dose capable of inducing diarrhea in 90% of the chickens. Overall mortality was 32% (8 of 25). Light microscopy, immunofluorescence, and electron microscopy of the gastrointestinal tract of serially sacrificed chickens were performed in control and experimental groups. A moderate infiltration of mononuclear cells was observed in ileum and cecum in the experimental group, with no disruption of intestinal mucosa. By immunofluorescence and electron microscopy, campylobacter was located within the epithelial cells and phagocytosed to a greater degree by mononuclear cells of the lamina propria.

The etiology of anorectal infections in homosexual men

The infectious etiology of symptomatic anorectal disease was studied in 52 homosexual men who did not have gonococci on initial Gram stain of anorectal exudate. Herpes simplex virus (HSV) was isolated from the anal canal or rectum in 15 of the 52 (29 percent) men and characteristically caused severe anorectal pain and focal ulcerations visible on sigmoidoscopy. Despite negative initial Gram stains, seven men (14 percent) had anorectal gonococcal infection. Six (12 percent) had syphilis, including two with dark-field positive anal lesions. Four were infected with enteric pathogens, including Giardia lamblia, Entamoeba histolytica or Campylobacter fetus ssp. jejuni. Chlamydia trachomatis (LGV 2 strain) was isolated from one patient with severe granulomatous proctitis. One or more etiologic pathogens were identified in 28 (67 percent) of 42 men who had anorectal leukocytic exudate and in two of 10 who did not (p = 0.01). A review of the prominent features of different etiologic forms of anorectal infection in homosexuals is presented.

Intestinal colonization of neonatal animals by Campylobacter fetus subsp. jejuni

Neonatal mice (2.3 to 2.8 g) were inoculated intragastrically with different human isolates of Campylobacter fetus subsp. jejuni. At weekly intervals thereafter, mice were sacrificed and dilution plate counts were performed on segments of the gastrointestinal tract. Mice were uniformly colonized by some strains for 2 weeks, whereas other strains were being cleared at that time. One strain (BO216) persisted in some mice for 3 weeks. The greatest number of organisms (10(7)) was recovered from the cecum and large intestine. The small intestine had from 10(2) to 10(5) colony-forming units. Colonization of the stomach was not found consistently. One strain killed 13% of the infected mice. Deaths occurred between 1 and 5 days postinfection. Two other strains killed a smaller percentage of challenged animals, and two additional strains killed none. Retarded weight gain was noticed in some, but not all, of the infected mice. The intestines of neonatal rats and rabbits were colonized much the same as those of mice, whereas hamsters were resistant to colonization. Preweanling mice, up to about 6.5 to 7.0 g, could be colonized with C. fetus subsp. jejuni after intragastric challenge, but weanling mice of larger weight (9.8 g) and young adult mice (18.3 g) could not. Scanning electron photomicrographs of the lower ileum showed campylobacters in and below the dried mucous gel that lines the intestines. The use of this model for additional studies is discussed.

Chlamydia trachomatis proctitis

One hundreds seventy-one homosexual men, 96 of whom had symptoms suggestive of proctitis and 75 of whom had no such symptoms, were consecutively enrolled in a study of the prevalence, clinical spectrum, and histopathology of Chlamydia trachomatis rectal infections. C. trachomatis was isolated from the rectums of 14 men. Three of the isolates, which had lymphogranuloma venereum (LGV) immunotypes, were recovered from three men with symptoms and signs of severe proctitis, two of whom had granulomatous inflammation that was observed at rectal biopsy and was initially suggestive of Crohn's disease. Eleven isolates, which had non-LGV immunotypes, were obtained from eight symptomatic and three asymptomatic men, all of whom had fecal leukocytes and mild abnormalities of the mucosa present at sigmoidoscopy, usually with mild nongranulomatous inflammatory changes that were seen on rectal biopsy. These observations suggest that the presence of LGV immunotypes of C. trachomatis in the rectum is associated with severe acute proctitis that mimics Crohn's disease of the rectum, whereas the non-LGV immunotypes are associated with a mild proctitis with or without symptoms.

Campylobacter infections in pregnancy. Case report and literature review

Campylobacter fetus is a major cause of venereally transmitted abortion and sterility in ungulates, and a recently recognized, common enteric pathogen in man. The role of the organism as a cause of human fetal wastage has not been delineated. We present a case of bacteremic campylobacter infection in a pregnant woman, and review the published cases of campylobacteriosis in pregnancy and the perinatal period. Systemic maternal infection may present either as prolonged febrile illness or fulminant sepsis, and transplacental spread may result in abortion, stillbirth, or early neonatal meningitis. Enteritis that occurs in infants born to women with campylobacter diarrhea may represent fecal-oral spread at or near the time of delivery. With improved microbiologic techniques and greater awareness by physicians, the prevalence and importance of campylobacteriosis in pregnancy should become better appreciated.

Erythromycin. New indications and toxicities

Although erythromycin was introduced into clinical medicine more than 28 years ago, the indications for its use continue to expand. This antibiotic has emerged as appropriate therapy for Legionnaires' disease, chronic bacterial prostatitis caused by Escherichia coli, Klebsiella pneumoniae, and Proteus species, enteritis and colitis produced by Campylobacter fetus, and soft tissue and pleuropulmonary anaerobic infections in which Bacteroides fragilis plays no role. In combination with an aminoglycoside, erythromycin has proven to be effective for perioperative antibiotic prophylaxis in patients undergoing elective colon surgery. Additional therapeutic indications continue to be explored. The renewed interest in erythromycin has resulted in a closer examination of its potential for toxicity. New untoward events attributed to erythromycin administration have been described. This antibiotic has produced both reversible hearing loss and pseudomembranous colitis. Erythromycin also possesses the ability to inhibit the degradation of theophylline.

Evaluation of transport and storage techniques for isolation of Campylobacter fetus subsp. jejuni from turkey cecal specimens

Immediate culturing of fecal specimens is not always possible, and appropriate methods for transport and storage of Campylobacter fetus subsp. jejuni specimens have not been fully evaluated. Using nine techniques, we studied the survival of C. fetus subsp. jejuni in cecal specimens from infected turkeys. The organisms survived in specimens held without transport medium for 3 to 15 days (median, 9 days) at 4 degrees C, and 2 to 9 days (median, 4 days) at 25 degrees C. Only 20% of specimens frozen for 24 h at either -20 or -70 degrees C yielded C. fetus subsp. jejuni. Specimens dried on filter paper strips were negative for C. fetus subsp. jejuni within 1.5 h. Cary-Blair medium with decreased agar was the best of the six transport media tested, it enabled recovery of the organism from 100% (3 days) and 71% (7 days) of cecal samples held at 4 degrees C and 94% (3 days) and 85% (7 days) of cecal specimens held at 25 degrees C. In contrast, more than half of all cecal specimens held at 4 or 25 degrees C in Culturettes or buffered glycerol saline were negative by 3 days, and all were negative at 7 days. Results with the other three media studied (Campy-thio, thioglycolate medium, and alkaline peptone water) were intermediate. Overnight incubation of specimens in alkaline peptone water at 37 or 42 degrees C did not enhance recovery of C. fetus subsp. jejuni. Therefore, refrigeration without a transport medium is satisfactory for up to 3 days for recovery of C. fetus subsp. jejuni from specimens, however, we recommend the use of Cary-Blair medium with decreased agar for specimens that must be transported or stored for longer than 3 days and for rectal swabs, to prevent drying.

Campylobacter fetus subsp. jejuni in a turkey processing plant

Cecal cultures taken over a 1-year period from 600 turkeys at a poultry processing plant were all positive for Campylobacter fetus subsp. jejuni. Swabs of the cloaca and fresh feces were likewise all positive. Of 33 freshly dressed turkey carcases, 94% were positive before chilling in tanks of chlorinated ice and water; 34% of 83 carcasses were still positive after overnight soaking in the tanks. Increasing the chlorine content from 50 to 340 ppm (50 to 340 micrograms/ml) did not cause a decrease in the number of positive carcasses. C. fetus subsp. jejuni was isolated from wastewater gutters as well as from chutes and conveyor belts in the packaging room. Water samples from the five water treatment lagoons for the plant were all positive for C. fetus subsp. jejuni while the plant was in operation, but 4 days after the plant closed for the winter, all water samples were negative.

A prospective clinical study of rotavirus diarrhoea in young children

The clinical and laboratory features of 96 children aged 6 to 36 months with acute rotavirus diarrhoea were compared to findings on 63 children of the same age with acute non-rotavirus diarrhoea. Of the rotavirus-associated cases 80% occurred between January and June. In general, the diarrhoea was more severe in these patients than in the others, but no difference was seen in duration of symptoms. Clinical features characteristic of rotavirus-associated cases included: dehydration and acidosis upon admission, vomiting, fever, neutropenia and sugar in the stools (Clinitest greater than or equal to 0.5%). In contrast, no difference was seen in the occurrence of respiratory symptoms (53% in the rotavirus, 62% in the non-rotavirus group), or in the presence of mucus strands, occult blood or leucocytes in stools. A combination of the above criteria may be helpful in the presumptive diagnosis of rotavirus diarrhoea.

Arthritis associated with Campylobacter jejuni enteritis

Among 342 patients with infection due to Campylobacter fetus ss. jejuni, 8 cases (2.3%) of arthritis were found. Three patients had monoarthritis and 5 oligoor polyarthritis. The arthritis began 4 days - 4 weeks after the onset of diarrhoea; this interval and the synovial fluid findings suggest that the arthritis was reactive. The histocompatibility antigen HLA-B 27 was identified in 5 of the 7 patients tested.

Isolation of Campylobacter fetus subsp. jejuni from Bangladeshi children

To determine the prevalence of infection with Campylobacter fetus subsp. jejuni in Bangladesh, culture surveys were conducted among three populations. In Dacca, Campylobacter was isolated from 5.2% of 97 individuals with clinical dysentery and from 12.3% of 204 patients with only diarrhea. This difference may have resulted from a greater representation of young children in the second group. Campylobacter was isolated from 17.7% of the 141 healthy village children aged 1 to 5.5 years and from 38.8% of the 1-year-old children. More infected children (48%) had a history of recent diarrheal illness than did a group of matched controls (20%; P = 0.016). These findings suggest that campylobacter infection is common for Bangladeshi children. However, this organism may not cause diarrheal illness in all instances in which it is isolated.

Campylobacter: common cause of enteritis in an infectious diseases hospital

Eleven patients were referred to the infectious diseases wards of the Prince Henry Hospital, Sydney, between August and December, 1979, with acute infectious diarrhoea acquired within Australia. Nine of the 11 had infection with Campylobacter species as the sole pathogens. In contrast, a variety of pathogens was isolated from the stools of 13 patients referred to the hospital with enteritis acquired during overseas travel, including three Shigella species, but only one Campylobacter species. The patients with campylobacter enteritis suffered fever, abdominal discomfort and diarrhoea, often with some blood. Complications of campylobacter enteritis included colitis, severe abdominal pain, renal failure, severe muscle cramps, headache with meningism, myalgias and arthralgias. Campylobacter enteritis resolved with cessation of solid food intake, together with intravenous or oral fluid therapy. Some patients were treated with erythromycin, with prompt improvement, though a role for antibiotic therapy has not yet been established.

Isolation of Campylobacter fetus subsp. jejuni from migratory waterfowl

Since the sources from which humans acquire Campylobacter enteritis are only partially known, we studied the frequency of carriage of Campylobacter fetus subsp. jejuni in migratory waterfowl. Cecal contents of various species of wild ducks were cultured on selective media that contained antibiotics to inhibit normal flora. Thirty-five percent of the 445 ducks cultured harbored C. fetus subsp. jejuni. Migratory waterfowl are yet another reservoir for this enteric pathogen and may be of public health importance for humans in the contamination of water or when used as food.

Enriched brucella medium for storage and transport of cultures of Campylobacter fetus subsp. jejuni

A semisolid brucella medium with 10% sheep blood was used for storage and transport of Campylobacter fetus subsp. jejuni and subsp. intestinalis and kept isolated alive about 3 weeks or longer at 25 degrees C or when sent through the regular mail.

The gay bowel syndrome: a common problem of homosexual patients in the emergency department

Sexually transmitted bowel and rectal diseases are common in gay men and are caused by a wide variety of infectious agents. Each of the entities implicated in the gay bowel syndrome is considered separately and epidemiologic considerations responsible for the appearance of such a syndrome are examined. The emergency physician should be prepared to diagnose and initiate treatment of these disorders on a rational basis. Specific practical guidelines for the workup and management of these patients are suggested.

Sulfamethoxazole- trimethoprim versus ampicillin in treatment of acute invasive diarrhea in adults

Twenty-seven Navajo adults with moderate to severe acute inflammatory diarrhea were hospitalized and randomly given ampicillin or sulfamethoxazole-trimethoprim. All patients had invasive diarrhea as defined by sheets of fecal leukocytes, seen on methylene blue wet-slide preparations, and significant clinical symptoms, including postural hypotension from dehydration or fever (temperature greater than 100 degrees F [or 37.8 degrees C]). Patients were followed daily for 5 days in the hospital. Responses of symptoms in all 13 patients who were given sulfamethoxazole-trimethoprim were comparable to or better than those 14 patients randomly assigned to receive ampicillin. Nineteen (73%) of the 27 patients had culture-proven shigellosis, 6 of whom had ampicillin-resistant Shigella isolates. All isolates were susceptible to sulfamethoxazole-trimethoprim in vitro. The eight patients with culture-proven shigellosis treated with sulfamethoxazole-trimethoprim responded as well as the eight patients with ampicillin-susceptible infections treated with ampicillin. Three of the eight patients successfully treated with sulfamethoxazole-trimethoprim had ampicillin-resistant organisms. The three patients with ampicillin-resistant organisms who were treated with ampicillin appeared to do less well; one was a clinical and bacteriological failure at 72 h and subsequently improved after sulfamethoxazole-trimethoprim therapy. As predicted by in vitro susceptibility studies and by studies in children, sulfamethoxazole-trimethoprim was highly effective in treating adult patients with shigellosis and appears to be the treatment of choice in areas where ampicillin resistance among Shigella is common.

Broiler chickens as potential source of Campylobacter infections in humans

Of 46 broiler chickens from a live poultry market in New York City, 38 (83%) harbored Campylobacter fetus subsp. jejuni in their rectal flora. The observed mean number of C. fetus per g of feces was 4.4 x 10(6). The organisms survived in the feces for at least 96 h at 4 degrees C whether stored in the gut or transferred to a vial. The best survival medium for pure cultures of C. fetus subsp.jejuni was heart infusion broth supplemented with sterile blood and kept in a microaerophilic atmosphere.

Cellular fatty acid composition of Campylobacter fetus

The cellular fatty acid composition of 29 human and animal isolates of Campylobacter fetus was determined with gas-liquid chromatography. All strains contained small amounts of 3-hydroxytetradecanoic acid, suggesting the presence of lipid A. Each of 13 different blood or stool isolates of C. fetus subsp. jejuni obtained from humans or fowl contained a 19-carbon cyclopropane acid which was not present in C. fetus subsp. fetus (6 strains from cattle) or C. fetus subsp. intestinalis (10 strains from humans and cattle). These findings indicate that C. fetus subsp. jejuni can be rapidly differentiated from other C. fetus by gas-liquid chromatography analysis of cellular fatty acids.

Survival of Campylobacter fetus subsp. jejuni in biological milieus

To provide new information on the epidemiology and pathophysiology of human infection with Campylobacter fetus subsp. jejuni, we studied its survival in several milieus. Standard inocula of organisms were placed in hydrochloric acid, human bile and urine, bovine milk, or stream water and kept at 4, 25, or 37 degrees C; viable organisms were then counted. Stools from humans infected with Campylobacter were similarly tested. Survival in acid was pH and time dependent, with 7-log kill within 5 min in solutions at pH 2.3. Organisms multiplied in bile at 37 degrees C and survived for 2 months. Organisms survived better in feces, milk, water, and urine kept at 4 degrees C than they did in these milieus at 25 degrees C. Maximal viabilities of Campylobacter organisms kept at 4 degrees C were 3 weeks in feces, 3 weeks in milk, 4 weeks in water, and 5 weeks in urine. Study results suggest that when these milieus are contaminated with C. fetus subsp. jejuni, they may be significant environmental reservoirs.

Campylobacter enteritis associated with unpasteurized milk

Campylobacter fetus ss. jejuni has recently been recognized as a human enteric pathogen. Laboratory isolation has been hindered by its fastidious nature. Methods for recovery of this organism from stool culture and a specific serologic test are described. An outbreak is reported in which three members of the same family became simultaneously ill with fever, severe abdominal cramps and diarrhea. C. fetus ss. jejuni was recovered from stool specimens from all three. A fourfold increase in serum immunoglobulin G (IgG) titer to this organism was demonstrated in each patient. All three patients had been consuming unpasteurized milk from a cow whose feces were infected with C. fetus ss. jejuni.