Associations between frequency of protective face mask usage and nasal carriage of MDRSA, <i>scn</i>-negative <i>S</i>. <i>aureus</i>, <i>and</i> tetracycline-resistant <i>S</i>. <i>aureus</i> among industrial hog operation workers in North Carolina, 2013–2014.

<p>Associations between frequency of protective face mask usage and nasal carriage of MDRSA, <i>scn</i>-negative <i>S</i>. <i>aureus</i>, <i>and</i> tetracycline-resistant <i>S</i>. <i>aureus</i> among industrial hog operation workers in North Carolina, 2013–2014.</p

Prevalence and distribution of characteristics of baseline <i>S</i>. <i>aureus</i> nasal carriage among 183 industrial hog operation workers and household members in North Carolina, 2013–2014.^a

<p>Prevalence and distribution of characteristics of baseline <i>S</i>. <i>aureus</i> nasal carriage among 183 industrial hog operation workers and household members in North Carolina, 2013–2014.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165713#t002fn002" target="_blank">^a</a></p

Characteristics of <i>S</i>. <i>aureus</i> recovered from the anterior nares of industrial hog operation workers and minors who reported recent skin and soft tissue infection (SSTI) in North Carolina, 2013–2014.^a

<p>Characteristics of <i>S</i>. <i>aureus</i> recovered from the anterior nares of industrial hog operation workers and minors who reported recent skin and soft tissue infection (SSTI) in North Carolina, 2013–2014.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165713#t004fn002" target="_blank">^a</a></p

Baseline characteristics of 183 industrial hog operation workers and household members participating in a cohort study of <i>S</i>. <i>aureus</i> nasal carriage in North Carolina, 2013–2014.

<p>Baseline characteristics of 183 industrial hog operation workers and household members participating in a cohort study of <i>S</i>. <i>aureus</i> nasal carriage in North Carolina, 2013–2014.</p

Association of baseline <i>S</i>. <i>aureus</i> nasal carriage patterns with recent skin and soft tissue infection (SSTI) among industrial hog operation workers and their child household members in North Carolina, 2013–2014.^a

<p>Association of baseline <i>S</i>. <i>aureus</i> nasal carriage patterns with recent skin and soft tissue infection (SSTI) among industrial hog operation workers and their child household members in North Carolina, 2013–2014.<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0165713#t003fn002" target="_blank">^a</a></p

The other <i>Campylobacters</i>: Not innocent bystanders in endemic diarrhea and dysentery in children in low-income settings

<div><p>Background</p><p><i>Campylobacter</i> is one of the main causes of gastroenteritis worldwide. Most of the current knowledge about the epidemiology of this food-borne infection concerns two species, <i>C</i>. <i>coli</i> and <i>C</i>. <i>jejuni</i>. Recent studies conducted in developing countries and using novel diagnostic techniques have generated evidence of the increasing burden and importance of other <i>Campylobacter</i> species, i.e. non-<i>C</i>. <i>coli/jejuni</i>. We performed a nested case-control study to compare the prevalence of <i>C</i>. <i>coli/jejuni</i> and other <i>Campylobacter</i> in children with clinical dysentery and severe diarrhea as well as without diarrhea to better understand the clinical importance of infections with <i>Campylobacter</i> species other than <i>C</i>. <i>coli/jejuni</i>.</p><p>Methodology/Principal findings</p><p>Our nested case-control study of 439 stool samples included dysenteric stools, stools collected during severe diarrhea episodes, and asymptomatic stools which were systematically selected to be representative of clinical phenotypes from 9,160 stools collected during a birth cohort study of 201 children followed until two years of age. Other <i>Campylobacter</i> accounted for 76.4% of the 216 <i>Campylobacter</i> detections by qPCR and were more prevalent than <i>C</i>. <i>coli/jejuni</i> across all clinical groups. Other <i>Campylobacter</i> were also more prevalent than <i>C</i>. <i>coli/jejuni</i> across all age groups, with older children bearing a higher burden of other <i>Campylobacter</i>. Biomarkers of intestinal inflammation and injury (methylene blue, fecal occult test, myeloperoxidase or MPO) showed a strong association with dysentery, but mixed results with infection. MPO levels were generally higher among children infected with <i>C</i>. <i>coli/jejuni</i>, but <i>Shigella</i>-infected children suffering from dysentery recorded the highest levels (26,224 ng/mL); the lowest levels (10,625 ng/mL) were among asymptomatic children infected with other <i>Campylobacter</i>. Adjusting for age, sex, and <i>Shigella</i> infection, dysentery was significantly associated with <i>C</i>. <i>coli/jejuni</i> but not with other <i>Campylobacter</i>, whereas severe diarrhea was significantly associated with both <i>C</i>. <i>coli/jejuni</i> and other <i>Campylobacter</i>. Compared to asymptomatic children, children suffering from dysentery had a 14.6 odds of <i>C</i>. <i>coli/jejuni</i> infection (p-value < 0.001, 95% CI 5.5–38.7) but were equally likely to have other <i>Campylobacter</i> infections–odds ratio of 1.3 (0.434, 0.7–2.4). Children suffering from severe diarrhea were more likely than asymptomatic children to test positive for both <i>C</i>. <i>coli/jejuni</i> and other <i>Campylobacter</i>–OR of 2.8 (0.034, 1.1–7.1) and 1.9 (0.018, 1.1–3.1), respectively. Compared to the <i>Campylobacter</i>-free group, the odds of all diarrhea given <i>C</i>. <i>coli/jejuni</i> infection and other <i>Campylobacter</i> infection were 8.8 (<0.001, 3.0–25.7) and 2.4 (0.002, 1.4–4.2), respectively. Eliminating other <i>Campylobacter</i> in this population would eliminate 24.9% of the diarrhea cases, which is almost twice the population attributable fraction of 15.1% due to <i>C</i>. <i>coli/jejuni</i>.</p><p>Conclusions/Significance</p><p>Eighty-seven percent of the dysentery and 59.5% of the severe diarrhea samples were positive for <i>Campylobacter</i>, <i>Shigella</i>, or both, emphasizing the importance of targeting these pathogens to limit the impact of dysentery and severe diarrhea in children. Notably, the higher prevalence of other <i>Campylobacter</i> compared to <i>C</i>. <i>coli/jejuni</i>, their increasing burden during early childhood, and their association with severe diarrhea highlight the importance of these non-<i>C</i>. <i>coli/jejuni Campylobacter</i> species and suggest a need to clarify their importance in the etiology of clinical disease across different epidemiological contexts.</p></div

Comparison of <i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical group (control, dysentery, severe diarrhea) using qPCR and culture.

<p>Comparison of <i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical group (control, dysentery, severe diarrhea) using qPCR and culture.</p

List of primers and probes used for the detection of <i>Campylobacter</i> (genus specific), <i>Campylobacte</i>r <i>coli/jejuni</i>, and <i>Shigella</i>.

<p>List of primers and probes used for the detection of <i>Campylobacter</i> (genus specific), <i>Campylobacte</i>r <i>coli/jejuni</i>, and <i>Shigella</i>.</p

Prevalence of <i>Campylobacter</i> and <i>Shigella</i> among children suffering from dysentery and severe diarrhea in peri-urban communities in Loreto, Peru.

<p>Prevalence of <i>Campylobacter</i> and <i>Shigella</i> among children suffering from dysentery and severe diarrhea in peri-urban communities in Loreto, Peru.</p

<i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical outcome (asymptomatic infection, dysentery, severe diarrhea) using the qPCR assay.

<p><i>C</i>. <i>coli/jejuni</i>, other <i>Campylobacter</i>, and <i>Shigella</i> prevalence by clinical outcome (asymptomatic infection, dysentery, severe diarrhea) using the qPCR assay.</p