Abstract
Campylobacter diagnosis is hampered because many laboratories continue to use traditional stool culture, which is slow and suffers false-negative results. This large multi-site study used a composite reference method consisting of a new FDA-cleared immunoassay and four molecular techniques to compare to culture. Prospectively collected patient fecal specimens (1552) were first preliminarily categorized as positive or negative by traditional culture. All specimens were also tested by EIA, and any EIA-positive or culture-discrepant results were further characterized by 16S rRNA qPCR, eight species-specific PCR assays, bidirectional sequencing, and an FDA-cleared multiplex PCR panel. The five non-culture methods showed complete agreement on all positive and discrepant specimens which were then assigned as true-positive or true-negative specimens. Among 47 true-positive specimens, culture incorrectly identified 13 (28%) as negative, and 1 true-negative specimen as positive, for a sensitivity of 72.3%. Unexpectedly, among the true-positive specimens, 4 (8%) were the pathogenic species C. upsaliensis. Culture had a 30% false result rate compared to immunoassay and molecular methods. More accurate results lead to better diagnosis and treatment of suspected campylobacteriosis.
Highlights
Cases of Campylobacter spp.-associated gastroenteritis and diarrhea are increasing, not just in under-developed countries, but in developed countries such as the USA and Australia as well [1, 2]
This study provides a previously unavailable estimate of how many C. jejuni or C. coli can be detected in fecal cultures and tests how soon viability losses in Cary-Blair transport medium affect detection of Campylobacter-positive specimens by culture
Culture-detectable levels of C. jejuni and C. coli in human stool
Summary
Cases of Campylobacter spp.-associated gastroenteritis and diarrhea are increasing, not just in under-developed countries, but in developed countries such as the USA and Australia as well [1, 2]. There are nearly one million cases of Campylobacter infection that are reported each year in the USA [3]. Campylobacteriosis is endemic, with 8–45% of children being infected, whether they have diarrheal symptoms or not [4,5,6]. Part of this research was presented as a poster at the 28th ECCMID meeting April, 2018. Hershey Medical Center and College of Medicine, Pathology and Laboratory Medicine, Hershey, PA, USA 4 TriCore Reference Laboratories, Albuquerque, NM, USA
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