Epidemiological aspects of enteritis due to Campylobacter spp. in Norway

Role of aeromonas isolated from feces of Finnish patients

Aeromonas species were isolated from 249/13,027 (1.9%) stool samples submitted to the Dept. of Bacteriology and Immunology, University of Helsinki, during 1 year, to be cultured for bacterial enteropathogens. Aeromonas was the third most common enteropathogen isolated, after campylobacter (3.6%) and salmonella (3.3%). Isolates and clinical information from 234 Aeromonas patients were available for further study. A. caviae (41%), A. hydrophila (27%), and A. veronii biovar sobria (22%) were the most frequent isolates. In 15% of the patients, other enteropathogens were found along with aeromonas. Only 2% of all aeromonas-positive patients were found to be asymptomatic, whereas no aeromonas isolates were detected in the stools of 343 asymptomatic individuals. Almost all (96%) patients with aeromonas in their feces had gastroenteritis. Patients infected with A. veronii biovar sobria had a shorter illness course and had more often travelled abroad. In conclusion, Aeromonas spp. were found to be a potential cause of diarrhea in Finnish patients.

Campylobacter enteritis in Saudi Arabia

A 12-month survey on the incidence of campylobacter infection in 1217 patients with diarrhoea was carried out in Jeddah, Saudi Arabia. Campylobacters were isolated from 55 (4.5%) patients, second in prevalence to salmonellas (6.2%). Shigellas were isolated from 4.2% of patients. Campylobacter isolation rates were high in children of all ages, as well as in young adults (36.5% of all isolates were from adults aged 20-39 years). Isolation rates peaked in September and November. Analysis of the results showed that 69% were Campylobacter jejuni (mostly biotype IV) and 31% C. coli. Serogroups 5 and 23 (Penner scheme) and phage type 125 (Preston scheme) were most frequently isolated. Resistance to erythromycin and tetracycline was observed in 7.3 and 32.7% of the isolates. Campylobacters are an important cause of bacterial enteritis in Saudi Arabia, both in adults and in children, and should be sought routinely.

Enterotoxigenicity and frequency of Campylobacter jejuni, C. coli and C. laridis in human and animal stool isolates from different countries

Campylobacter jejuni and C. coli strains were collected during three different years from adult patients with enterocolitis in Sweden (n = 372) from 49 patients in Kuwait, and Campylobacter strains from hens from Mexico, Pakistan and Sweden (n = 107) and Swedish pigs (n = 47). C. jejuni was the predominant species in human and hen isolates, and C. coli in pigs C. coli was significantly more common in human isolates from Sweden, and more common in hen isolates from Pakistan, than in hens from Sweden and Mexico. C. laridis was only isolated from pigs (17%) and was in no case enterotoxigenic. Both in human and hen isolates, C. jejuni strains were more enterotoxigenic than C. coli strains. C. jejuni strains from Swedish hens were less enterotoxigenic than those from Pakistan and Mexico (P less than 0.001), and strains from pigs were less enterotoxigenic than those from hens (P less than 0.001). We conclude that C. jejuni are more often enterotoxigenic and possibly more virulent than c. coli and C. laridis. The relative frequency of C. jejuni and C. coli in humans and animals differs from one country to another.

Antibody response to Campylobacter coli in children during intestinal infection and carriage

In the Central African Republic, etiological studies of diarrhea have shown that Campylobacter coli accounts for almost 40% of Campylobacter enteric isolations. This prompted us to investigate the antibody response to C. coli infection in children. As expected from the literature on Campylobacter jejuni infections, our results show that both infection and carriage elicited antibodies against glycine-extracted membrane antigens, flagella, and cholera toxin. The human antibody response to C. coli resembles the response to C. jejuni, and this similarity will allow comparative studies on larger numbers of infections, both symptomatic and asymptomatic. Anti-cholera toxin antibodies were directed against both the A and B subunits.

Expression of Campylobacter jejuni invasiveness in cell cultures coinfected with other bacteria

Enteroinvasive Salmonella, Shigella, and Escherichia coli strains were found to exert an effect which rendered Campylobacter jejuni capable of intracellular localization in epithelial cells in vitro. When monolayers of HEp-2 or A-549 cells were challenged with pure cultures of C. jejuni or Campylobacter coli, none of the eight strains tested invaded the cells. In contrast, four of these strains were able to localize intracellularly when the cells were challenged with a mixture of campylobacters and enteroinvasive Salmonella typhimurium, Shigella flexneri, Shigella boydii, Shigella sonnei, or E. coli strains. Invasiveness of campylobacters was also induced by one nonenteroinvasive strain of E. coli O124. Coinfection with other nonenteroinvasive E. coli strains did not induce invasiveness in C. jejuni. The degree of internalization induced by S. typhimurium was significantly higher than that induced by Shigella or E. coli strains. The invasive capacity of C. jejuni was found to differ considerably between strains. No evidence of an invasive potential was demonstrable for two C. coli strains or for two enterotoxigenic isolates of C. jejuni examined. C. jejuni was only able to localize intracellularly in cell cultures when the interaction occurred in a microaerobic atmosphere. None of the strains tested evoked keratoconjunctivitis in guinea pig eyes (Sereny test), regardless of the presence of coinfectants. The results indicate that a synergistic interaction that exists between C. jejuni and other enteropathogens facilitates invasion by C. jejuni.

Campylobacter etiology in human gastroenteritis demonstrated by antibodies to acid extract antigen

Campylobacter antibodies of the immunoglobulin G (IgG), IgM, and IgA classes were determined by enzyme immunoassay with acid glycine extract antigen in patients and controls involved in two Campylobacter outbreaks and in 266 unselected patients with acute enteritis. The assay showed a specificity of 99% for each immunoglobulin class in sera from 200 healthy blood donors. Elevated Campylobacter antibody titers were shown in 97% of stool culture-positive patients involved in the outbreaks. Rapid changes of IgA and IgM Campylobacter antibodies were typical of the early phase of serologic response in the outbreaks and thus offered the best diagnostic value in the serologic diagnosis of acute campylobacteriosis. In unselected patients with acute enteritis, the assay revealed elevated Campylobacter antibody titers in 37 patients, of whom only 12 had had positive Campylobacter stool cultures. In the sera of patients with other bacterial findings in addition to high titers of Campylobacter antibodies, no cross-reacting antibodies were found, but there was evidence of several mixed infections.

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.

Occurrence, serotypes and biotypes of thermophilic Campylobacters isolated in Vienna

During the 1982-1986 period of all bacterial pathogens found to have caused diarrhoea, 35% belonged to the genus Campylobacter (C). Approximately 70% of the strains were isolated from persons under the age of 30 years, with a distinct peak of occurrence in the autumn. Biotyping and serotyping according to Lior yielded the following results: C. jejuni biotype I: 32.9%, C. jejuni biotype II: 48.6%, C. coli biotype I: 10.3%, C. coli biotype II: 8.2%. From the 121 strains serotyped, 118 (97.5%) were typable. The serotypes most frequently encountered were type 1 (15.7%), 4 (9.9%), 2 and 11 (7.4% each). There were 2 familial outbreaks of Campylobacter enteritis which could be completely elucidated by biotyping and serotyping. One outbreak was caused by C. jejuni biotype I serotype 11, the other by C. jejuni biotype II serotype 6. Considering the frequent occurrence of Campylobacter infections, isolates should be routinely typed. The existing typing methods and schemes are highly developed.

Polymicrobial infection in campylobacter enteritis

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Serotyping of Campylobacter jejuni, Campylobacter coli, and Campylobacter laridis from domestic and wild animals

By using 50 unabsorbed antisera, we were able to serotype 272 (65.7%) of 414 thermotolerant campylobacters from wild and domestic animals, on the basis of heat-stable antigens identified by means of passive hemagglutination. Forty-two serotypes were recognized. The pattern of serotypes detected in the various animal species was compared to human clinical isolates by using the Czekanowski index (proportional similarity index). The highest degree of similarity to the clinical isolates was observed for the poultry isolates, followed by strains from wild birds, flies, and pigs (in order of decreasing similarity). The serotypes recovered most frequently from poultry (LAU 1 and LAU 2) were also most prevalent in Norwegian patients. In contrast, serotype LAU 35/44, the predominant porcine serotype, was never recovered from human clinical specimens. Flies captured in chicken farms and in piggeries harbored serotypes which were also commonly seen in chickens and pigs, respectively. Nine of the strains included in this study could not be ascribed to any defined species. All of these were resistant to nalidixic acid and did not produce H2S.

Serotyping and biotyping of Campylobacter jejuni and Campylobacter coli from sporadic cases and outbreaks in Norway

Of 172 thermophilic campylobacters isolated from human cases of gastroenteritis in Norway, 149 (86.6%) were classified as Campylobacter jejuni, whereas 23 isolates (13.4%) belonged to Campylobacter coli. C. jejuni biotype 1 comprised 66.3% and C. jejuni biotype 2 comprised 20.3% of the total number. Using 50 unabsorbed antisera, we were able to serotype 109 (80.1%) of 136 campylobacters on the basis of heat-stable antigens identified by means of passive hemagglutination. The typable strains fell into 36 different serotypes. A large proportion of the strains were isolated from travellers returning from abroad, a state of affairs which may have influenced the serotype and biotype distribution. Two family outbreaks were found to be caused by a bio-serotype common to all diseased members of the particular families. A third family outbreak and an outbreak among employees at a poultry processing plant each involved two distinct strains.