Acute Bacterial Gastroenteritis Research Articles

Characterization of Antibiotic Treatment among Children Aged 0-59 Months Hospitalized for Acute Bacterial Gastroenteritis in Israel.

We examined the extent and correlates of appropriate antibiotic use among children hospitalized with bacterial acute gastroenteritis (AGE) in Israel, a high-income country setting. Data were collected from children aged 0-59 months who participated in active hospital-based surveillance of AGE undertaken during 2007-2015. Bacterial AGE was defined as having a positive stool culture for Salmonella, Shigella, Campylobacter, or dysentery. Appropriate antibiotic use was defined as the administration of ciprofloxacin, azithromycin, or third-generation cephalosporins during hospitalization or at discharge. Overall, 550 children had bacterial AGE; of those, 369 (67.1% [95% CI 63.1-70.9]) received antibiotics, mostly azithromycin (61.8%) and third-generation cephalosporins (37.9%). Appropriate antibiotic treatment was given to 318/550 (57.8% [95% CI 53.7-61.9]). Children aged 0-11 months vs. 24-49 months were more likely to receive appropriate antibiotic treatment (OR = 1.90 [95% CI 1.09-3.33]). Having dysentery (OR = 5.30 [95% CI 3.35-8.39]), performing blood culture (OR = 1.59 [95% CI 1.02-2.48]), and C-reactive protein (CRP) levels (OR = 1.01 [95% CI 1.01-1.02]) were positively associated with receiving appropriate antibiotic treatment. Most children with bacterial AGE received appropriate antibiotic treatment, which correlated with young age, dysentery, CRP level, and performing blood culture, suggesting more severe illness, thus supporting the clinical decisions of physicians.

Salmonella and Salmonellosis: An Update on Public Health Implications and Control Strategies

Salmonellosis is globally recognized as one of the leading causes of acute human bacterial gastroenteritis resulting from the consumption of animal-derived products, particularly those derived from the poultry and pig industry. Salmonella spp. is generally associated with self-limiting gastrointestinal symptoms, lasting between 2 and 7 days, which can vary from mild to severe. The bacteria can also spread in the bloodstream, causing sepsis and requiring effective antimicrobial therapy; however, sepsis rarely occurs. Salmonellosis control strategies are based on two fundamental aspects: (a) the reduction of prevalence levels in animals by means of health, biosecurity, or food strategies and (b) protection against infection in humans. At the food chain level, the prevention of salmonellosis requires a comprehensive approach at farm, manufacturing, distribution, and consumer levels. Proper handling of food, avoiding cross-contamination, and thorough cooking can reduce the risk and ensure the safety of food. Efforts to reduce transmission of Salmonella by food and other routes must be implemented using a One Health approach. Therefore, in this review we provide an update on Salmonella, one of the main zoonotic pathogens, emphasizing its relationship with animal and public health. We carry out a review on different topics about Salmonella and salmonellosis, with a special emphasis on epidemiology and public health, microbial behavior along the food chain, predictive microbiology principles, antimicrobial resistance, and control strategies.

Identification of Pediatric Bacterial Gastroenteritis From Blood Counts and Interviews Based on Machine Learning.

Differentiating between bacterial and viral gastroenteritis is crucial in pediatric enteritis practice. Our objective was to use machine learning (ML) to identify acute gastroenteritis (AG) caused by bacteria based on blood cell counts and interview findings. ML was performed using a decision tree classifier based on data from previously published papers. We included 164 children between one and 108 months diagnosed with gastroenteritis, with 112 having bacterial AG and 52 having viral AG as subjects and controls. Feature selection was performed using least absolute shrinkage and selection operator (LASSO), and the classifier's performance was evaluated by five-fold cross-validation. Additionally, we presented a tree diagram of the decision tree classifier as a flowchart for practical applications. The area under curve (AUC) was 0.80, indicating a moderate model. Three important features in this model were platelet-lymphocyte ratio, eosinophil count, and leukocyte count. In conclusion, this study demonstrates that bacterial AG can be estimated from blood cell counts with moderate accuracy. These findings may be valuable in narrowing down bacterial AG in children with gastrointestinal symptoms.

A randomized controlled open labelled study to evaluate clinical efficacy of Bacillus clausii (TIL 19T, TIL 21C, TIL 28S, TIL 30R) in the management of acute diarrhoea in children

Acute Diarrhoea in children is the most frequent gastroenterological disorder and is a common cause of dehydration in children. The management of acute diarrhoea consists of the replacement of lost fluid with glucose-electrolyte oral rehydration solution. Probiotics have been used as adjunctive therapy in the treatment of acute diarrhoea. In this study we evaluated the efficacy of Bacillus clausii (TIL 19T, TIL 21C, TIL 28S, TIL 30R) in management of Acute diarrhoea in children. 48 children aged between 6 months and 15 years with acute bacterial gastroenteritis or acute viral gastroenteritis were included in the study. The study group received poly antibiotic resistant B. clausii strains (TIL 19T, TIL 21C, TIL 28S, TIL 30R)as a probiotic along with standard treatment for diarrhoea and the control group received standard treatment for diarrhoea without B. clausii. The results at the end of 48 hours showed a significant improvement in very severe and high grade diarrhoea category in the children belonging to the study group. That is, all patients had recovered to low grade or normal grade (P < 0.01). Analysis of diarrhoeal stool group showed 64% of children in the control group continued to have loose stools as compared to just 24% in the study group (P < 0.01). No serious adverse events were recorded in both the groups. The use of B. clausii strains(TIL 19T, TIL 21C, TIL 28S, TIL 30R)in Acute Diarrhoea in children has shown to improve the recovery time from the illness and improvement in stool consistency due to its probiotic effect.

Holistic Strategies to Control Salmonella Infantis: An Emerging Challenge in the European Broiler Sector.

Salmonella spp. has been globally recognized as one of the leading causes of acute human bacterial gastroenteritis resulting from the consumption of animal-derived products. Salmonella Enteritidis, S. Typhimurium, and its monophasic variant are the main serovars responsible for human disease. However, a serovar known as S. Infantis has emerged as the fourth most prevalent serovar associated with human disease. A total of 95% of isolated S. Infantis serovars originate from broilers and their derived products. This serovar is strongly associated with an elevated antimicrobial (AMR) and multidrug resistance, a resistance to disinfectants, an increased tolerance to environmental mercury, a heightened virulence, and an enhanced ability to form biofilms and attach to host cells. Furthermore, this serovar harbors genes that confer resistance to colistin, a last-resort antibiotic in human medicine, and it has the potential to acquire additional transferable AMR against other critically important antimicrobials, posing a new and significant challenge to global public health. This review provides an overview of the current status of the S. Infantis serovar in the poultry sector, focusing on its key virulence factors, including its virulence genes, antimicrobial resistance, and biofilm formation. Additionally, novel holistic strategies for controlling S. Infantis along the entire food chain are presented in this review.

A Guideline for Assessment and Characterization of Bacterial Biofilm Formation in the Presence of Inhibitory Compounds.

Campylobacter jejuni, a zoonotic foodborne pathogen, is the worldwide leading cause of acute human bacterial gastroenteritis. Biofilms are a significant reservoir for survival and transmission of this pathogen, contributing to its overall antimicrobial resistance. Natural compounds such as essential oils, phytochemicals, polyphenolic extracts, and D-amino acids have been shown to have the potential to control biofilms formed by bacteria, including Campylobacter spp. This work presents a proposed guideline for assessing and characterizing bacterial biofilm formation in the presence of naturally occurring inhibitory molecules using C. jejuni as a model. The following protocols describe: i) biofilm formation inhibition assay, designed to assess the ability of naturally occurring molecules to inhibit the formation of biofilms; ii) biofilm dispersal assay, to assess the ability of naturally occurring inhibitory molecules to eradicate established biofilms; iii) confocal laser scanning microscopy (CLSM), to evaluate bacterial viability in biofilms after treatment with naturally occurring inhibitory molecules and to study the structured appearance (or architecture) of biofilm before and after treatment.

Can ultrasound help differentiate between Yersinia enteritis and other bacterial enteritides? A feasible but not easy-to-use diagnostic imaging method

Yersinia enterocolitica is a Gram-negative facultative anaerobic coccobacillus. Although uncommon, it is an important cause of acute bacterial gastroenteritis in humans. The global overall prevalence of Y. enterocolitica in gastroenteritis cases was estimated to be 1.97% (1.32%–2.74%) and 2.41% (1.07%–4.22%) using culture and molecular methods, respectively.1 In Taiwan, little is known about the prevalence of Y. enterocolitica infection. In an earlier study published in 1985, Tang et al. reported that Y.

Detection of Campylobacter coli and Campylobacter jejuni in Fecal Samples From Domestics and Livestock Employees

Background: Campylobacter jejuni and Campylobacter coli are two zoonotic pathogens that commonly colonize the digestive tract of animal sources, including poultry, dogs, cats, and other various domestic farm animals. Colonization can lead to acute bacterial gastroenteritis in humans after close contact with animals or through the consumption of contaminated food or water. Objective: The present study aimed to detect and identify these bacteria in the fecal samples of domestic and livestock employees. Materials and Methods: A total of 96 samples were collected, including 48 sheep faces and 48 livestock workers’ stool samples. DNA was extracted from the samples, and the presence of Campylobacter species was investigated by the polymerase chain reaction due to the detection of specific marker genes. Results: Based on the PCR on hippuricase gene (hipO) and aspartokinase gene (asp), C. jejuni was found in 7 (7.3%) and C. coli in 4 (4.2%) of 96 isolates. Analysis of nucleotide sequences of PCR amolicons showed the genetic similarity of isolates from a common livestock center. Conclusion: Direct animal-to-human contamination seems unlikely. However, the contamination of farm water sources and sheep products with Campylobacter species can be a potential risk to human health.

Relevance and Importance of Biofilms in the Resistance and Spreading of Campylobacter spp. Within the Food Chain.

Campylobacter spp. are Gram-negative microaerophilic and non-spore-forming bacteria that primarily live as commensal organisms in the gastrointestinal tract of many domestic and wild birds and mammals. These frequently provoke foodborne illness, being responsible for the most common cause of acute bacterial gastroenteritis worldwide. Although these are typically fastidious and slow-growing microorganisms which are sensitive to desiccation and other stresses (e.g., extreme pH, freezing, UV, disinfectants), these can still survive outside their host for long periods, with their attachment to surfaces and the formation of and/or inclusion into biofilms to be considered quite important for their environmental survival and widespread dissemination. In this chapter, the most representative studies on the existence, relevance, and importance of biofilms in the resistance and spreading of Campylobacter spp. within the food chain are presented. Hopefully, such accumulated and focused knowledge is expected to highlight the problem and trigger more effective ways for its mitigation, improving the safety of our food supply and protecting public health.

Campylobacter Biofilms: Potential of Natural Compounds to Disrupt Campylobacter jejuni Transmission.

Microbial biofilms occur naturally in many environmental niches and can be a significant reservoir of infectious microbes in zoonotically transmitted diseases such as that caused by Campylobacter jejuni, the leading cause of acute human bacterial gastroenteritis world-wide. The greatest challenge in reducing the disease caused by this organism is reducing transmission of C. jejuni to humans from poultry via the food chain. Biofilms enhance the stress tolerance and antimicrobial resistance of the microorganisms they harbor and are considered to play a crucial role for Campylobacter spp. survival and transmission to humans. Unconventional approaches to control biofilms and to improve the efficacy of currently used antibiotics are urgently needed. This review summarizes the use plant- and microorganism-derived antimicrobial and antibiofilm compounds such as essential oils, antimicrobial peptides (AMPs), polyphenolic extracts, algae extracts, probiotic-derived factors, d-amino acids (DAs) and glycolipid biosurfactants with potential to control biofilms formed by Campylobacter, and the suggested mechanisms of their action. Further investigation and use of such natural compounds could improve preventative and remedial strategies aimed to limit the transmission of campylobacters and other human pathogens via the food chain.

Characterization of Campylobacter jejuni An Important Zoonotic Food Borne Pathogen from Mastitis Milk and Raw Milk Samples

Background: Campylobacter has emerged as an important zoonotic food borne pathogen of human and animals worldwide. Campylobacter is one of the most common bacterial enteropathogens of food borne origin in industrialized countries with C. jejuni being the most common species followed by C. coli. There are very few cases reported from mastitis therefore this study was aimed to determine the incidence of Campylobacter jejuni from from mastitis milk and raw milk samples. Methods: Total of 72 milk samples comprising mastitis milk (20) and raw milk (52) were collected. The samples were subjected to cultural examination, biochemical as well as molecular identification. The isolates were further subjected to phenotypic characterization by biochemical test and genotypic characterization by Polymerase Chain Reaction. The isolates were subjected to PCR targeting hip O and MAP A genes. Result: The 52 samples showed growth on modified Blood Free Charcoal Cefoperazone Deoxycholate agar media and 18 (34.61%) samples showed typical morphological characteristics. The result revealed that 10 (19.23%) isolates were positive by phenotypic characteristic and 7(70%) by Polymerase chain reaction for C. jejuni. The outcome result showed that importance of Campylobacter jejuni in cattle, especially raw milk and milk from mastitis cows, as a potential source for transmission of Campylobacteriosis in human and dairy farm environment. This can cause acute bacterial gastroenteritis in humans and associated with foodborn infection, food safety and a serious public health threat.

Expression of the Campylobacter jejuni FliD protein and its reaction to chicken sera.

Campylobacter is a leading causative pathogen of acute bacterial gastroenteritis among humans. Contaminated chicken products are regarded as major sources of human infection. The flagellar capping protein (FliD), which plays important roles in colonization and adhesion to the mucosal surface of chicken ceca, is conserved among Campylobacter jejuni strains. In this study, the recombinant C. jejuni FliD protein was expressed, purified and used as a coated protein to examine the prevalence of C. jejuni antibodies in chickens. The anti-FliD antibody was prevalent among chicken serum samples taken from different farms in the diverse regions of Jiangsu province by using enzyme-linked immunosorbent assay. The Campylobacter antibody was present in culture-negative chickens. No strong dose-response relationships were observed between serum FliD antibody levels and Campylobacter cultural status. These results provide a basis for further evaluating FliD as a vaccine candidate for broiler chickens or for examining host-C. jejuni interactions, with implications for improving food safety.

Study of the diagnostic value of interleukin-6 and interleukin-8 in children with acute gastroenteritis.

Gastroenteritis in children is responsible for high morbidity and mortality. Our aim was to determine the serum and fecal levels of interleukin-6 (IL-6) and interleukin-8 (IL-8) in children with acute gastroenteritis of viral and bacterial etiology to assess their utility as diagnostic biomarkers for these infections. In this case-control study, the children were classified according to the pathogen recovered from the stool by bacterial culture or by direct viral antigen detection by enzyme immunoassay (EIA) into 50 children with acute bacterial gastroenteritis and 50 children with acute viral gastroenteritis. In addition, 50 apparently healthy children were included as a control group. Blood and stool samples were subjected to detection of IL-6 and IL-8. There were statistically significant elevations of total leucocytes counts, absolute neutrophils count, C-reactive protein, serum IL-6 and serum IL-8 in children with gastroenteritis compared to healthy children (p<0.001). CRP, serum IL-6 and IL-8 had significantly elevated levels in children with bacterial gastroenteritis compared to viral gastroenteritis. Fecal IL-6 and IL-8 had significantly elevated levels in children with acute gastroenteritis than in healthy control (p<0.001). The area under the curve (AUC) showed that CRP and serum IL-6 could be used as discriminative markers for acute bacterial gastroenteritis in children, in comparison to serum IL-8. Elevated serum IL-6 and CRP can aid in differentiation between viral and bacterial gastroenteritis. Serum IL-8 had limited discrimination ability between viral and bacterial gastroenteritis. Stool levels of IL-6 and IL-8 were elevated in children with viral and bacterial gastroenteritis, however, their assessment by enzyme linked immunosorbent assay had technical limitations to be used as differentiation biomarkers.

Retrospective study showed that bacterial gastroenteritis was an important cause of bloody stools in newborn infants.

Acute bacterial gastroenteritis is a major cause of morbidity and mortality, especially in the developing countries. We examined the incidence, clinical features and outcomes in the first week of life. This was a retrospective study of culture-proven bacterial gastroenteritis in newborn infants that were diagnosed between January 2011 and September 2018 in a tertiary centre in Israel. There were 10 cases of culture-proven bacterial gastroenteritis, detected out of 91 stool cultures. All infants were born vaginally and nine were full-term infants. The annual incidence was 0.096 per 1000 live births. The responsible pathogen was Campylobacter in six patients, Salmonella in two and Shigella sonnei in two. The mean age of disease onset was two days of life. Antibiotics were given to five patients, but were inappropriate in two cases. Only one patient with the Shigella sonnei infection required respiratory support. All patients fully recovered. One in ten newborn infants with bloody stools had bacterial gastroenteritis, contradicting the low rates found in other studies and indicating the importance of considering this diagnosis. Antimicrobials active against Salmonella or Shigella should be given to newborn infants who have bloody stools and look ill.

EFICIÊNCIA DE DIFERENTES PROTOCOLOS PARA ISOLAMENTO DE Campylobacter jejuni DE CARNE DE FRANGO

Resumo Campylobacter jejuni é o principal causador de gastroenterite bacteriana aguda e a carne de frango é um importante veículo do agente. Entretanto, as metodologias convencionais de isolamento de Campylobacter muitas vezes não são eficientes, podendo levar a resultados errôneos. Sendo assim, este trabalho teve como objetivo avaliar diferentes métodos utilizados na detecção de C. jejuni em produtos de frango. Carne moída experimentalmente contaminada com três diferentes diluições do microrganismo foi analisada com diferentes protocolos para isolamento de C. jejuni. Foram feitas semeaduras diretamente nos ágares mCCDA, Columbia e ágar sangue, e após pré-enriquecimento nos caldos Bolton ou Brucella. As colônias características de Campylobacter foram identificadas e os resultados comparados a fim de avaliar qual o método foi mais eficaz. Os únicos protocolos em que foi possível recuperar o microrganismo de todos os testes foram aqueles em que foi utilizado o ágar mCCDA associado com o Caldo Bolton ou com o Caldo Brucella. Estes foram também os únicos protocolos que permitiram a recuperação de C. jejuni 24 horas após a contaminação experimental com inóculo igual a 100 UFC/25 g. Entretanto, o ágar mCCDA sem o uso de pré-enriquecimento apresentou desempenho insatisfatório, inferior ao dos demais protocolos. Conclui-se que ágar mCCDA com pré-enriquecimento em caldo Brucella ou em caldo Bolton foram mais eficientes para o isolamento de C. jejuni que os demais protocolos.

Experience of &amp;lt;italic&amp;gt;Campylobacter&amp;lt;/italic&amp;gt; gastroenteritis in Korean children: Single-center study

Although Campylobacter is the main cause for bacterial acute gastroenteritis (AGE), there has been no notable clinical research into it, especially for Korean children. In this study, we share our experience of clinical, laboratory and image findings with Campylobacter AGE. Methods Between May 2013 and June 2016, children diagnosed as having Campylobacter AGE were retrospectively enrolled in our study. Campylobacter AGE was considered diagnosed when a patient had symptoms of bacterial AGE and a positive Campylobacter result in stool using multiplex PCR. Results Among 539 patients with suspected bacterial AGE, 31 (5.8%) patients had a positive result for Campylobacter. The average age of the 31 patients was 10.2 ± 5.0 years with a range between 1.1 and 16.9 years. Eighteen (58%) of the total patients were hospitalized between June and August. Diarrhea (93.5%), abdominal pain (83%) and fever (83%) were common symptoms. For 20 patients (65%), diarrhea lasted for less than three days, and fever lasted for 2.1 days on average. Among the 20 patients subjected to imaging studies, 12 patients (60%) showed bowel wall thickening on the right side of colon. In blood tests of 30 patients, 22 (73%) and 29 (97%) patients exhibited leukocytosis and elevated C-reactive protein, respectively. During treatment for Campylobacter AGE, prediagnostic empirical antibiotics were used for 6 (19%) patients. All patients recovered without complications. Conclusions Among the children with suspected bacterial AGE, 5.8% had a positive result on Campylobacter in stool using multiplex PCR. Therefore, we observe that Campylobacter AGE should be considered in school-age children who have diarrhea, fever, and abdominal pain.

Epitope mapping of Salmonella flagellar hook-associated protein, FlgK, with mass spectrometry-based immuno-capture proteomics using chicken (Gallus gallus domesticus) sera

Salmonella, a Gram-negative rod, is the leading foodborne pathogen associated with human acute bacterial gastroenteritis worldwide. The Salmonella flagellum is responsible for bacterial movement, colonization and invasion in the host gastrointestinal tract. The flagellum has a complex structure, composed of more than 35 proteins. Among them, we were interested in the flagellar hook-associated protein (FlgK), which is an immunodominant protein in chickens. In this communication, we applied mass spectrometry-based proteomics in conjunction with chicken immunized sera to map the linear immunoepitopes in the FlgK protein, validated the epitopes with peptide ELISA, and determined serum reactivity to the epitopes from commercial chickens. We previously demonstrated the FlgK proteins are highly conserved among Salmonella serovars. The rFlgK protein was produced by the recombinant technique, and was able to induce immune response in chickens. Further, this study identified four peptides (AEG, GAQ, TAD and LEI) in the rFlgK protein that were captured by sera from chickens immunized with the rFlgK protein. These four peptides were also reacted to 64 individual serum samples collected from 44 − 52 weeks old chickens, suggesting that these peptides may represent the shared immuno-epitopes on the FlgK protein. The findings of the specific shared linear immuno-epitopes on the FlgK protein in this study provide a rationale for further evaluation to determine their utility as epitope vaccines covering multiple serotypes for chicken immunization, and subsequently, for providing safer poultry products for human consumption.

Nontyphoidal Salmonella Gastroenteritis in a Tertiary Children's Hospital in Southern China: Characteristics and Dietary Considerations.

Background Nontyphoidal Salmonella infection is a common cause for acute bacterial gastroenteritis in children in China. There have been no reports of the prevalence of lactose intolerance or food allergies in children with nontyphoidal Salmonella infection. The aim of this study was to characterize nontyphoidal Salmonella gastroenteritis in a tertiary children's hospital and evaluate clinical presentation, lactose intolerance, and food allergies in children with prolonged nontyphoidal Salmonella gastroenteritis. Methods A retrospective case-series analysis was carried out in a tertiary children's hospital in Guangzhou, China. We included all infants and children who were diagnosed with nontyphoidal Salmonella gastroenteritis between 1 January 2014 and 31 December 2016. Patients' clinical features, feeding patterns, laboratory tests, and treatment outcomes were reviewed. Results A total of 142 infants and children were diagnosed with nontyphoidal Salmonella gastroenteritis. 52.1% of cases occurred in infants ≤ 12 months of age and the majority (89.4%) in children younger than 3 years old. The most common symptoms were diarrhea (100%), fever (62%), and vomiting (18.3%). Salmonella Typhimurium was the predominant serotype, accounting for 82.4%. 91.5% of patients were treated with antibiotics. Forty-one (28.9%) and 9 (6.3%) children improved with a lactose-free diet and hypoallergenic formula, respectively, when diarrhea persisted for more than a week. Conclusions Salmonella Typhimurium was the predominant serotype. Most patients with nontyphoidal Salmonella gastroenteritis were younger than 3 years old. Lactose intolerance occurred frequently in children with nontyphoidal Salmonella gastroenteritis and dietary modification should be considered when diarrhea is persistent and prolonged.

The bile salt sodium taurocholate induces Campylobacter jejuni outer membrane vesicle production and increases OMV-associated proteolytic activity.

Campylobacter jejuni, the leading cause of bacterial acute gastroenteritis worldwide, secretes an arsenal of virulence-associated proteins within outer membrane vesicles (OMVs). C.jejuni OMVs contain three serine proteases (HtrA, Cj0511, and Cj1365c) that cleave the intestinal epithelial cell (IEC) tight and adherens junction proteins occludin and E-cadherin, promoting enhanced C.jejuni adhesion to and invasion of IECs. C.jejuni OMVs also induce IECs innate immune responses. The bile salt sodium taurocholate (ST) is sensed as a host signal to coordinate the activation of virulence-associated genes in the enteric pathogen Vibrio cholerae. In this study, the effect of ST on C.jejuni OMVs was investigated. Physiological concentrations of ST do not have an inhibitory effect on C.jejuni growth until the early stationary phase. Coculture of C.jejuni with 0.1% or 0.2% (w/v) ST stimulates OMV production, increasing both lipid and protein concentrations. C.jejuni ST-OMVs possess increased proteolytic activity and exhibit a different protein profile compared to OMVs isolated in the absence of ST. ST-OMVs exhibit enhanced cytotoxicity and immunogenicity to T84 IECs and enhanced killing of Galleria mellonella larvae. ST increases the level of mRNA transcripts of the OMVs-associated serine protease genes and the cdtABC operon that encodes the cytolethal distending toxin. Coculture with ST significantly enhances the OMVs-induced cleavage of E-cadherin and occludin. C.jejuni OMVs also cleave the major endoplasmic reticulum chaperone protein BiP/GRP78 and this activity is associated with the Cj1365c protease. These data suggest that C.jejuni responds to the presence of physiological concentrations of the bile salt ST that increases OMV production and the synthesis of virulence-associated factors that are secreted within the OMVs. We propose that these events contribute to pathogenesis.

Acute bacterial gastroenteritis: 729 cases recruited by a Primary Care national network

Abstract Objective To determine the main clinical and epidemiological features of bacterial gastroenteritis in our environment. Patients and methods An observational study of a Spanish population in 17 Autonomous Communities. Questionnaires of children with a stool positive culture to bacteria were collected over a one year period. A bivariate analysis was performed on the variables involved, as well as two multivariate models (for antibiotic treatment variables, and comparison Campylobacter / Salmonella ). Results A total of 729 bacterial gastroenteritis episodes were recorded in the 17 Spanish autonomous regions, of which 41.2% were girls and 58.8% boys. The median age was 3.41 years old (interquartile range 1.55–6.72). The bacteria isolated were 59.9% Campylobacter , 31.8% non-Typhi Salmonella , 2.7% Aeromonas , 2.4% Yersinia , and 1.5% had more than one strain. Most infections (70%) were direct contacts, and food poisoning was less probable (25.9%). Salmonella is significantly less frequent than Campylobacter in children under the age of 3 years (adjusted OR 0.61; 95% CI: 0.43–0.86; P = .005), and Campylobacter is more frequent in rural areas (adjusted OR 1.48; 95% CI: 1.07–2.07; P = .012). Antibiotic was prescribed in 33.2% of cases. There was a greater significant difference if stools contained blood or mucus (adjusted OR 1.53; 95% CI: 1.04–2.27; P = .031), if the symptoms lasted more than 7 days (adjusted OR 2.81; 95% CI: 2.01–3.93; P P = .027). Conclusions The aetiology of bacterial diarrhoea in paediatrics is typical of that of a developed country. The transmission mechanism is mainly direct, and more cases than appropriate are treated with antibiotics.