Campylobacter Infection in Children in Malawi Is Common and Is Frequently Associated with Enteric Virus Co-Infections

University of Aberdeen, United Kingdom
PLoS ONE (Impact Factor: 3.23). 03/2013; 8(3):e59663. DOI: 10.1371/journal.pone.0059663
Source: PubMed


Campylobacter species are the most common cause of bacterial gastroenteritis in the developed world. However, comparatively few studies have determined the epidemiological features of campylobacteriosis in resource-poor settings.
A total of 1,941 faecal specimens collected from symptomatic (diarrhoeic) children and 507 specimens from asymptomatic (non-diarrhoeic) children hospitalised in Blantyre, Malawi, between 1997 and 2007, and previously tested for the presence of rotavirus and norovirus, was analysed for C. jejuni and C. coli using a real time PCR assay.
Campylobacter species were detected in 415/1,941 (21%) of diarrhoeic children, with C. jejuni accounting for 85% of all cases. The median age of children with Campylobacter infection was 11 months (range 0.1-55 months), and was significantly higher than that for children with rotavirus and norovirus (6 months and 7 months respectively; P<0.001). Co-infection with either rotavirus or norovirus was noted in 41% of all cases in the diarrhoeic group. In contrast, the detection rate of Campylobacter in the non-diarrhoeic group was 14%, with viral co-infection identified in 16% of children with Campylobacter. There was no association between Campylobacter detection rate and season over the 10 year period.
Using molecular detection methodology in hospitalised Malawian children, we have demonstrated a high prevalence of Campylobacter infection, with frequent viral co-infection. The burden of Campylobacter infection in young African children may be greater than previously recognised.

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    • "These differences may reflect differences in environment, context and study design between settings. In addition, technical difficulties in the isolation of Campylobacter species in developing countries, due to their fastidious growth requirements and/or the relative insensitivity of culture techniques, may influence detection rates [29]. We do not have data on the presence of other bacterial or parasitic pathogens, thus we are therefore unable to ascertain which pathogen is the causative agent of the diarrhoeal episode. "
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    ABSTRACT: Background Campylobacter infection is the most common cause of bacterial gastroenteritis in developing countries, including Madagascar. Reports of pathogenicity have not been consistent and repeated exposures over time seem to lead to the development of protective immunity in developing areas. We conducted this study to support evidence for these hypotheses by exploring the association between infection and age, the reoccurrence of infection and the pathogenicity of Campylobacter. Methods We carried out a community-based longitudinal study of children under the age of 24 months in two rural villages in Moramanga, Madagascar. Children were visited twice a week and a stool specimen was collected in cases of diarrhoea. Stools specimens were collected bimonthly from all children enrolled, regardless of symptoms. Children were followed-up until the age of 36 months. Results Between January 2010 and May 31st 2012, 508 children were included in the cohort. We detected 319 episodes of Campylobacter infection in total, and 43.3% (n = 220) of the children had at least one episode of intestinal Campylobacter infection. The rate of Campylobacter isolation from stool specimens was 9.3%. The annual incidence rate for symptomatic Campylobacter infection was 0.05 episodes/child. The probability of Campylobacter infection was highest between the ages of six and 23 months. Taking children under six months of age as the reference group, the age-specific odds ratio for the association was 5.0 (95% CI: 2.9-8.6) for children aged six to 11 months, 5.7 (95% CI: 3.3-10.0) for children aged 12 to 17 months and 3.3 (95% CI: 1.8-5.8) for children aged 18 to 23 months. A second episode of infection occurred 63 days after the first episode in children with primary infections, and after 137 days in children with multiple infections (p < 0.01). First episodes of Campylobacter infection were associated with diarrhoea (odds ratio = 16.1; 95% CI: 1.8-140.8). Conclusion Our findings suggest that protective immunity to Campylobacter may be acquired over time, following repeated exposures. However, Campylobacter infection prevention measures should be reinforced in the first year of life, as this age seems to be associated with the highest risk of diarrhoea during Campylobacter infection.
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    Diagnostic Microbiology and Infectious Disease 01/2013; 78(3). DOI:10.1016/j.diagmicrobio.2013.11.021 · 2.46 Impact Factor
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    ABSTRACT: Campylobacter is a common bacterial enteropathogen that can be detected in stool by culture, enzyme immunoassay, or PCR. We compared culture for C. jejuni/coli, EIA (ProSpecT), and duplex PCR to distinguish Campylobacter jejuni/coli and non-jejuni/coli Campylobacter on 432 diarrheal and matched control stool samples from infants in a multisite longitudinal study of enteric infections in Tanzania, Bangladesh, and Peru. Sensitivity and specificity of culture was 8.5% and 97.6% respectively compared with EIA and 8.7% and 98.0% compared with PCR for C. jejuni/coli. Most (71.6%) EIA-positive samples were positive by PCR for C. jejuni/coli but 27.6% were positive for non-jejuni/coli Campylobacter species. Sequencing of 16S rRNA from 53 of these non-jejuni/coli Campylobacter samples most closely matched C. hyointestinalis subsp. lawsonii (56%), C. troglodytis (33%), C. upsaliensis (7.7%) and C. jejuni/coli (2.6%). Campylobacter negative stool spiked with each of the above Campylobacter species revealed reactivity with EIA. PCR detection of Campylobacter species was strongly associated with diarrhea in Peru (OR 3.66, P < .001) but not in Tanzania (OR 1.56, P = .24) or Bangladesh (OR 1.13, P = .75). According to PCR, Campylobacter jejuni/coli infections represented less than half of all infections with Campylobacter species. In sum, in infants in developing country settings the ProSpecT EIA and PCR for Campylobacter reveal extremely high rates of positivity. We would propose the use of PCR because it retains high sensitivity, can ascertain burden, and can distinguish between Campylobacter infections at the species level.
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