Campylobacter Research Articles

Prevalence of Campylobacter spp. in broilers in North Lebanon.

Great attention has been given recently to the prevalence of different Campylobacter spp. in poultry since the latter are considered the major contributing reservoir of human campylobacteriosis. In Lebanon, the occurrence of campylobacteriosis in humans is high. The aim of our first-of-its-kind study in the country was to estimate the prevalence of Campylobacter spp. in broilers from a convenient sample of farms in North Lebanon. One hundred twenty-five fecal samples were collected from 25 broiler farms, which were selected, examined, and classified according to their biosecurity level and rearing system. All samples were subjected to qualitative microbiological culture testing and polymerase chain reaction (PCR) assays to detect Campylobacter spp. Despite the reported use of antibiotics, cell culture and PCR were positive for 44% and 88%, respectively. This implies that this bacterium is resistant to antibiotics used on the farms. Furthermore, Campylobacter infection rate was higher in open (92%) than in closed (85%) system farms. All farms with poor biosecurity measures, and 82% of farms with good biosecurity measures had Campylobacter infections, and the difference was significant (p < 0.05). Our results show that campylobacteriosis was found prevalent among broilers in North Lebanon, making them potential carriers of Campylobacter spp. Future studies should include antibiotic susceptibility testing to check the susceptibility pattern of isolates.

In silico prediction and expression analysis of vaccine candidate genes of Campylobacter jejuni

Campylobacter jejuni (C. jejuni) is the most common food-borne pathogen that causes human gastroenteritis in the United States. Consumption of contaminated poultry products is considered as the major source of human Campylobacter infection. An effective vaccine would be a promising alternative to antibiotic supplements to curb C. jejuni colonization in poultry gastrointestinal (GI) tract. However, the genetic diversity among the C. jejuni isolates makes vaccine production more challenging. Despite many attempts, an effective Campylobacter vaccine is not yet available. This study aimed to identify suitable candidates to develop a subunit vaccine against C. jejuni, which could reduce colonization in the GI tract of the poultry. In the current study, 4 C. jejuni strains were isolated from retail chicken meat and poultry litter samples and their genomes were sequenced utilizing next-generation sequencing technology. The genomic sequences of C. jejuni strains were screened to identify potential antigens utilizing the reverse vaccinology approach. In silico genome analysis predicted 3 conserved potential vaccine candidates (phospholipase A [PldA], TonB dependent vitamin B12 transporter [BtuB], and cytolethal distending toxin subunit B [CdtB]) suitable for the development of a vaccine. Furthermore, the expression of predicted genes during host-pathogen interaction was analyzed by an infection study using an avian macrophage-like immortalized cell line (HD11). The HD11 was infected with C. jejuni strains, and the RT-qPCR assay was performed to determine the expression of the predicted genes. The expression difference was analyzed using ΔΔCt methods. The results indicate that all 3 predicted genes, PldA, BtuB, and CdtB, were upregulated in 4 tested C. jejuni strains irrespective of their sources of isolation. In conclusion, in silico prediction and gene expression analysis during host-pathogen interactions identified 3 potential vaccine candidates for C. jejuni.

In-sewer decay and partitioning of Campylobacter jejuni and Campylobacter coli and implications for their wastewater surveillance

Campylobacter jejuni and coli are two main pathogenic species inducing diarrhoeal diseases in humans, which are responsible for the loss of 33 million lives each year. Current Campylobacter infections are mainly monitored by clinical surveillance which is often limited to individuals seeking treatment, resulting in under-reporting of disease prevalence and untimely indicators of community outbreaks. Wastewater-based epidemiology (WBE) has been developed and employed for the wastewater surveillance of pathogenic viruses and bacteria. Monitoring the temporal changes of pathogen concentration in wastewater allows the early detection of disease outbreaks in a community. However, studies investigating the WBE back-estimation of Campylobacter spp. are rare. Essential factors including the analytical recovery efficiency, the decay rate, the effect of in-sewer transport, and the correlation between the wastewater concentration and the infections in communities are lacking to support wastewater surveillance. This study carried out experiments to investigate the recovery of Campylobacter jejuni and coli from wastewater and the decay under different simulated sewer reactor conditions. It was found that the recovery of Campylobacter spp. from wastewater varied with their concentrations in wastewater and depended on the detection limit of quantification methods. The concentration reduction of Campylobacter. jejuni and coli in sewers followed a two-phase reduction model, and the faster concentration reduction during the first phase is mainly due to their partitioning onto sewer biofilms. The total decay of Campylobacter. jejuni and coli varied in different types of sewer reactors, i.e. rising main vs. gravity sewer. In addition, the sensitivity analysis for WBE back-estimation of Campylobacter suggested that the first-phase decay rate constant (k1) and the turning time point (t1) are determining factors and their impacts increased with the hydraulic retention time of wastewater.

Prevalence, Risk Factors Analysis and Antimicrobial Resistance Profile of Campylobacter Species Isolated from Food Animals in District Okara, Pakistan

Campylobacter, one of the most prevalent bacteria responsible for gastroenteritis in human worldwide. Campylobacter infections result from ingestion of contaminated food and water depending upon susceptibility of individuals and virulence of infecting strain. The prevalence of these bacteria is highly diverse and present worldwide. Increase in antibiotic resistance among these bacteria is recognized as emerging public health problem. Current study is designed to analyze the risk factors related with Campylobacteriosis, prevalence in meat (chicken, beef and mutton) and antimicrobial resistance profiles of these bacteria from district Okara, Pakistan. The time span for lab work was from October 2020 to March 2021including sampling and testing. A total of 300 swab samples were collected from poultry, beef and mutton. The ISO 10272-1:217(E) method for isolation through biochemical and molecular identification carried out. Disc diffusion method used for AMR calculation. The overall prevalence of campylobacter was only 2%, detected only in poultry meat out of 300 samples. Among the isolated strains, Campylobacter indicated highest resistance against Tetracycline 100%, followed by Cefotaxime, Tylocine 83%, Enrofloxacin 66%, Clindamycin and Nalidixic acid 50%, lowest resistance against Streptomycin and Doxycycline only 33% and 16% respectively. The significance relation was obtained for two variables that include eating during dealing meat and contact of excreta with meat. Prevalence of Campylobacter is very low as compared to study conducted earlier in Pakistan. The drug of choice for Campylobacter related infections is doxycycline and streptomycin. The results indicate that prevalence of Campylobacter is very low on meat in Okara region but higher microbial resistance.

Research Note: Analysis of immune responses in broilers after vaccination against Campylobacter jejuni

Campylobacter infections traced mainly to poultry products are major bacterial foodborne zoonoses. Among the many control strategies evaluated at primary poultry level to reduce these infections, vaccination could be a solution, but no effective vaccines are available to date. A better understanding of the immune mechanisms involved in protection against Campylobacter would be helpful for designing novel vaccine strategies. The present study was designed to analyze in more depth the immune responses developed in broilers in order to potentially identify which immune parameters may be important for establishing protection against Campylobacter by comparing the immune responses obtained here with those obtained in a previous study performed on vaccinated specific-pathogen-free Leghorn chickens that presented a partial reduction of Campylobacter after experimental challenge. The protection against Campylobacter colonization was evaluated at different time points over 40 d of rearing, by measuring specific IgY levels in serum and IgA antibodies in bile reflecting the systemic and mucosal humoral responses respectively and the relative expressions of 9 cecal immune marker genes (cytokines and antimicrobial peptides), which reflect the innate and cellular immune responses. Despite no reduction of Campylobacter in the cecum, a systemic immune response over time characterized by the production of specific anti-flagellin IgY was observed, in addition to upregulation of the antimicrobial peptide avian β-defensin (AvBD) 12 gene expression in the cecum of vaccinated broilers compared with the placebo group. However, the levels of specific anti-flagellin mucosal IgA antibodies in the bile as well as the relative expression of other cecal cytokines studied was underexpressed in the vaccinated group or similar in both groups.

Epidemiologic and Clinical Features of Campylobacter Enteritis Before and During COVID-19 in Korea.

With the increase in meals at home due to coronavirus disease 2019 (COVID-19), the pattern and incidence of enteritis seemed to change. Some types of enteritis, such as Campylobacter enteritis, appear to have increased. Our study aimed to evaluate the change in the trend of enteritis, especially Campylobacter enteritis, before COVID-19 (2016-2019) and at the present time during COVID-19 in South Korea. We analyzed data from the Health Insurance Review and Assessment Service. From 2016 to 2020, the International Classification of Diseases codes related to enteritis were examined to distinguish bacterial and viral enteritis and the trends of each were analyzed. The aspects of enteritis, before and after the COVID-19 outbreak, were compared. Both bacterial and viral enteritis declined in all age groups from 2016 to 2020 (P < 0.001). In 2020, the reduction rate of viral enteritis was higher than that of bacterial enteritis. However, unlike other causes of enteritis, even after COVID-19, Campylobacter enteritis increased in all age groups. An increase of Campylobacter enteritis in 2020 was particularly noticeable in children and adolescents. The prevalence of viral and bacterial enteritis was higher in urban areas than in rural areas (P < 0.001). Campylobacter enteritis was more common in the rural areas (P < 0.001). Although the prevalence of bacterial and viral enteritis have decreased in COVID-19, Campylobacter enteritis has increased in all age groups and in rural areas compared to urban areas. Recognizing that the trend of Campylobacter enteritis before and during COVID-19 is helpful for future public health measures and interventions.

Antimicrobial resistance profiles of Campylobacter jejuni and Salmonella spp. isolated from enteritis patients in Japan.

Understanding the antimicrobial resistance of Campylobacter jejuni and Salmonella spp. isolated from patients with enteritis will aid in therapeutic decision-making. This study aimed to characterize C. jejuni and Salmonella spp. isolates from patients with enteritis. For C. jejuni, the resistance rates against ampicillin, tetracycline, and ciprofloxacin were 17.2%, 23.8%, and 46.4%, respectively. All the C. jejuni isolates were susceptible to erythromycin, which is recommended as a first-choice antimicrobial if Campylobacter enteritis is strongly suspected. C. jejuni was classified into 64 sequence types (STs), and the five major STs were ST22, ST354, ST21, ST918, and ST50. The ciprofloxacin-resistance rate of ST22 was 85.7%. For Salmonella, the resistance rates against ampicillin, cefotaxime, streptomycin, kanamycin, tetracycline, and nalidixic acid were 14.7%, 2.0%, 57.8%, 10.8%, 16.7%, and 11.8%, respectively. All the Salmonella spp. isolates were susceptible to ciprofloxacin. Therefore, fluoroquinolones are the recommended antimicrobials against Salmonella enteritis. S. Thompson, S. Enteritidis, and S. Schwarzengrund were the three most prevalent serotypes. The two cefotaxime-resistant isolates were serotyped as S. Typhimurium and were found to harbor blaCMY-2. The results of this study would help select antimicrobials for treating patients with Campylobacter and Salmonella enteritis.

Molecular Prevalence and Risk Factors of Campylobacter Infection in Puppies in the Nairobi Metropolitan Region, Kenya.

Campylobacter species are widely distributed pathogens; however, data on its epidemiology in puppies remain scanty, especially in Kenya. A cross-sectional study was conducted in the Nairobi Metropolitan Region to determine molecular prevalence and associated risk factors of Campylobacter species infection in puppies. A total of 260 rectal swabs were collected from puppies from breeding kennels, shelters, and the University of Nairobi Veterinary Teaching and Referral Hospital. The samples were subjected to polymerase chain reaction (PCR) assays for identification of Campylobacter species. Data on potential risk factors associated with puppy exposure were collected using a semistructured questionnaire. Multivariable mixed effects logistic regression analyses were performed with kennels as random effects. Campylobacter species were detected in 64 of the 260 sampled puppies yielding an overall prevalence of 24.6%. Multivariable results showed that puppies from shelters, puppies from kennels that are washed daily, puppies with a recent history of vomiting, and those treated with antibiotics in the past month were significantly associated with the presence of Campylobacter species. Being a kenneled puppy and having had concurrent bacterial infections were identified as protective factors. This study provides molecular evidence of puppy exposure to Campylobacter species which could have impact on puppy health and highlights the need to develop awareness and management strategies to potentially reduce the risk of transmitting this pathogen among puppies, to humans, and other animals.

Campylobacter Infection Associated Intestinal Perforation: A Case Report

Campylobacter Infection Associated Intestinal Perforation: A Case Report

CAMPYLOBACTER: A BRIEF REVIEW OF ITS CAUSES, DIAGNOSTIC APPROACHES AND PREVENTION

The most frequent bacterial which is cause of gastroenteritis in humans is Campylobacter. According to Centers for Disease Control and Prevention (CDC) reports around 1.3 million cases of Campylobacter infection in the US occurs per year. This review was designed with the aim to discuss in detail the root causing agents of Campylobacter infection, its diagnostic and prevention methods. Campylobacteriosis starts with the attachment of the pathogenic bacteria to intestinal cells, followed by colonization and, lastly, penetration of the cells following ingestion by the host. Consumption of raw milk, undercooked poultry, and contaminated water have all been associated with Campylobacter infection. Intestinal mucosal Campylobacter toxins proliferate, necrotizing the intestinal villi. A toxin known as cytolethal distending toxins (CDT) damages DNA by acting as a deoxyribonuclease (DNase). Old aged patients and immunocompromised patients are more at risk of morbidity, mortality, and long-term sickness. In addition to additional virulence and survival factors, this review gathers information on motility, chemotaxis, adhesion, invasion, multidrug resistance, and stress response variables. It has been found that mishandling of raw poultry and consumption of undercooked poultry are the major risk factors for human campylobectriosis. Various preventive measures can be adopted to decrease the transmission of the pathogens and the subsequent disease such as the vaccination of the poultry, the health surveillance and the precise food hygiene all over the entire production chain.

Relationship between infection with Campylobacteriosis and genital disorder in ewes

Bacteria is the main cause of the genital disorder. Abortion, recurrent abortion and placenta retention are the main disorder accompanying with pregnancy failure. The current study aimed to find the relationship between this disorder and Campylobacter infection and main Campylobacter species related to this disorder. For this purpose, 50 aborted fetuses and vaginal swabs were collected. Case history and multiplex PCR were applied. The result showed that Campylobacter detected at a rate 26% in abortion cases and 61.5% of positive cases of campylobacter spp. are accompanied by placenta retention. The current study revealed that 75% of positive cases of campylobacter spp. accompany with recurrent abortion. According to MPCR test, Campylobacter fetus, Campylobacter jejuni, and Campylobacter coli were detected in a rate of 86.65%, 12.3%, and 0%, respectively.

Occurrence of Campylobacter spp. and Phenotypic Antimicrobial Resistance Profiles of Campylobacter jejuni in Slaughtered Broiler Chickens in North-Western Romania

Campylobacteriosis is recognized as one of the most common food-borne zoonoses, with worldwide distribution, having undercooked poultry meat and other cross-contaminated foodstuffs as the main sources of human infections. The current study aimed to provide data on the occurrence of the thermophilic Campylobacter spp. in seven broiler chicken flocks, from three north-western Transylvanian counties of Romania, as well as to determine the antimicrobial resistance profile of the isolated C. jejuni strains. A total of 324 fresh cecal samples were collected during the slaughtering process, and screened for the presence of Campylobacter spp., using routine microbiological and molecular diagnostic tools. Overall, 85.2% (276/324; 95% CI 80.9-88.6) of the tested samples expressed positive results for Campylobacter spp., with dominant occurrence of C. coli towards C. jejuni (63.4% vs. 36.6%). From the six tested antimicrobials, the 101 isolated C. jejuni strains were resistant against ciprofloxacin (79.2%), nalidixic acid (78.2%), tetracycline (49.5%), and streptomycin (7.9%), but total susceptibility was noticed against erythromycin and gentamicin. Seven (6.9%) isolates exhibited multidrug resistance. The study results emphasize the role of broiler chicken as reservoir of Campylobacter infections for humans, as well as strengthen the necessity of the prudent using of antimicrobials in the poultry industry.

Gullian Barr Syndrome – A Rare Disease Case Report

Guillain-Baree syndrome also called guillain–Barré–Strohl syndrome, Landry's paralysis, post - infectious polyneuritis whichis a rare, at one or two cases per 100, 000 people every year, where auto-immune disorder in which a persons own immune system damaged the nerves, causing muscule weakness and sometimes paralysis. GBS can cause symptoms that last for a few weeks to several years. Most people recover fully, but some have permanent nerve damage. some people have died of GBS. Several things are known to tigger GBS. About two-thirds of people with GBS had diarrhea or a respiratory illness several weeks before developing symptoms. Infection with campylobacter jejuni, which causes diarrhea, is one of the most common risk factors for GBS. People can develop GBS after some other infections, such as flu, cytomegalovirus, Epstein barr virus, and zika virus. Very rarely, people have developed GBS in the days or weeks after receiving certain vaccines. It can be caused by campylobacter infection that is diagnosed when a laboratory tests detect campylobacter bacteria in stool, body tissue, or fluids. The test could be a culture that isolates the bacteria or a rapid diagnostic test that detects genetic material of the bacteria. The major aim of this case report is to present a classic case of this condition, to highlight an awareness of differing treatment options, and to advocate referral to a given its physician potential severity. Treatment for GBS including antibiotics, drink extra fluids as long as diarrhea lasts, plasma exchange, immunoglobulin therapy2.

A Case Report of Perimyocarditis as a Rare Complication of Campylobacteriosis

Campylobacter species is one of the most common infections that cause gastroenteritis in developed countries. Although most Campylobacter infections are self-limited, cases can be complicated by extraintestinal presentation, such as myocarditis, pericarditis, or perimyocarditis. We report herein a case of perimyocarditis complicating gastroenteritis in a 24-yearold male. The patient presented with abdominal pain, diarrhea, and dehydration over a couple of days, progressively worsening with substernal chest pain and dyspnea. Troponins were elevated, and ECG showed diffuse concave ST elevation and PR segment depression. Based on the clinical signs and symptoms, the diagnosis of perimyocarditis was made, and he was treated accordingly with a favorable outcome.

A Case Report of Perimyocarditis as a Rare Complication of Campylobacteriosis

Campylobacter species is one of the most common infections that cause gastroenteritis in developed countries. Although most Campylobacter infections are self-limited, cases can be complicated by extraintestinal presentation, such as myocarditis, pericarditis, or perimyocarditis. We report herein a case of perimyocarditis complicating gastroenteritis in a 24-yearold male. The patient presented with abdominal pain, diarrhea, and dehydration over a couple of days, progressively worsening with substernal chest pain and dyspnea. Troponins were elevated, and ECG showed diffuse concave ST elevation and PR segment depression. Based on the clinical signs and symptoms, the diagnosis of perimyocarditis was made, and he was treated accordingly with a favorable outcome.

The impacts of biosecurity measures on Campylobacter contamination in broiler houses and slaughterhouses in the Netherlands: A simulation modelling approach

Intestinal campylobacteriosis, caused by Campylobacter ingestion, is the most reported zoonosis in the EU; it is societally costly and can lead to more severe sequelae. To reduce Campylobacter infections, biosecurity measures at both farms and slaughterhouses are warranted. However, the potential improvements achieved by these interventions have not been quantified. We used a systems science approach to develop a simulation model, synthesizing information from interviews with stakeholders in the Dutch broiler production industry and the current literature. The model includes both farms and slaughterhouses in a “system of systems,” helping to clarify the complexity of interrelated components of these systems and analyse the impact of various interventions. Insects, transportation crates, farm personnel, and catchers were identified as potential Campylobacter sources and modelled as elements of feedback loops. Insect control, farm hygiene, visitor control, thinning, and transportation control interventions were analysed. The model was shown to accurately describe the seasonality of Campylobacter, which supports its validity. Model simulation revealed that insect control interventions had the strongest impacts, followed by combined farm hygiene and visitor control, and combined thinning and transportation control. Insect control interventions alone reduced the peak percentage of contaminated chickens from 51% to 26% and the peak percentage of highly contaminated (>1000 CFU/g) neck samples of chicken carcasses from 13% to 8%. Implementing all interventions concurrently reduced the peak percentages of contaminated chickens to 5% and highly contaminated chicken neck samples to 2%. These results suggest that multiple biosecurity measures must be implemented to reduce Campylobacter contamination.

Identifying the sources of human campylobacteriosis in Nigeria

Campylobacter spp. have been shown to be the most common cause of bacterial gastroenteritis worldwide. Cases of human campylobacteriosis are usually reported as sporadic and not part of an outbreak which makes the identification of the source of infection difficult. A study of the relationships within isolate populations in Nigeria and source attribution analysis of Nigerian human Campylobacter spp. to other animal isolates was carried out to determine the possible sources for human Campylobacter infection in Nigeria. The results showed nine sequence types (STs) common to both humans and livestock isolated from abattoirs, farms and live bird markets with similar STs clustering together on a phylogenetic tree, confirming a degree of genetic similarity. Source attribution analysis suggests wild birds as the most important reservoir (38%) for human Campylobacter spp. infection in Nigeria followed by chicken (23%), pig (19%), cattle (11%) and sheep (8%). This might be an indication of the importance of this infection source to humans in Nigeria and probably other low-income countries due to farming practices and human habits.

Isolation, identification and antibiotic resistance profile of thermophilic Campylobacter species from Bovine, Knives and personnel at Jimma Town Abattoir, Ethiopia.

Thermophilic Campylobacter species are common cause of animal and human bacterial diseases with growing resistance to antimicrobials. The aim of this study was to determine the prevalence and antimicrobial susceptibility pattern of Campylobacter species from bovine, knives and personnel in Jimma Town, Ethiopia. Faecal samples and carcasses swabs were collected from cattle systematically selected from the annual plan of Jimma Municipal Abattoir. Personnel hand and knife swabs were collected after slaughtering each selected cattle. A cross-sectional study with systematic sampling method was conducted from October 2019 to September 2020 for the isolation, identification and antimicrobial susceptibility pattern of thermophilic Campylobacter species. Isolation and identification of Campylobacter species were performed according to the techniques recommended by the International Organization for Standardization, and in vitro antibiotic susceptibility testing was screened using the standard agar disc diffusion method as recommended by Clinical and Laboratory Standards Institutions. A total of 684 samples (171 samples from faeces, carcasses, knives and personnel hands, were collected independently). The overall prevalence of thermophilic Campylobacterspecies was 5.6% (38/684). Majority of the isolates were from faecal samples (12.9%, n = 22) followed by carcass swabs(4.1% n = 7), knife swabs(3.5% n = 6) and personnel hand swabs(1.8% n = 3). Isolated and identified species of C.jejuni, C. coli and C. lari accounted for 63.2%, 23.7% and 13.2%, respectively. The isolated Campylobacter species were found to be resistant to Cephalothin (100%), Ampicillin (60.5%), Cefotaxime (60.5%), Chloramphenicol (47.4%) and Tetracycline (42.1%). On the other hand, the isolates were susceptible to Nalidixic acid (86.8%), Ciprofloxacin (86.8%), Sulphamethazole (84.2%), Ceftriaxone (78.9%), Clindamycin (68.4%) and Cefixime (65.8%). 84.2% of the isolates showed multi-drug resistance for three-to-six drug classes. All the C. lari isolates were multidrug resistant. All the three isolated species of Campylobacter were resistant to Cephalothin, and most were multidrug resistant. Isolation of Campylobacter species from faecal, carcass, knife and hand swabs revealed possible risk of contamination and exposure to Campylobacter infection of those who consume raw meat. Therefore, enactment of hygienic practices during the slaughtering process, proper handling and cooking of meat and awareness creation on jurisdictional antibiotic usage are required to avoid Campylobacter infection.

Preliminary Incidence and Trends of Infections Caused by Pathogens Transmitted Commonly Through Food - Foodborne Diseases Active Surveillance Network, 10 U.S. Sites, 2016-2021.

To evaluate progress toward prevention of enteric infections in the United States, the Foodborne Diseases Active Surveillance Network (FoodNet) conducts active population-based surveillance for laboratory-diagnosed infections caused by Campylobacter, Cyclospora, Listeria, Salmonella, Shiga toxin-producing Escherichia coli (STEC), Shigella, Vibrio, and Yersinia at 10 U.S. sites. This report summarizes preliminary 2021 data and describes changes in annual incidence compared with the average annual incidence for 2016-2018, the reference period for the U.S. Department of Health and Human Services' (HHS) Healthy People 2030 goals for some pathogens (1). During 2021, the incidence of infections caused by Salmonella decreased, incidence of infections caused by Cyclospora, Yersinia, and Vibrio increased, and incidence of infections caused by other pathogens did not change. As in 2020, behavioral modifications and public health interventions implemented to control the COVID-19 pandemic might have decreased transmission of enteric infections (2). Other factors (e.g., increased use of telemedicine and continued increase in use of culture-independent diagnostic tests [CIDTs]) might have altered their detection or reporting (2). Much work remains to achieve HHS Healthy People 2030 goals, particularly for Salmonella infections, which are frequently attributed to poultry products and produce, and Campylobacter infections, which are frequently attributed to chicken products (3).

S2009 Chronic Diarrhea Due to Campylobacter Infection in an Immunocompetent Host: A Case Report

Introduction: Campylobacter infection is a foodborne illness transmitted by ingestion of contaminated food or water. It is responsible for roughly 1.5 million infections annually in the U.S. Typical symptoms include acute diarrhea (< 2 weeks) that can be bloody or non-bloody, periumbilical pain, fever, and body aches. The enteritis is often self-limited in immunocompetent hosts. Subacute or chronic diarrhea can be observed in immunocompromised patients, but rarely in the immunocompetent host. Case Description/Methods: A 58-year-old male with a history of Korsakoff syndrome and anoxic brain injury was admitted with chronic diarrhea of 2 months, severe metabolic acidosis and acute kidney injury. Patient had 5 to 6 episodes of large volume watery diarrhea daily. There was serum leukocytosis with 17.2 K/mcL. Fecal immunochemical test was negative for blood. Stool culture was positive for Campylobacter antigen. CT abdomen showed numerous mildly enlarged mesenteric root lymph nodes without pericolonic fat stranding (Figure). Serum and stool inflammatory markers were elevated (Table). Stool testing for other infectious agents was unremarkable. Diarrhea did not improve with fasting. Patient did have underlying chronic pancreatitis due to prior alcohol abuse, but had been abstinent for 3 years. He was not previously on pancreatic enzyme and vitamin supplementation, which was started but did not improve his symptoms. Screening for celiac disease, HIV, and viral hepatitis was also unremarkable. It was concluded that in addition to chronic pancreatic insufficiency, Campylobacter was the culprit for his chronic diarrhea, which was treated with IV azithromycin for 10 days. Patient’s diarrhea resolved after completion of antibiotics. Repeat CT abdomen showed near-complete resolution of previously seen lymphadenopathy. Discussion: Chronic diarrhea due to Campylobacter infection is rare in immunocompetent hosts. Long-term Campylobacter colonization has been described in immunocompromised hosts. Colonization, or chronic campylobacteriosis, is confirmed by persistent Campylobacter-positive feces in the setting of prolonged diarrhea. It is typically treated with oral azithromycin or ciprofloxacin for 3 days. However, our patient required an intravenous administration and longer course of treatment since his symptoms were refractory to oral antibiotics. This is an uncommon case of complicated Campylobacter infection resulting in chronic diarrhea in an immunocompetent patient.Figure 1.: Left: CT Abdomen without contrast (axial) showing mesenteric lymphadenopathy, lymph node measuring 1.2cm x 2.4cm (arrow). Right: Resolution of lymphadenopathy after completion of 10-day course of azithromycin. Table 1. - Stool and serum laboratory profile of the patient Test Result Reference Range Stool Studies Stool culture Campylobacter sp Negative WBC Positive Negative Calprotectin 447 Normal < 50 mcg/g Pancreatic Elastase 1 < 15 Normal >200 mcg/g C. Difficile PCR Negative Negative Giardia antigen Negative Negative Fecal sodium 114 N/A Fecal potassium 14.0 N/A Fecal chloride 73 N/A Fecal Osmolality 437 275-295 mOsm/kg* Fecal Osmotic Gap 34 Secretory diarrhea: < 50 mOsm/kg Osmotic diarrhea: >75 mOsm/kg Fecal Fat (Qualitative) Abnormal (positive) Normal Ova and parasites Negative Negative Serum Studies WBC 17.2 4.8-10.8 K/mcL TSH 1.5 0.55-4.78 uIU/mL ESR 62 < 20 mm/hr for men over 50 years CRP 95 0-7.5 mg/L Lipase 7 22-51 U/L HIV 1 and 2 antibody Nonreactive Nonreactive Celiac panel (tTg IgA) Negative Negative Total IgA 293 47-310 mg/dL Blood cultures Negative Negative *Stool osmolality greater than 290 and up to 600 are common because of bacterial metabolism of fecal carbohydrate during storage of the stool sample.Abbreviations: WBC: white blood cells, CRP: C-reactive protein, HIV: human immunodeficiency virus, tTg: tissue transglutaminase, IgA: Immunoglobulin A.