Clinical manifestation of Campylobacter enteritis in children

Antibiotic Prescribing Practices and Clinical Outcomes of Pediatric Patients with Campylobacter Enterocolitis

Antibiotics are not routinely recommended for patients with Campylobacter enterocolitis. We conducted a retrospective review of hospitalized patients younger than 18 years diagnosed with Campylobacter enterocolitis from July 2015 to December 2019. This study aimed to investigate antibiotic prescribing practices and the clinical outcomes and to evaluate the factors associated with antibiotic use. A total of 157 patients (median age, 10.7 years) were included in this study. Most patients (93.0%) had a fever, and a quarter of the patients complained of bloody diarrhea. The overall antibiotic prescribing rate was 36.7% (57/157), 91.2% of the patients received antibiotics within hospital day 2. The semi-annual antibiotic prescribing rate ranged from 16.7 to 50.0%. There were no increasing or decreasing trends in antibiotic prescribing rates. Cephalosporins were the most prescribed antibiotics for initial antibiotic therapy. Azithromycin use increased significantly during the study period. The independent factors associated with early antibiotic therapy were leukocytosis (adjusted odds ratio (aOR), 3.95; 95% confidence interval (CI), 1.76-9.27), C-reactive protein ≥50 mg/L (aOR, 4.19; 95% CI, 1.84-10.21), and performing abdominal imaging studies (aOR, 3.44; 95% CI, 1.55-7.99). There was no significance in defervescence between the early and no-antibiotic therapy groups (p = 0.232). A careful assessment of the need for antibiotic therapy in patients with acute diarrhea should be conducted to avoid unnecessary use. After identifying the causative pathogens, the appropriateness of antibiotic prescription should be evaluated.

Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway

Very few reports describe all hospitalized patients with campylobacteriosis in the setting of a single waterborne outbreak. This study describes the demographics, comorbidities, clinical features, microbiology, treatment and complications of 67 hospitalized children and adults during a large waterborne outbreak of Campylobacter jejuni in Askoy, Norway in 2019, where more than 2000 people in a community became ill. We investigated factors that contributed to hospitalization and treatment choices. Data were collected from electronic patient records during and after the outbreak. Fifty adults and seventeen children were included with a biphasic age distribution peaking in toddlers and middle-aged adults. Most children, 14 out of 17, were below 4 years of age. Diarrhea was the most commonly reported symptom (99%), whereas few patients (9%) reported bloody stools. Comorbidities were frequent in adults (63%) and included cardiovascular disease, pre-existing gastrointestinal disease or chronic renal failure. Comorbidities in children (47%) were dominated by pulmonary and gastrointestinal diseases. Adult patients appeared more severely ill than children with longer duration of stay, higher levels of serum creatinine and CRP and rehydration therapy. Ninety-two percent of adult patients were treated with intravenous fluid as compared with 12% of children. Almost half of the admitted children received antibiotics. Two patients died, including a toddler. Both had significant complicating factors. The demographic and clinical findings presented may be useful for health care planning and patient management in Campylobacter outbreaks both in primary health care and in hospitals.

Human Immunity Against Campylobacter Infection

Campylobacter is a worldwide foodborne pathogen, associated with human gastroenteritis. The efficient translocation of Campylobacter and its ability to secrete toxins into host cells are the 2 key features of Campylobacter pathophysiology which trigger inflammation in intestinal cells and contribute to the development of gastrointestinal symptoms, particularly diarrhoea, in humans. The purpose of conducting this literature review is to summarise the current understanding of: i) the human immune responses involved in the elimination of Campylobacter infection and ii) the resistance potential in Campylobacter against these immune responses. This review has highlighted that the intestinal epithelial cells are the preliminary cells which sense Campylobacter cells by means of their cell-surface and cytosolic receptors, activate various receptors-dependent signalling pathways, and recruit the innate immune cells to the site of inflammation. The innate immune system, adaptive immune system, and networking between these systems play a crucial role in bacterial clearance. Different cellular constituents of Campylobacter, mainly cell membrane lipooligosaccharides, capsule, and toxins, provide protection to Campylobacter against the human immune system mediated killing. This review has also identified gaps in knowledge, which are related to the activation of following during Campylobacter infection: i) cathelicidins, bactericidal permeability-increasing proteins, chemokines, and inflammasomes in intestinal epithelial cells; ii) siglec-7 receptors in dendritic cell; iii) acute phase proteins in serum; and iv) T-cell subsets in lymphoid nodules. This review evaluates the existing literature to improve the understanding of human immunity against Campylobacter infection and identify some of the knowledge gaps for future research.