A rapid diagnosis of Campylobacter enteritis by direct smear examination

Impact of changing from staining to culture techniques on detection rates of Campylobacter spp. in routine stool samples in Chile

BACKGROUND

Campylobacter is a leading cause of bacterial gastroenteritis, but sensitive diagnostic methods such as culture are expensive and often not available in resource limited settings. Therefore, direct staining techniques have been developed as a practical and economical alternative. We analyzed the impact of replacing Campylobacter staining with culture for routine stool examinations in a private hospital in Chile.

METHODS

From January to April 2014, a total of 750 consecutive stool samples were examined in parallel by Hucker stain and Campylobacter culture. Isolation rates of Campylobacter were determined and the performance of staining was evaluated against culture as the gold standard. Besides, isolation rates of Campylobacter and other enteric pathogens were compared to those of past years.

RESULTS

Campylobacter was isolated by culture in 46 of 750 (6.1 %) stool samples. Direct staining only identified three samples as Campylobacter positive and reached sensitivity and specificity values of 6.5 and 100 %, respectively. In comparison to staining-based detection rates of previous years, we observed a significant increase of Campylobacter cases in our patients.

CONCLUSION

Direct staining technique for Campylobacter had a very low sensitivity compared to culture. Staining methods might lead to a high rate of false negative results and an underestimation of the importance of campylobacteriosis. With the inclusion of Campylobacter culture, this pathogen became a leading cause of intestinal infection in our patient population.

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

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

Impact of different storage factors on the survivability of Campylobacter jejuni in turkey meat

Campylobacter jejuni is often prevalent in turkey and poultry, but the effects of storage temperatures and storage periods and the interruption of the cooling chain on its survival have not been evaluated so far. In this study, 700 samples of turkey meat were artificially contaminated by inoculating their surface with 10(3) CFU of C. jejuni per sample, wrapped in airtight cellophane bags, and stored under different chilling and freezing conditions for various storage periods; this was followed by analysis of the cultures. Subsequent to incubation at 25 degrees C for 48 h, C. jejuni was reisolated in only 7% of the samples. When the samples were stored under refrigerator conditions at 4 degrees C, the organism was reisolated in 42% of the samples after 1 week, and in 28% of the samples after 2 weeks. The recovery rates in the samples that had been stored frozen at -20 degrees C without interruption of the cooling chain were 68% after 2 weeks and 24% after 4 weeks. Different storage conditions were simulated in order to examine the impact of an interruption of the cooling chain on the survival of Campylobacter.

Detection of Campylobacter species in faecal samples by direct Gram stain microscopy

AIMS

To evaluate the Gram stain with carbol-fuchsin counterstain for the rapid detection of Campylobacter species in faecal samples.

METHODS

In total, 842 consecutive diarrhoeic faecal samples were prospectively examined for Campylobacter species by Gram stain and culture.

RESULTS

Campylobacter species were isolated from 84 faecal samples (all Campylobacter jejuni). Compared with culture, Gram stain microscopy had a sensitivity of 89%, specificity of 99.7%, positive predictive value of 97%, and negative predictive value of 99% for detecting Campylobacter species.

CONCLUSIONS

The direct Gram stain method can provide a presumptive result within 30 minutes of receipt of a faecal sample in the laboratory with relatively high sensitivity, and at low cost. Laboratories in areas where Campylobacter enteritis is common and/or with limited resources for Campylobacter culture should consider adopting this as a routine method.

Rapid Immunoassay for detection of Escherichia coli O157 directly from stool specimens

A new and rapid ( < 1 h) enzyme-linked immunosorbent assay (ELISA) was compared with conventional sorbitol-MacConkey agar (SMAC) culture for the detection of Escherichia coli O157 from stool specimens. Among 34 positive specimens, confirmed by colony-sweeping and immunofluorescence stain methods, 6 did not exhibit visible sorbitol-negative colonies on SMAC. These six specimens would have been considered to be negative if SMAC alone had been used. The ELISA detected 31 of the 34 positive samples, including 5 of the above-mentioned 6 false-negative samples, resulting in a sensitivity and specificity of 91.2 and 99.5%, respectively. Cross-reactivity with other enteric pathogens was not noted by ELISA. The SMAC method had a sensitivity and specificity of 82.4 and 100%, respectively. The ELISA-negative specimens do not require culture confirmation, whereas positive results must be considered to be presumptive until confirmed by culture. The test is accurate and is easy to perform, making it a very efficient method for screening stool specimens for E. coli O157.

Detection of campylobacter by immunofluorescence in stools and rectal biopsies of patients with diarrhoea

Rabbit antiserum, elicited by the intravenous injection of a strain of Campylobacter jejuni heated to 100 degrees C, cross reacted strongly with all other thermophilic campylobacters tested as well as with "C pyloridis" and could be detected by indirect fluorescence with labelled anti-rabbit serum. Antisera to formalin killed cells did not do so. The correlation of positive stool culture with positive immunofluorescence of stools and rectal biopsies from patients with diarrhoea was 70-80%. Some inconsistent, weak reactions showing differently shaped organisms have been seen with some strains of Bacteroides fragilis. Wolinella spp reacted weakly, but one strain of Vibrio cholerae tested did not. Other intestinal organisms, commensals, and pathogens tested were negative.