Abstract
Background 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.MethodsA 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.Results 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.DiscussionUsing 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.
Highlights
It is estimated that 3.552 million children under the age of five years die each year in Africa; diarrhoeal disease accounts for 11% of these deaths [1]
In the non-diarrhoeic group 41% and 59% of positive specimens occurred in the dry and wet season respectively (p = 0.89; data not shown). In this large study of Campylobacter infection in Malawian children, using a sensitive molecular assay we documented Campylobacter in 21% of specimens obtained from children,5 years of age hospitalised with diarrhoea
Estimates of the prevalence of Campylobacter infection in hospitalised children,5 years of age with diarrhoea in Sub Saharan Africa range from 1.5% in Botswana [12], 1.7% in Mozambique [8], 9% in Uganda [7], 11% in The Central African Republic [9] to 18% in Tanzania [10]
Summary
It is estimated that 3.552 million children under the age of five years die each year in Africa; diarrhoeal disease accounts for 11% of these deaths [1]. Campylobacter is a fastidious gram negative bacterium and C. jejuni and C. coli are considered the most common cause of bacterial gastroenteritis in the developed world. Estimates of the prevalence of Campylobacter infection in young children with diarrhoea in Sub Saharan Africa range from 1.5% to 18% [7,8,9,10,11]. While molecular techniques have been developed and employed for Campylobacter detection in epidemiological studies in developed countries, such methods have not been widely adopted in Sub Saharan Africa. Where molecular detection (notably PCR) was used to examine for Campylobacter species in adults and children with diarrhoea in South Africa the prevalence estimates of C. jejuni, C. coli and C. concisus were 12%, 7.5% and 2.7% respectively; only 34 of the 255 samples analysed were from children ,5 years of age [12]. Comparatively few studies have determined the epidemiological features of campylobacteriosis in resource-poor settings
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