Association between <i>Campylobacter</i> and weight gain.

<p>*significant at the p< = 0.10 level.</p>**<p>significant at the p< = 0.05 level.</p>***<p>significant at the p< = 0.01 level.</p><p>Weight models adjusted for stunting at onset of interval, WHZ category at onset of interval, season, age, birth weight and per capita income.</p><p>Fractional polynomial age term 1: ; age term 2: where <i>age</i> is the child's age, in days, divided by 1000.</p><p>In model 1, <i>Campylobacter</i>-related variables were asymptomatic <i>Campylobacter</i>, and symptomatic (diarrhea-associated) <i>Campylobacter</i> (2 variables).</p><p>In model 2, <i>Campylobacter-</i>related variables were asymptomatic <i>campylobacter</i>, symptomatic treated <i>campylobacter</i>, and symptomatic untreated <i>campylobacter</i> (three variables).</p

Poisson model of risk factors for <i>Campylobacter.</i>

*<p>significant at <0.100 level,</p>**<p>significant and <0.050 level,</p>***<p>significant at <0.010 level.</p><p>Sex, seasonal terms, maternal age, breastfeeding status, birth weight, private household latrine, and the presence of household poultry, were not significant in any model and are not shown.</p><p>The association between prior nutritional status and prior diarrhea, and prior <i>Campylobacter</i>, were examined via correlations and kappa statistics and found to be low (rho<0.05).</p

Diarrhea episodes and asymptomatic stools, by <i>Campylobacter</i> species.

*<p>Diarrheal episodes were considered associated with <i>Campylobacter</i> when at least one stool sample from the episode was culture-positive for Campylobacter. A stool sample was considered associated with the episode when it was collected during, or up to one day after, the episode. Only stool samples that could be associated with anthropometry are reported here.</p><p>Asymptomatic stools were collected quarterly.</p

Association between <i>Campylobacter</i> and linear growth.

*<p>significant at the p = 0.10 level.</p>**<p>significant at the p = 0.05 level.</p>***<p>significant at the p = 0.01 level.</p><p>Height models adjusted for stunting at onset of interval, WHZ category at onset of interval, season, age, birth weight and per capita income.</p><p>Fractional polynomial age term 1: ; age term 2: where <i>age</i> is the child's age, in days, divided by 1000.</p><p>In model 1, <i>Campylobacter</i>-related variables were asymptomatic <i>Campylobacter</i>, and symptomatic (diarrhea-associated) <i>Campylobacter</i> (2 variables).</p><p>In model 2, <i>Campylobacter-</i>related variables were asymptomatic <i>campylobacter</i>, symptomatic treated <i>campylobacter</i>, and symptomatic untreated <i>campylobacter</i> (three variables).</p

Smoothed plots of incidence versus age, and the percentage of stools positive by etiology.

<p>The peak incidence of <i>Campylobacter</i>-associated diarrhea occurs at approximately 18 months of age, and declines rapidly thereafter. However, its isolation rate in diarrheal and asymptomatic stool samples remains roughly constant from 18–72 months of age.</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

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

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

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

<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