Campylobacteriosis, Shigellosis and Salmonellosis in Hospitalized Children with Acute Inflammatory Diarrhea in Georgia.

Maia Metreveli,Salome Bulia,Kerstin Stingl,Iamze Shalamberidze,Juan Cruz Goenaga,Shota Tsanava,Paata Imnadze,Liana Tevzadze

doi:10.3390/pathogens11020232

Abstract

This is the first study on campylobacteriosis carried out in Georgia. It targeted 382 hospitalized children with acute inflammatory diarrhea. The study was conducted between July 2020 to July 2021 based on the main infection clinic of the capital city. Culture-based bacteriological methods were followed by phenotypic and Real-time PCR tests for bacterial confirmation and identification. The data revealed recent epidemiologic prevalences of the three main causative bacteria in the target population. Shigella sonnei with 19.1% (95% CI: 15.2–23.4%) was the most frequently detected pathogen followed by Campylobacter spp. with 12.3% (95% CI: 9.2–16.0%) and Salmonella spp. with 4.9% (95% CI: 3.0–7.6%). However, in 63.6% of the samples, the causative agent remained unknown. Species differentiation of Campylobacter spp. revealed 81% Campylobacter jejuni and 19% Campylobacter coli. An epidemiological pyramid with estimated magnification factors may give more insights into the burden of campylobacteriosis among the studied population, resulting in a putative annual incidence of 6 per 1000 children in Tbilisi. Children with campylobacteriosis were younger (median age 40 months (interquartile range (IQR) 22−95)) than with shigellosis (median age 92 months (interquartile range (IQR) 52−140)). However, no statistically significant difference was found with the age range of patients with campylobacteriosis and salmonellosis as well as with salmonellosis and shigellosis. In conclusion, Campylobacter spp. may be suspected to be the second most frequent bacterial causative agent of acute inflammatory diarrhea in hospitalized children and the primary cause in the 0–3 age group in Georgia. In addition, Campylobacter CROMagar showed better selectivity in comparison to mCCDA selective agar of stool samples in our study.

Highlights

Campylobacter is the leading food-borne bacterial pathogen, causing gastroenteritis worldwide
382 stool samples were collected between July 2020 and July 2021 from hospitalized children with acute inflammatory diarrhea and gastroenteritis
Our results showed that campylobacteriosis might be the second leading bacterial cause of acute inflammatory diarrhea in hospitalized children in the country

Summary

Introduction

Campylobacter is the leading food-borne bacterial pathogen, causing gastroenteritis worldwide. Infection with Campylobacter cause acute, mostly self-limited gastrointestinal illness characterized by diarrhea, fever and abdominal cramps [3]. Clinical outcomes in most patients are reported as watery and bloody diarrhea and increased bowel movements per day during acute illness [4]. Most patients with Campylobacter infection have a self-limited illness for 3 to 7 days [5]. There are, severe cases with a need for antibiotic treatment, which include patients with high fevers, bloody stools, prolonged illness, pregnancy and immunocompromised states [6,7,8]. In around 30% of the reported cases in Germany, antibiotic treatment, in particular, fluoroquinolones and macrolides, were used [9]. Campylobacter infections can cause long-term autoimmune sequelae, such as reactive arthritis, irritable bowel syndrome and the Guillain-Barré syndrome. The results indicated that Campylobacter may account for up to 41% of all cases of Guillain-Barré syndrome [10]

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Discussion

Conclusion