This article is more than 5 years old. Information may no longer be current.
C. concisus infection associated with prolonged diarrhea
Click Here to Manage Email Alerts
Campylobacter concisus infection in children is associated with more prolonged diarrhea; however, there is a milder course of acute gastroenteritis compared with C. jejuni/C. coli infection, according to recent study findings published in The Pediatric Infectious Disease Journal.
“Campylobacter jejuni, and the closely related but less frequent Campylobacter coli, are the most commonly reported bacteriologic agents in gastrointestinal disease,” researchers wrote. “A related species, Campylobacter concisus, was first isolated from human periodontal lesions, and it is commonly isolated from saliva in healthy individuals, including children.”
The 2-year study included 85 children aged younger than 18 years with C. concisus and 109 with C. jejuni/C. coli. Clinical data were collected from a questionnaire study and the participants’ medical records.
Researchers found a significantly lower prevalence of fever, chills and blood in stools in 44 C. concisus participants compared with 64 C. jejuni/C. coli participants.
However, 48% of participants with C. concisus compared with 25% of participants with C. jejuni/C. coli reported diarrhea for more than 2 weeks (P<.05).
“Campylobacter concisus infection in children was almost as prevalent as the common C. jejuni/coli through the 2-year study period,” researchers wrote. “Campylobacter concisus was frequent among infants (<1 year), and toddlers, whereas C. jejuni/coli were more frequent in school children. Overall, the children in both Campylobacter groups were more or less otherwise healthy, and no one has a prehistory of [inflammatory bowel disease] or other non-infective colitis, and only three patients were excluded due to a co-infecting bacterial agent.”
Disclosure: The study was funded in part by grants from The A.P. Møller Foundation for the Advancement of Medical Science, Heinrich Kopp’s legate and the Hertha Christensen foundation.
Perspective
The ability to differentiate between opportunistic organism and pathogen is a challenge in the management of infectious diseases and especially in enteric infections. As we improve our capacity to detect organisms, we must decide whether or not the information from the laboratory is clinically relevant. Studies such as this prospective observational study conducted by Danish researchers from January 2009 through December 2010 compared the clinical manifestations of gastroenteritis among 1,867 children from whom 2,372 stools were collected. Campylobacterconcisus was isolated from 85 children while Campylobacter jejuni or C. coli was isolated from 109 children; three subjects with bacterial co-infections with non-Campylobacterspp. organisms were excluded. The 44 (52%) of children from whom C. concisus was isolated and clinical information could be obtained were less likely to have systemic symptoms, hematochezia, and a preceding international travel history but were more likely to be younger and have prolonged diarrhea than the 64 (59%) of children from whom C. jejuni/coli was isolated and clinical information available The children from whom C. concisus was isolated were less likely to receive antimicrobial treatment than those with C. jejuni/coli isolates. One child with C. concisus was diagnosed with Crohn Disease at a 6 month post-isolation evaluation. Limitations of the results include response bias with only between 50 to 60% of parents of subjects contributing data to the clinical assessment. The subjects were not matched by age, possibly contributing to less informative subjective data in the younger C. concisus subjects.
Surveillance of C. concisus stool isolates from children receiving care at a tertiary institution in Cape Town, South Africa noted an increased prevalence of underlying conditions, yet fewer clinical symptoms, compared to this Danish cohort. This variability supports the numerous habitats of the organism including periodontal, dermatologic, gastrointestinal, and hematologic. Molecular analyses note genotypic and phenotypic diversity, which may contribute to variability in source and corresponding clinical presentations. This study contributes to our emerging knowledge about the potential pathogenicity of C. concisus and suggests that it may be an etiology of persistent diarrhea in young children, albeit with less severe systemic manifestations than infections attributed to C. jejuni/coli.
Andi L. Shane, MD, MPH, MSc
Infectious Diseases in Children Editorial Board Member
Collapse
Click Here to Manage Email Alerts