Campylobacter enteritis in Central Africa

Campylobacter species and drug resistance in a north Indian rural community

Campylobacter species are known as agents of enteritis worldwide. However, rural community-based studies on Campylobacter infections are lacking. We carried out a prospective case-control study from July to December 2002 to investigate the prevalence and socio-epidemiological determinants of Campylobacter infection in a rural community in north India and the drug resistance of Campylobacter strains isolated from the community. Stool specimens from 348 subjects with diarrhoea and 351 age- and gender-matched asymptomatic controls were cultured for Campylobacter, Salmonella and Shigella. All Campylobacter strains were identified and tested for antibiotic susceptibility. Campylobacter species were isolated from 47 (13.5%) subjects with diarrhoea and 2 (0.6%) asymptomatic controls respectively (P<0.001). Campylobacter infection was significantly higher in children aged less than 5 years, families engaged in agriculture and persons who did not wash their hands with soap after peri-anal washing following defaecation. Campylobacter infections were more frequent than combined Salmonella and Shigella infections (47/348 vs. 15/351; P<0.001) in subjects with diarrhoea. Only two Campylobacter-infected individuals with diarrhoea had bloody stools. Antibiotic resistance of Campylobacter species was as follows: ampicillin 81.6%, ciprofloxacin 71.4%, tetracycline 26.5%, furazolidine 14.3%, gentamicin 10.2% and erythromycin 6.1%; 30.6% of strains were multidrug resistant. Increased quinolone resistance and multidrug resistance pose major risks for treatment failure.

Campylobacter, from obscurity to celebrity

After its successful isolation from stools in the 1970s, Campylobacter jejuni has rapidly become the most commonly recognised cause of bacterial gastroenteritis in man. Reported cases of human campylobacteriosis represent only a small fraction of the actual number. In industrialised countries, the incidence of C. jejuni/Campylobacter coli infections peaks during infancy, and again in young adults aged 15-44 years. Acute self-limited gastrointestinal illness, characterised by diarrhoea, fever and abdominal cramps, is the most common presentation of C. jejuni/C. coli infection. The introduction of selective media has made the diagnosis of Campylobacter enteritis a simple procedure. In general, Campylobacter enteritis is a self-limiting disease which seldom requires antimicrobial therapy, although one in 1000 infections may lead to the Guillain-Barré syndrome. In industrialised countries, most infections are acquired through the handling and consumption of poultry meat. In developing countries, where the disease is confined to young children, inadequately treated water and contact with farm animals are the most important risk factors. Many infections are acquired during travel. Fluoroquinolone resistance has been reported in C. jejuni since the late 1980s in Europe and Asia, and since 1995 in the USA. The use of fluoroquinolones to treat animals used for food has accelerated this trend of resistance. In Australia, where fluoroquinolones have not been licensed for use in food production animals, C. jejuni remains susceptible to fluoroquinolones. The public health burden of Campylobacter spp. other than C. jejuni/C. coli remains unmeasured. Better diagnostic methods may reveal the true health burden of these organisms.

Diarrhea in children under 5 years of age from Ifakara, Tanzania: a case-control study

A matched case-control study was conducted in the Maternal and Child Health Clinic (MCH) in Ifakara, Tanzania, during the rainy season in order to elucidate the risk factors for and etiology of diarrheal diseases in children under 5 years of age. Cases (103) and controls (206) were matched for sex and age group. Precoded questionnaires with demographic details, clinical history, and physical signs were completed. Stools samples were collected for bacterial, parasitological, and viral studies. A high number of siblings (odds ratio [OR], 0.86; P = 0.027), the number of siblings surviving (OR, 0.82; P = 0.007), the birth order (OR, 0.85; P = 0.018) and the distance from the house to the water source (OR, 0.33; P = 0.011) were associated with the risk of diarrhea. There were high rates of enteropathogen isolates in stool samples from children without diarrhea (52.23%). Shigella species were the only enteropathogen statistically related with diarrhea (OR, 2.90; P < 0.029). Enterotoxigenic, enteropathogenic, and enteroaggregative strains of Escherichia coli were not related with diarrhea, and neither were Giardia lamblia or Salmonella species.

CAMPYLOBACTER JEJUNI AS A CAUSE OF DIARRHOEA

This study was carried out to isolate and identify Campylobacter jejuni from stool samples of patients suffering from diarrhoea. The study spanned a two-year period and C. jejuni was isolated in 10 (4.5%) out of 220 patients of diarrhoea] disorders. In samples of stool collected from 50 healthy individuals, C. jejuni was isolated in one (2%) case. Further, to isolate other enteropathogens alongwith C. jejuni, procedures were undertaken simultaneously to identify Salmonella, Shigella and Vibrio cholerae infection. Salmonella sp was isolated in 8 (3.6%), Shigella sp in 4 (1.8%) and Vibrio cholerae in 10 (4.5%) cases out of 220 faecal cultures studied. In one stool specimen Shigella flexneri was isolated alongwith C. jejuni.

Campylobacter enteritis among children in north-west Ethiopia: a 1-year prospective study

The incidence of campylobacter enteritis among children visiting the outpatient department of a teaching hospital in north-west Ethiopia was prospectively studied over a period of 12 months from June 1994 to May 1995. Campylobacter spp. were isolated from the stools of 60 children out of 434 investigated by culture (13.8%). The highest isolation rate was found in children aged from 6 to 24 months. The period of peak isolation was September to November. Among children aged 1-5 years, campylobacter was more frequently isolated from those presenting with persistent diarrhoea than from among those with acute illness (OR 2.53; 95% CI: 1.02-6.18). Culture positivity was higher among malnourished children. Our findings demonstrate the important role played by this pathogen in childhood diarrhoeal illness in the area.

High prevalence of campylobacter excretors among Liberian children related to environmental conditions

Campylobacter was the bacterial pathogen most prevalent in 859 children, aged 6-59 months, examined in a house-to-house diarrhoea survey in two Liberian communities. 44.9% of the children from an urban slum and 28.4% from a rural area were excretors. Since the prevalence of diarrhoea was very high and consequently many convalescent carriers were found, it was not possible to evaluate the pathogenic role of campylobacter. The excretor rate increased with age and was significantly correlated to the use of supplementary feeding, inversely correlated to the quality of the water supply, and also associated with helminthic infestation. Results from re-examination of 172 children suggested a high intensity of transmission. The findings all indicate the existence of a heavy environmental contamination with campylobacter, probably of both human and animal faecal origin.

Campylobacter infections: the emerging national pattern

In the United States, 8,837 Campylobacter isolates and eight outbreaks of Campylobacter infections were reported in 1984, a national isolation rate of 4.9/100,000. C. jejuni represented 99 per cent of reported isolates. Age-specific incidence was highest among infants (11/100,000), and young adults (8/100,000); infants in the second month of life were at highest risk. An unexplained nationwide November peak, not observed in previous years, occurred in all age groups and suggests there is an homogeneous nationwide source for this infection.

The aetiology of diarrhoea in a farming community in Zimbabwe

A survey of enteric pathogens in 143 children with diarrhoea, 116 age-matched controls and 524 asymptomatic people of all ages in a commercial farming area was carried out over a period of one year. Giardia lamblia was detected in 34% of the cases, 29% of the controls and 23% of asymptomatic people of all ages. Various bacterial pathogens (Campylobacter, Shigella, Salmonella and enteropathogenic Escherichia coli) were isolated from 23% of the cases and 15% of the controls. Enteropathogenic E. coli was isolated as frequently from the cases as from the controls and asymptomatic people of all ages.

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.

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.

Demonstration of a cytotoxin from Campylobacter jejuni

A 48-hour culture filtrate of Campylobacter jejuni was found to produce cytopathic effects on three human cell lines--that is, HeLa, MRC-5 and Hep-2. The cytopathic effects observed include cell rounding, loss of adherence and cell death after 24-48 h of incubation. Such morphological changes were observed with eight of the eleven strains of Campylobacter jejuni isolated from the blood/stools of patients who suffered from either acute gastroenteritis or septicaemia. The toxic factor did not retain its activity after treatment at 100 degrees C for 30 min. Trypsinisation of the filtrate totally abolished its toxic activity thus indicating that it was probably protein in nature. It is most probably an extracellular toxin as bacterial sonicates did not produce any toxic effect. This study reports the finding of toxic factor(s) in the culture filtrate of Campylobacter jejuni which is cytotoxic to human tissue culture cells.

Age related susceptibility to Campylobacter jejuni infection in a high prevalance population

In a year long prospective study of diarrhoea in children under 2 years of age in Soweto, South Africa, Campylobacter jejuni was isolated in 18 of 60 children under 9 months of age with diarrhoea, compared with 4 of 60 age matched controls. In the older children, 16 of 51 children with diarrhoea and 17 of 51 control children excreted this organism in their faeces. These results indicate a change in susceptibility to C jejuni in children over 9 months of age. Campylobacter enteritis in the young children was usually mild, without macroscopic blood in the faeces, and prolonged excretion of the organism after acute attacks was not infrequent. Breast feeding did not seem to protect against colonisation with C jejuni.

Cholera-like enterotoxin produced by Campylobacter jejuni. Characterisation and clinical significance

The presence and clinical significance of enterotoxins produced by Campylobacter jejuni were investigated. The supernatant of a prototype virulent strain grown in supplemented medium induced intraluminal fluid secretion in rat ileal loop but not in rabbit ileal loop or the infant mouse assay. It induced elongation and increased intracellular cyclic AMP levels in Chinese hamster ovary cells. Toxin activity was blocked by cholera antitoxin and was destroyed by heat and high or low pH; its molecular weight is in the range 10(4)-10(5) daltons. Toxin production was detected in 24 of 32 C jejuni strains from patients with diarrhoea and 1 of 6 from carriers. Antibody response to autologous C jejuni somatic antigen was investigated in 19 subjects for whom serial serum specimens were available. A fourfold rise was observed in all 10 patients with enterotoxigenic C jejuni diarrhoea, in 1 of 3 patients with non-enterotoxigenic C jejuni, and in none of the symptomless carriers of non-enterotoxigenic strains. These findings demonstrate that C jejuni produces an enterotoxin that may be important in pathogenesis of diarrhoea.

Studies on well water and possible health risks in Katsina, Nigeria

Well water was sampled from all four major wards in Katsina town. All 20 samples taken showed high coliform counts. Sixty-five per cent contained greater than or equal to 2400 coliforms per 100 ml while the remainder had counts ranging from 79 to 920. Faecal coliforms and non-cholera vibrios were detected in all samples. There was no significant relationship between the coliform counts and the distances of latrines to wells, water table to ground level, slope relationship between wells and latrines, the pH of water and whether the wells were left permanently open or not. Salmonella sp., Enterobacter sp. and Pseudomonas sp. were each isolated from about 10% of the samples, while Proteus sp. was isolated from 40%, Citrobacter sp. 15%, Alcaligenes sp. 5% and an unidentified Gram-negative rod from 5%. Only 2 (10%) of the sampled households, representing 23 (9.6%) of the 239 people exposed to well-water had pipeborne water in addition. It was concluded that well water in Katsina town could be a human health hazard.

Campylobacter jejuni enteritis in Honolulu, Hawaii

The incidence of Campylobacter jejuni in patients with acute diarrhoea was studied in Honolulu, Hawaii. C. jejuni was recovered from 8.7% of diarrhoeal stools, compared to isolation rates of 4.2% for Salmonella and 3.8% for Shigella. C. jejuni occurred mainly in the summer and autumn, and in all age and racial groups. There was a significantly higher incidence of abdominal pain, fever history, bloody stools and faecal leucocytes in patients with Campylobacter enteritis.

A comparison of the prevalence of campylobacter, Shigellae and Salmonellae in faeces of malnourished and well nourished children in The Gambia and Northern Nigeria

The proportion of children in whom bacterial pathogens were isolated in faeces was compared in 59 malnourished and 59 age-matched well nourished children in Fajara, The Gambia, with 38 malnourished and 38 age-matched well nourished children in Malumfashi, Northern Nigeria. Campylobacters were identified more frequently in malnourished (10.2%) and well nourished (6.8%) children in The Gambia than in malnourished (2.6%) and well nourished (2.6%) children in Nigeria. Salmonellae were more frequently isolated in the malnourished Nigerian children (28.9%) than in the malnourished Gambian children (3.4%) and were present in similar proportions (5.1% and 5.3%) in well nourished children in both communities. Shigellae were isolated in a few individuals in each group. The differences in the epidemiology of these enteropathogens are discussed with respect to the differences in ecology between these two sub-Saharan, savanna communities.

Isolation and characterization of Campylobacter jejuni from acute diarrhoeal cases in Calcutta

During a seven-month survey, Campylobacter jejuni was isolated from 9.6% of the 116 acute diarrhoeal cases admitted to the Infectious Diseases Hospital, Calcutta. In six of the 11 cases, C. jejuni occurred together with V. cholerae biotype El Tor (Ogawa) while in one case it was found in association with Shigella sonnei. No age or sex specific incidence was observed. A distinct clinical profile in cases suffering from Campylobacter enteritis was not discernible. Biochemically all strains isolated in this study conformed to the typical reported characteristics of C. jejuni. Survival of the organism in positive stool samples held at 4 degrees C without any transport medium was limited. This preliminary study indicates that C. jejuni is an important aetiological agent of acute diarrhoea and must be routinely monitored in enteric laboratories in India.

Campylobacter jejuni survival in chicken meat as a function of temperature

Recognition of Campylobacter fetus subsp. jejuni (referred to hereafter as C. jejuni) as an important human pathogen and its isolation from meat products indicate the need for knowledge of its survival characteristics in meats. Thermal death times (D-values) for a single strain and a five-strain composite were determined in 1% peptone and autoclaved ground chicken meat at temperatures ranging from 49 to 57 degrees C. Survival was determined for these strains in chicken meat at 4, 23, 37, and 43 degrees C. Survival was also determined on raw chicken drumsticks stored at 4 degrees C in either an ambient or a CO2 atmosphere. D-values were greater in chicken meat than in peptone in all cases. D-values in peptone for strain H-840 at 49, 51, 53, 55, and 57 degrees C were 15.2, 4.90, 1.71, 0,64, and 0.25 min, respectively. The corresponding D-values in ground chicken meat were 20.5, 8.77, 4.85, 2.12, and 0.79 min, respectively. Similar results were obtained with a composite of five strains. When sterile ground chicken meat was inoculated with approximately 10(6) to 10(7) C. jejuni cells per g and stored at 37 degrees C in an ambient atmosphere, a 1-to 2-log count increase occurred during the first 4 days, followed by a gradual decline of about 1 log during the remainder of the 17-day storage period. No growth was observed among similarly inoculated samples that were stored at 4, 23, and 43 degrees C but counts declined by about 1 to 2 logs at 4 degrees C (17 day), by 2.5 to 5 logs at 23 degrees C (17 days), and to undetectable levels at 43 degrees C (between 10 and 16 days). Survival on raw chicken drumsticks stored at 4 degrees C in CO2 and in an ambient atmosphere declined by about 1.5 and 2.0 logs, respectively, during 21 days of storage. The effect of temperature on the survival of C. jejuni in chicken meat was similar to that reported in other natural and laboratory milieus. Ordinary cooking procedures that destroy salmonellae would be expected to destroy C. jejuni.

Prevalence of Campylobacter fetus subsp. jejuni in healthy populations in southern India

Campylobacter fetus subsp. jejuni was isolated from the feces of 14.8% of a random sample of the healthy population of rural southern India. The rate of isolation was highest in preschool children. This finding emphasizes the need to identify markers of pathogenicity in strains of C. fetus subsp. jejuni, which so far are identified only by cultural characteristics. The pathogenic role of this organism in patients with diarrhoea in tropical developing countries can be understood when such markers of pathogenicity are found.

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.

Intestinal occurrence of Campylobacter fetus subspecies jejuni and Clostridium difficile in children in Sweden

Stool samples were cultured from 356 children in different states of health and in different age groups between birth and six years of age in order to investigate the occurrence of Campylobacter jejuni and Clostridium difficile. Campylobacter jejuni was isolated from two of 56 children with diarrhoea but was not isolated from any of 300 healthy children or children recently treated with antibiotics. Campylobacter jejuni does not seem to be a common cause of diarrhoea in children in Sweden and is definitely not a member of the normal fecal flora. Clostridium difficile was isolated from 17 of 100 healthy children one week to one year old, and from one of 100 perinatal children. About the same isolation frequency was found in children with diarrhoea and in children recently treated with antibiotics. A total of 34 isolates of Clostridium difficile were obtained, 29 of which were from children less than one year old. The isolation of Clostridium difficile in stools of children should in most cases be considered a normal finding.

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.

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.

Gastroenteritis due to Campylobacter jejuni in Riyadh, Saudi Arabia

During one year, 1452 specimens of faeces from patients with diarrhoea were investigated for Campylobacter jejuni. This organism was isolated from nine specimens only (0.6%). None was isolated from 160 control subjects who did not have diarrhoea. Though the number of isolates is small, diarrhoea due to C. jejuni was found to be more common in males; the ratio of males to females was 7:2. Out of the nine patients, only four were Saudis. This indicates that Campylobacter gastroenteritis exists in this part of the world. Its incidence was, however, much lower than gastroenteritis due to other bacterial pathogens which constituted 7%. The source of infection was possibly chickens, both live and dressed. Most of the latter are imported.

A comparison of two media for the isolation of campylobacter in the tropics

Two selective media for the isolation of campylobacter from the faeces have been compared. Both have a similar isolation rate, but Butzler's medium allows easier identification and sub-culturing of campylobacter than Skirrow's medium because it is more inhibitory to other faecal organisms. Butzler's medium is made with sheep blood which is usually more easily available in Africa, so for these reasons it may be a more suitable medium for use there.

Campylobacter enteritis in The Gambia

In a three-month survey in The Gambia, campylobacters were isolated from 14.3% of 287 patients suffering from diarrhoea and from 4.2% of 383 patients and controls without diarrhoea. The equivalent figures for shigellas were 6.3% and 2.1%, and for salmonella 7.0% and 2.6% respectively. 53 (93%) of the 57 campylobacters were isolated from children less than five years old; none were isolated from indigenous adults (greater than 15 years old). By using two selective media in parallel (Butzler's medium and Skirrow's medium), it was found that the number of isolations was increased by one third over that obtained with either medium alone. It is concluded that in The Gambia the transmission of campylobacters is of high intensity, with most infections occurring in young children, in whom these organisms are an important cause of morbidity and mortality.

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 fetus subsp. jejuni as a cause of gastroenteritis in Jakarta, Indonesia

Campylobacter fetus subsp. jejuni was isolated from the feces of 15 out of 144 (10%) children (0 to 9 years old) and 4 out of 251 (2%) adults with gastroenteritis and was found together with another enteric pathogen in 2 of the children and in all 4 adults. It was isolated from 2 out of 7 (28%) children and 3 out of 160 (2%) adults with suspected typhoid fever. The bacterium was recovered from 3 out of 4 orphanage children with diarrhea and from 1 without symptoms and was isolated from only 1 child in a control group of 221 persons.

Bacteriostatic and bactericidal activities of 24 antimicrobial agents against Campylobacter fetus subsp. jejuni

The bacteriostatic and bactericidal activities of 24 antimicrobial agents were tested with the Dynatech MIC 2000 system against 86 strains of Campylobacter fetus subsp. jejuni from human sources. The penicillins (penicillin G, ampicillin, amoxycillin, carbenicillin) had poor activity. Ampicillin and amoxycillin were equally active. Cefotaxime revealed a rather good activity. Erythromycin, gentamicin, tobramycin, amikacin, and furazolidone were the most active compounds. Two strains (2.3%) were resistant to erythromycin. One strain (1.2%) was completely resistant to tobramycin. The tetracyclines (tetracyline, doxycycline, minocycline) were generally effective, but 8% of the strains were totally resistant to them. Minocycline was the most active. Chloramphenicol, thiamphenicol, and clindamycin had good activity. The bacteriostatic and bactericidal distributions for colistin, nalidixic acid, and metronidazole were broad.

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.

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.

Campylobacter fetus infection in human subjects: association with raw milk

Within a three week period, four cases of Campylobacter fetus infection were identified in a hospital in Los Angeles County. Three of the four patients had drunk large quantities of an identical brand of commercially available certified raw milk. Campylobacter fetus subspecies jejuni was isolated from the blood of these three patients. The fourth patient, who did not drink raw milk, had Campylobacter fetus subspecies intestinalis isolated from his blood. A telephone survey comparing cases and controls for possible risk factors associated with Campylobacter fetus infection confirmed the association with raw milk (P = 0.003). In a serologic survey, evidence suggested that Campylobacter fetus infection was associated with raw milk consumption.

Campylobacter enteritis in children

In 37 children with Campylobacter enteritis seen over a 6-month period, ages ranged from 2 weeks to 15 years. The sex ratio (male:female) was three:two. Fever, diarrhea, and bloody stools occurred in about 90% of patients. Blood appeared in the stools characteristically 2 to 4 days after onset of symptoms. Over 90% of older children developed abdominal pain. Vomiting was mild and occurred in 30% of patients. Dehydration was not a feature. Infection occurred in all social classes and was not associated with parental occupation, travel, or animal contact. The illness often presented characteristically and a rapid laboratory diagnosis could be made in patients presenting acutely by direct phase-contrast microscopy of stools. The organism persisted in the stools for up to seven weeks in untreated patients, but could no longer be cultured after 48 hours of therapy with erythromycin, to which all strains were highly sensitive. Significant serologic responses were elicited using a serum bactericidal assay. The Skirrow-type selective medium used by us could be improved by increasing the concentration of polymyxin B sulfate to 5 microgram/ml.

Campylobacter enteritis associated with canine infection

Campylobacter fetus ss. jejuni has recently been recognised as a human enteric pathogen. Five cases of campylobacter enteritis are described. All five patients had abdominal pain and diarrhoea. Two of the five patients had bloody diarrhoea and relapses. All the patients had been in contact with young dogs which had had diarrhoea. Campylobacter fetus ss. jejuni was isolated from these dogs or from their litter-mates. Canine infection with Campylobacter fetus ss. jejuni may be an important source of infection causing diarrhoea in man.