Molecular investigation of Campylobacter spp. and Salmonella infection in children with community acquired diarrhea

Introduction : Acute gastroenteritis is a typical disorder that accounts for 8-12% of pediatric outpatient visits. Campylobacter and Salmonella infections account for about 8.4% and 11% of global diarrhea cases. Due to the importance of these bacteria in pediatric diseases, the aim of this study was to determine the infectious rate of Salmonella and Campylobacter species and also the frequency of the gene encoding Cytholethal distending toxin in children with community-acquired diarrhea. Materials and Methods: Stool samples of children under 5 years of age with diarrhea were collected. The samples were related to children referred to hospitals in Hamadan, Ardabil, Bandar Abbas and two hospitals in Tehran. DNA was extracted from the samples using a DNA extraction kit from stool. The presence of Campylobacter in the studied samples was detected by polymerase chain reaction using specific primers. A control stool sample was spiked with 10-fold dilution of C. jejuni suspension for LOD (detection limit determination) measurement. Results: In this study, PCR results showed a LOD of 100 CFU per gram in the spiked feces sample. Accordingly, out of 144 fecal samples of children with acute diarrhea, one case was positive for Campylobacter jejuni;this sample was also positive for the presence of cdtB gene. Presence of Salmonella was confirmed in two samples of the patients (1.4%). Conclusion: Low prevalence of Campylobacter and Salmonella was detected in symptomatic children under 5 years of age during the Covid-19 pandemic. Examination of these samples for viruses and other microbial agents can clarify the etiology of diarrhea in children referred to the hospitals.

Fatal gastritis and enterocolitis due to concurrent Helicobacter pylori and Campylobacter jejuni infection in a captive cheetah (Acinonyxjubatus).

A 3.5-year-old female cheetah (Acinonyx jubatus) died after a 10-day history of anorexia, regurgitation and diarrhoea despite symptomatic therapy. At gross post-mortem examination, the stomach was blood-filled with mucosal thickening and multifocal ulcerations. The intestinal mucosa was thickened and reddened, and the intestinal lumen was filled with dark red to black pasty content. Gastric histological lesions were compatible with gastritis due to Helicobacter infection, which was confirmed by polymerase chain reaction. Histology of the intestines revealed a severe necrotizing neutrophilic enterocolitis with abundant intralesional curved to spiral bacteria, corresponding to Campylobacter jejuni, which were subsequently isolated from both small and large intestinal contents. No other intestinal pathogens were detected despite thorough investigations. These findings suggest that C. jejuni may have played an aetiological role in the enterocolitis. Such an association has not been previously reported in non-domestic felids.

Triggers of Guillain-Barré Syndrome: Campylobacter jejuni Predominates.

Guillain-Barré syndrome (GBS) is a rare immune-mediated acute polyradiculo-neuropathy that typically develops after a previous gastrointestinal or respiratory infection. This narrative overview aims to summarise and discuss current knowledge and previous evidence regarding triggers and pathophysiology of GBS. A systematic search of the literature was carried out using suitable search terms. The most common subtypes of GBS are acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor axonal neuropathy (AMAN). The most common triggers of GBS, in three quarters of cases, are previous infections. The most common infectious agents that cause GBS include Campylobacter jejuni (C. jejuni), Mycoplasma pneumoniae, and cytomegalovirus. C. jejuni is responsible for about a third of GBS cases. GBS due to C. jejuni is usually more severe than that due to other causes. Clinical presentation of GBS is highly dependent on the structure of pathogenic lipo-oligosaccharides (LOS) that trigger the innate immune system via Toll-like-receptor (TLR)-4 signalling. AIDP is due to demyelination, whereas in AMAN, structures of the axolemma are affected in the nodal or inter-nodal space. In conclusion, GBS is a neuro-immunological disorder caused by autoantibodies against components of the myelin sheath or axolemma. Molecular mimicry between surface structures of pathogens and components of myelin or the axon is one scenario that may explain the pathophysiology of GBS.

Acute motor and sensory axonal neuropathy in a patient with undiagnosed mixed connective tissue disease

Case Report: Acute motor and sensory axonal neuropathy (AMSAN) syndrome is a rare subtype of Guillain-Barre syndrome (GBS) with poor recovery [1]. While respiratory and gastrointestinal infections may precipitate AMSAN, an underlying autoimmune disorder is seldom reported in literature. We herein report the complex case of a patient with undiagnosed, asymptomatic mixed connective tissue disease (MCTD) who developed AMSAN syndrome. Case: A 44-year-old Asian male without medical history presented with progressively worsening weakness of both upper and lower extremities and inability to perform daily activities. His symptoms started 12 weeks prior with difficulty standing from a seated position. He felt subjectively better for some time until a week prior, when he became bedbound. He had diarrhea 6 months ago, with 5-6 loose bowel movements a day for a few weeks. Vital signs on admission was normal. On neurological examination, he was alert and oriented, with bilateral upper and lower extremity flaccid paralysis, diffuse muscle atrophy, bilateral hand and foot drop, negative Hoover sign, diffuse areflexia, and intact sensation. Cerebrospinal fluid (CSF) analysis showed WBC 0 and protein level 136. MRI cervical, thoracic, and lumbar spine were normal. EMG revealed sensory involvement with positive sharp waves in proximal muscles along with fibrillations. Intravenous immunoglobulin (IVIG) was initiated at 0.4 mg/kg for 5 days. Infectious workup for COVID-19, stool culture, HIV, TB, RPR and campylobacter jejuni antibody (Ab), was negative. ANA was positive in a speckled pattern with titres 1:1280, with a positive RNP Ab, SS-A, and RF IgM, IgG and IgA. Rest of the autoimmune workup (anti-dsDNA, anti-CCP, SS-B, aldolase, anti-Jo-1, anti-Scl-70, p-ANCA, c-ANCA, anti-GM1, anti-GQ1b, and anti-GD1a ganglioside Ab) was negative. The myositis specific 11 Ab panel was negative. Despite IVIG therapy, he developed dysphagia, respiratory distress, with a negative inspiratory force of -0, requiring intubation. He had a tracheostomy and PEG tube placed and remains quadraplegic nearly 120 days later. Discussion(s): The authors report a unique case of a patient who became progressively weak over 3 months, leading to complete quadriplegia. Interestingly, this is more consistent with chronic inflammatory demyelinating poly-neuropathy (CIDP), as AMSAN typically develops over a short period of 2 to 4 weeks [2]. Despite having negative anti-GM1 and anti-GD1a Ab (in which positive Ab are pathognomonic but not always present in AMSAN syndrome), the patient had weakness that began in the lower extremities, progressing to paralysis, along with albuminocytological dissociation on CSF analysis, pointing to a GBS diagnosis [3]. He had sensory involvement in the EMG, thus making the diagnosis as AMSAN. He had an undiagnosed, asymptomatic autoimmune process most consistent with MCTD. Whether the two disease processes are related to each other is a concept that has not yet been investigated. Pediatric Clinical Case Reports Concurrent Session Saturday February 4, 2023 1:00 PM Copyright © 2023 Southern Society for Clinical Investigation.

Global epidemiology of campylobacteriosis and the impact of COVID-19.

Campylobacteriosis is a gastroenteritis caused by pathogenic Campylobacter species and an important topic in public health. Here we review the global epidemiology of campylobacteriosis in the last eight years between 2014-2021, providing comprehensive and updated information on the reported incidence and outbreaks of Campylobacter infections. The government public health website of each of the 195 countries and publications from 2014 to September 2022 in public databases were searched. The reported incidence of campylobacteriosis in pre-COVID-19 years was compared to that during the COVID-19 pandemic in countries where data were available. Czech Republic had the highest reported incidence of campylobacteriosis worldwide (215 per 100,000 in 2019), followed by Australia (146.8 per 100,000 in 2016) and New Zealand (126.1 per 100,000 in 2019). Campylobacter was one of the most common human enteric pathogens in both developed and developing countries. About 90% of cases of campylobacteriosis were caused by Campylobacter jejuni, whereas less than 10% of cases were caused by Campylobacter coli. Other Campylobacter species were also isolated. The reported incidence and case numbers of campylobacteriosis in developed nations have remained steadily high prior to the COVID-19 pandemic, whilst some countries reported an increasing trend such as France and Japan. While outbreaks were more frequently reported in some countries, Campylobacter infections were mainly sporadic cases in most of the developed countries. Campylobacter infection was more common in summer in some but not all countries. Campylobacter infection was more common in males than females. The COVID-19 pandemic has reduced the reported incidence of campylobacteriosis in most countries where 2020 epidemiology data were available. In conclusion, Campylobacter infection remains a global health concern. Increased research and improved strategies are needed for prevention and reduction of Campylobacter infection.

Molecular investigation of Campylobacter spp. and salmonella infection in children with community acquired diarrhea

Introduction: Acute gastroenteritis is a typical disorder that accounts for 8-12% of pediatric outpatient visits. Campylobacter and Salmonella infections account for about 8.4% and 11% of global diarrhea cases. Due to the importance of these bacteria in pediatric diseases, the aim of this study was to determine the infectious rate of Salmonella and Campylobacter species and also the frequency of the gene encoding Cytholethal distending toxin in children with community-acquired diarrhea. Material(s) and Method(s): Stool samples of children under 5 years of age with diarrhea were collected. The samples were related to children referred to hospitals in Hamadan, Ardabil, Bandar Abbas and two hospitals in Tehran. DNA was extracted from the samples using a DNA extraction kit from stool. The presence of Campylobacter in the studied samples was detected by polymerase chain reaction using specific primers. A control stool sample was spiked with 10-fold dilution of C. jejuni suspension for LOD (detection limit determination) measurement. Result(s): In this study, PCR results showed a LOD of 100 CFU per gram in the spiked feces sample. Accordingly, out of 144 fecal samples of children with acute diarrhea, one case was positive for Campylobacter jejuni;this sample was also positive for the presence of cdtB gene. Presence of Salmonella was confirmed in two samples of the patients (1.4%). Conclusion(s): Low prevalence of Campylobacter and Salmonella was detected in symptomatic children under 5 years of age during the Covid-19 pandemic. Examination of these samples for viruses and other microbial agents can clarify the etiology of diarrhea in children referred to the hospitals. Copyright © 2022, Semnan University of Medical Sciences. All rights reserved.

Guillain-Barre Syndrome and Parsonage-Turner Syndrome Following COVID-19 Viral Vector Vaccination

Case Diagnosis: Patient is a 63-year-old male with Guillain-Barre Syndrome and Parsonage-Turner Syndrome following COVID-19 Vaccination Case Description or Program Description: Eight days after receiving a viral vector COVID-19 vaccination, the patient developed low back and left thigh pain with severe right shoulder pain developing the following day. He denied recent viral illnesses, gastrointestinal symptoms, or prior right shoulder pain. Pain, weakness, and sensory changes gradually involved all four extremities. He was hospitalized and Guillain-Barre Syndrome (GBS) was confirmed by lumbar puncture. He tested negative for Campylobacter jejuni. Cervical and lumbar spine MRIs showed mild degenerative changes without stenosis or neuroforaminal impingement. Right shoulder MRI showed no abnormality. He responded to a 5-day course of IVIG. His extremity pain gradually resolved but right shoulder weakness remained. Electrodiagnostic testing six months after symptom onset showed evidence of GBS in recovery. Right shoulder girdle muscles were not tested during the first EMG. After stays at an LTAC and SNF, the patient was admitted to IPR. While at IPR, he reported debilitating right shoulder weakness and limited ROM. On exam, significant atrophy of the right deltoid, infraspinatus, and supraspinatus muscles was observed. A repeat electrodiagnostic study showed evidence of a right Parsonage-Turner syndrome (PTS) in addition to the GBS in recovery. Setting(s): Inpatient Rehabilitation (IPR) Assessment/Results: Patient's presentation and EMG findings pointed to a concurrent occurrence of PTS and GBS after his COVID-19 vaccination. A right shoulder ultrasound-guided glenohumeral joint corticosteroid injection improved his shoulder ROM. The patient was discharged home with outpatient therapy after four weeks of IPR. Discussion (relevance): Rare instances of GBS and Parsonage-Turner Syndrome have been reported after a COVID-19 vaccination. This appears to be the first reported case where GBS and PTS have both occurred in a patient soon after receiving a COVID-19 vaccination. Conclusion(s): Concurrent PTS and GBS can develop after COVID-19 vaccine administration.

A RARE CASE of ACUTE INFLAMMATORY DEMYELINATING POLYRADICULOPATHY FOLLOWING the SECOND DOSE of PFIZER COVID-19 VACCINE

Background: We present a case of a 36 year-old female who developed Acute Immune-mediated Demyelinating Polyneuropathy (AIDP) after receiving the second dose of Pfzer COVID-19 vaccine. Objectives: To report a rare auto-immune complication of COIVD-19 vaccination. To educate and inform physicians about the approach to diagnosing AIDP and narrowing down its etiology. Methods: Case report and literature review Results: A 36 year-old female with no signifcant past medical history presented to the hospital with progressive bilateral paresthesia. She started to experience numbness and tingling sensation in her extremities 1 week after receiving the second dose of Pfzer COVID-19 vaccine. Following 5 days of symptoms onset, she was no longer able to hold onto objects and experienced difficulty ambulating without assistance. Physical exam was notable for decreased distal sensation to touch and pain in all 4 limbs, otherwise, the rest of her neurological and musculoskeletal evaluation was normal. MRI-head showed small scattered foci of increased FLAIR signal in the white matter, suggesting an underlying infammatory process. Electromyography (EMG) was performed and showed evidence of acute diffuse sensorimotor neuropathy with mixed axonal and demyelinating features. These results along with the clinical features allowed us to diagnose our patient with Acute Immune-mediated Demyelinating Polyneuropathy (AIDP). Extensive autoimmune workup, including anti-GM1, GD1b, Gq1b, ANA, DS-DNA, RF, CCP, and C/P ANCA, were unremarkable. She had positive anti-Ro atb but did not have any clinical or physical features that would suggest Sjogren's Syndrome. Vitamin levels (B12, folate, thiamine) were found to be normal. Infectious workup of serum and CSF which included hepatitis serologies, Campylobacter jejuni serology, Lyme atb, CMV atb, EBV atb were all negative. The possible etiology of her disease was attributed to Pfzer COVID-19 vaccine given the temporal correlation. She was subsequently treated with 6 cycles of IVIG which resulted in moderate symptomatic improvement. Conclusion: AIDP is an autoimmune-guided infammatory neuropathy which result in axonal degeneration of myelinated nerves [1]. In some extremely rare cases, molecular mimicry following vaccination may lead to this disease [1]. There have been reports of AIDP linked to Johnson & Johnson and AstraZeneca COVID-19 vaccines [2]. Recently, a few cases have also been observed with Pfzer COVID-19 vaccine [2-3]. Interestingly, the majority of these cases occurred after the frst dose of the vaccine, making our case even more peculiar [2]. We report this case as physicians should be made aware that AIDP is a potential complication of COVID-19 vaccination. Given the extreme rarity of these cases, it is also important to note that more common infectious and autoimmune etiology of AIDP should be investigated before attributing any potential causal relationship to COVID-19 vaccines.

Persistently positive PCR after COVID-19. How to diagnose reinfections? [Spanish]

Persistence of a long-term positive polymerase chain reaction (PCR) test in patients with severe coronavirus-associated respiratory syndrome may interfere with the diagnosis of reinfections, causing false positives of the disease, with the potential implications to determine the need for isolation and, consequently, for Public Health. In these field notes we present the experience of a patient with positive PCR of eight months of evolution to which an erroneous diagnosis of COVID-19 reinfection was made due to a gastrointestinal disease, resulting in a Campylobacter jejuni infection.

[Pcr persistentemente positiva tras la COVID-19. ¿Cómo diagnósticar las reinfecciones?]

Persistence of a long-term positive polymerase chain reaction (PCR) test in patients with severe coronavirus-associated respiratory syndrome may interfere with the diagnosis of reinfections, causing false positives of the disease, with the potential implications to determine the need for isolation and, consequently, for Public Health. In these field notes we present the experience of a patient with positive PCR of eight months of evolution to which an erroneous diagnosis of COVID-19 reinfection was made due to a gastrointestinal disease, resulting in a Campylobacter jejuni infection.

Bacteriological and molecular detectionof Compylobacter species in human and animals in Diyala province

Campylobacteriosis is one of the most well-characterized bacterial foodborne infections worldwide, the species are the most common zoonotic pathogens. Chicken and chicken products are known to be the major sources of Campylobacter infection in humans. Campylobacter species represent one of the most common causes of bacterial diarrheal illness worldwide, it is the main cause of bacterial gastrointestinal infections occurring at any age, but it peaks in children and young adults. This study aims to investigate the presence and prevalence of Campylobacter bacteria in humans and chicken and aims for determination the extent of the contamination of this bacteria. The study involved two parts;the first part designed for isolation Campylobacter species from chickens which were alive, while the second part was about isolation Campylobacter species from human stool samples for different ages. The current study based on analysis of three hundred and fifty (350) stool samples taken from humans with different ages. The patients samples were collected from Al-Batool Teaching Hospital for Maternity and Pediatric, Baquba Teaching Hospital and Central Health Laboratories in Diyala, these patients were had vary clinical aspects like : (diarrhea, Fever, nausea, vomiting, abdominal pain and cramp, fatigue and muscle pain). On the other hand, one hundred seventy five (175) stool samples of chicken which they apparently had diarrhea were collected randomly from different areas of Diyala Governorate. The collection of both humans and chicken samples were during 2020 - 2021. The analysis of 350 samples of patients their ages ranged from 3 months to 59 years showed that the mean +or- SD of age was 24.5 +or- 14.3 years. The most predominant age group was 20-29 years (26.9%), while the lowest age group was 50-59 years (4.9%). Regarding the gender, 151 (43.1%) of the included patients were male and 199 (56.9%) were female. Patients included in the current study were collected from four districts of Diyala province. The highest collection rate was from Baquba district 217(62.0%), while the lowest collection rate was from Baladrooz district 18 (5.1%). the distribution of clinical signs and symptoms of included patients. Persistent diarrhea forming the predominance of signs 179 (51.1%), followed by watery diarrhea 55 (15.7%), while the least sign was vomiting 1(3%). Furthermore, 15 (4.3%) of patients showed all that signs and symptoms. The signs and symptoms were : diarrhea was found in 194 (55.4%) patients, followed by watery diarrhea in 77 (22.0%) patients. Fever was found in 30 (8.6%) patients. The least sign was nausea which was found in 15 (4.3%) patients. Abdominal pain and cramps were detected in 22 (6.3%) patients. Out of 350 stool specimens submitted for bacteriological culture, 62 (17.7%) were positive versus 288 (82.3%) were negative. Among the 62-culture positive, 13 specimens yield Campylobacter growth, so the campylobacter detection rate among human specimens was 3.7%. The isolated Campylobacter were as follow;11(3.1%) were Campylobacter jejuni, one (0.3%) was Campylobacter coli, one (0.3%) was undifferentiated campylobacter. On the other hand, 58 (16.6%) of the specimens yield bacterial growth other than Campylobacter, as follows: E. coli was detected in 28 (8.0%), Proteus Spp. was detected in 12 (3.4%), H. pylori was detected in 10 (2.9%) and Klebsiella Spp. was detected in 8 (2.3%). The remaining specimens 279 (79.7%) yield no growth. The results of the PCR technique revealed that 8 (2.38%) specimens were positive for Campylobacter, while the majority 335 (95.7%) were negative and 7(2.0%) of the specimens were not done. While the analysis of 175 chicken fecal samples taken from chickens were mainly suffering from diarrhea showed that the distribution of chickens according to their ages in days showed predominance was those 30-39 (40.6%) days old. It is clear that the majority of specimens (74.3%) were collected from Baquba districts. The results showed that specimens collected Al- Muqdadiya district farms had yielded the high

Recurrent Campylobacter jejuni Infection in an Immunodeficient Patient Treated with Repeated Faecal Microbiota Transplant (FMT)-A Case Report.

There is limited evidence to guide successful treatment of recurrent Campylobacter infection in patients with common variable immunodeficiency (CVID) already managed on regular immunoglobulin therapy. The role of faecal microbiota transplant (FMT) is uncertain. We report a case of recurrent Campylobacter jejuni infection in a patient with CVID treated with repeated FMT with 18 months of symptom resolution prior to relapse.

Immunocapture Magnetic Beads Enhanced the LAMP-CRISPR/Cas12a Method for the Sensitive, Specific, and Visual Detection of Campylobacter jejuni.

Campylobacter jejuni is one of the most important causes of food-borne infectious disease, and poses challenges to food safety and public health. Establishing a rapid, accurate, sensitive, and simple detection method for C. jejuni enables early diagnosis, early intervention, and prevention of pathogen transmission. In this study, an immunocapture magnetic bead (ICB)-enhanced loop-mediated isothermal amplification (LAMP) CRISPR/Cas12a method (ICB-LAMP-CRISPR/Cas12a) was developed for the rapid and visual detection of C. jejuni. Using the ICB-LAMP-CRISPR/Cas12a method, C. jejuni was first captured by ICB, and the bacterial genomic DNA was then released by heating and used in the LAMP reaction. After the LAMP reaction, LAMP products were mixed and detected by the CRISPR/Cas12a cleavage mixture. This ICB-LAMP-CRISPR/Cas12a method could detect a minimum of 8 CFU/mL of C. jejuni within 70 min. Additionally, the method was performed in a closed tube in addition to ICB capture, which eliminates the need to separate preamplification and transfer of amplified products to avoid aerosol pollution. The ICB-LAMP-CRISPR/Cas12a method was further validated by testing 31 C. jejuni-positive fecal samples from different layer farms. This method is an all-in-one, simple, rapid, ultrasensitive, ultraspecific, visual detection method for instrument-free diagnosis of C. jejuni, and has wide application potential in future work.

Investigating the Anti-Viral and Anti-Bacterial activities of Jordanian Medicinal plants: A narrative review

The diversity in Jordan’s flora due to its geographical areas make is well noted in the scientific literature. The challenge of disease and death caused by infectious diseases like viruses and bacteria, and as infectious diseases evolve and pathogens develop resistance to existing pharmaceuticals, the search for new novel leads, possibly with different modes of action, against bacterial and viral diseases has intensified in recent years. The intent of this review is to provide prevalent information on the antibacterial and antiviral potential in medicinal plants in Jordan, mode of action, type of viruses and bacteria, and phytochemical contents. It has been demonstrated by several studies presented in this review that medicinal plants in Jordan are rich in phytochemicals and possess antiviral and antibacterial properties.

Case report of Campylobacter jejuni-associated myopericarditis: rare case of cardiac involvement by a common gastroenteritis pathogen.

BACKGROUND: Myocarditis is caused by inflammation affecting the heart muscle. The usual aetiological factor is viral, especially in immunocompetent hosts and developed countries. Campylobacter jejuni is a common cause of bacterial gastroenteritis but has rarely been associated with myocarditis. CASE SUMMARY: We report a case of a 22-year-old male admitted with pleuritic chest pain and a diarrhoeal illness. Thorough evaluation of the patient history did not reveal any sources for contracting the diarrhoea. Stool cultures confirmed that the patient had C. jejuni infection as well as myopericarditis confirmed on cardiac magnetic resonance imaging (cardiac MRI). Treatment with colchicine 0.5 mg BD, ibuprofen 600 mg TDS, and ciprofloxacin 500 mg BD orally for 5 days was started, together with an intravenous infusion of 0.9% normal saline 1 L TDS. The patient showed signs of improvement over a span of three days and the ST changes on electrocardiogram resolved. DISCUSSION: Although C. jejuni-associated myopericarditis is uncommon, it can be potentially life-threatening if not considered in the differential. Its diagnosis involves good history taking, examination, and investigation with electrocardiography, troponins and inflammatory markers, echocardiography, and cardiac MRI. Several mechanisms of infection have been suggested, including direct insult by toxin or bacterium as well as an immune-mediated response. Both supportive and causative treatments are important to ensure recovery while reducing the risk of complications. It is therefore crucial to ensure that the patient receives adequate follow-up to ascertain patient progress and to mitigate any complications that may arise as well as tackle patient concerns. The patient had a rapid recovery.