Clinical
Microbiology
Newsletter
Vol. 28, No. 7
April 1, 2006
Emerging Campylobacter spp.: the Tip of the Iceberg
Albert J. Lastovica, Ph.D., Clinical Laboratory Science (Medical Microbiology) and IIDMM, University of Cape Town,
Cape Town, South Africa
Abstract
Campylobacter jejuni is universally recognized as the most common bacterial cause of human gastroenteritis. This organism is
also associated with septicemia, meningitis, and the post-infective sequelae of the Guillain-Barré syndrome and reactive arthritis.
Interest is increasing in Campylobacter species other than C. jejuni and their roles in human and animal disease. However, these
emerging campylobacteria are dramatically under-isolated because of the application of less than optimal laboratory protocols.
A Cape Town protocol in which stool is filtered onto antibiotic-free culture media and incubated in a hydrogen-enriched, microaerobic atmosphere is a simple and cost-effective means of optimizing the recovery of all species of Campylobacter, as well as
species of the related genera Arcobacter and Helicobacter, from stool, blood, and other clinical samples. Subsequent biochemical
identification by means of a flowchart easily identifies presumptive Campylobacter isolates to the species level. As emerging
Campylobacter spp. are dramatically under-isolated, the true disease potential of these organisms is unknown at present.
Introduction
“Only one percent of human illness
due to Campylobacter is caused by
Campylobacter species other than C.
jejuni or C. coli.” (http://www.cdc.gov/
campylobacter)
Campylobacter spp. are universally
acknowledged as the most common bacterial cause of enteritis worldwide. Of
the 17 recognized and named species of
the genus Campylobacter, 14 species —
Campylobacter coli, Campylobacter concisus, Campylobacter curvus, Campylobacter fetus, Campylobacter hominis,
Campylobacter hyointestinalis, Campylobacter jejuni, Campylobacter lanienae,
Campylobacter lari, Campylobacter
mucosalis, Campylobacter rectus, Campylobacter showae, Campylobacter
sputorum, and Campylobacter upsaliensis — have been isolated from
symptomatic and asymptomatic
Mailing address: Albert J Lastovica, Ph.D.,
Medical Microbiology, IIDMM,University
of Cape Town, Medical School, Anzio Road,
Observatory, 7925, Cape Town, South
Africa. Tel.: (+27) 21 406 6083. Fax: (+27)
21 448 8150. E-mail: lastoaj@mweb.co.za
Clinical Microbiology Newsletter 28:7,2006
humans. C. jejuni is by far the most
commonly isolated Campylobacter
species. C. jejuni has two subspecies, C.
jejuni subsp. jejuni and C. jejuni subsp.
doylei. Although infrequently isolated,
C. jejuni subsp. doylei has been associated with gastroenteritis and septicemia
in pediatric patients (1). C. jejuni subsp.
jejuni is overwhelmingly the most frequently isolated Campylobacter worldwide and is associated with enteritis,
particularly in young children, in both
developed and developing countries.
This bacterium is recognized as the
most common antecedent pathogen
associated with the Guillain-Barré syndrome and reactive arthritis. C. jejuni
subsp. jejuni has also been associated
with other clinical conditions, such as
septicemia, meningitis, the hemolyticuremic syndrome, pancreatitis, and
abortion.
The role of C. jejuni subsp. jejuni in
human disease is well established, but
the clinical relevance of other Campylobacter species (emerging campylobacteria) is far less well understood because
relatively few strains of these organisms
have been isolated from clinical mater© 2006 Elsevier
ial. The paucity of isolated Campylobacter strains is undoubtedly due to a
variety of reasons (Table 1). Current
isolation protocols for Campylobacter
spp.are biased in favor of the isolation
of C. jejuni subsp. jejuni and C. coli.
Less than optimal conditions of temperature, atmosphere, and incubation
time contribute to the failure to isolate
emerging Campylobacter spp. Most
diagnostic microbiology laboratories
use commercially available isolation
plates containing antibiotics for suppressing the growth of bacteria other
than Campylobacter spp. However,
these selective media contain components that inhibit the growth of emerging Campylobacter spp., as has been
extensively documented by Loades et al.
(2); varying susceptibilities by agar disk
diffusion are shown in Fig. 1A. The
isolation of C. upsaliensis and other
0196-4399/00 (see frontmatter)
49
emerging campylobacteria from stool
and other clinical material is unsuccessful when media containing antibiotics
to which these organisms are susceptible are used.
Some emerging Campylobacter spp.,
such as C. concisus, C. showae, C. rec-
tus, and C. curvus, have an essential
growth requirement for hydrogen or
formate (Fig. 1B). They are found in
the gingival flora of the human mouth,
notably in periodontal pockets of diseased gums, although a causal role for
these organisms has not been established.
Table 1. Reasons for failure to detect emerging campylobacteria and related organisms
• Preconception that emerging Campylobacter spp. are not commonly found
• Lack of appreciation of the growth and biochemical characteristics of emerging
Campylobacter spp.
• Use of antibiotic-containing selective media that may inhibit growth of emerging
Campylobacter spp.
• Inappropriate isolation temperature
• Inappropriate isolation atmosphere
• Inappropriate length of time for isolation
A
B
C
D
Figure 1. (A) A C. upsaliensis isolate showing a 4-cm inhibitory zone for nalidixic acid
(30-µg disk) on the left and a 5-cm inhibitory zone for cephalothin (30-µg disk) on the right.
(B) Clinical isolates of C. concisus and C. jejuni subsp. jejuni grown on tryptose blood agar
under microaerophilic conditions (right) and H2-enriched microaerophilic conditions (left).
(C) Variation of colony morphology for clinical isolates of C. jejuni subsp. jejuni (Cjj), C.
concisus (C con) and C. hyointestinalis (C hyo). (D) Stool filtration onto antibiotic-free
tryptose blood agar: stool application (left) and the isolation plate (right) after 48 h of
incubation at 37°C in an H2-enriched microaerophilic atmosphere.
50
0196-4399/00 (see frontmatter)
© 2006 Elsevier
These Campylobacter species have
been isolated from the stools of patients
suffering from gastroenteritis, septicemia, and other clinical conditions (3).
Hydrogen-dependent organisms are
extremely difficult, if not impossible,
to recover by the standard culture techniques currently employed in most
routine diagnostic laboratories.
Some diagnostic laboratories use
42°C as a primary incubation temperature, which allows growth of C. jejuni
subsp. jejuni and C. coli but not of other
species, such as C. fetus or C. hyointestinalis, which grow at 37°C but not
42°C. C. jejuni subsp. jejuni and C.
coli contaminate chicken which has an
internal temperature of 42°C. This is
probably the historical precedent for
using 42°C as a primary incubation
temperature. For clinical specimens, it
is recommended that incubation at 37°C
is a more appropriate temperature, as all
Campylobacter spp. infecting humans
can be isolated and maintained at this
temperature.
Up to 17% of clinical samples may
have two to five distinct species of
Campylobacter or species of the related
genera Arcobacter and Helicobacter
identified on the primary isolation plate
(4). C. jejuni subsp. jejuni may be coisolated with an emerging Campylobacter sp. Different species of Campylobacter and related genera can often be
detected initially by differences in colony
morphology (Fig. 1C) and subsequently
confirmed by biochemical testing (Fig.
2). Most strains of C. jejuni subsp. jejuni
and C. coli are relatively fast growing,
while other Campylobacter species, such
as C. upsaliensis, C. rectus, C. hyointestinalis, and C. concisus, are much
slower growing. A bench technologist
might isolate a C. jejuni subsp. jejuni
strain after 2 days and promptly discard
the isolation plate, which, if kept and
re-incubated for an additional 2 to
4 days, could subsequently yield
Clinical Microbiology Newsletter 28:7,2006
Figure 2. Biochemical flowchart for the identification of Campylobacter, Helicobacter, and Arcobacter species from clinical material. This procedure is used after the presumptive isolate is determined to be gram negative and negative for the L-ALA test, and also if the isolate can grow
under aerobic conditions or if it has an essential requirement for a microaerophilic or an H2-enriched microaerophilic atmosphere. The biochemical tests outlined are standard diagnostic tests for Campylobacter spp. Useful additional tests are nitrate reductase, catalase, lead acetate, and
pyrazinamidase. Nalidixic acid (30 µg disk) and cephalothin (30-µg disk) have limited diagnostic use, as an increasing number of Campylobacter strains are resistant or intermediate for these antibiotics. The complete biochemical profiles of C. jejuni subsp. jejuni, emerging
Campylobacter spp., Arcobacter spp., and Helicobacter spp. are detailed in reference 1.
additional strains of Campylobacter or
related genera.
Reservoirs of Emergent
Campylobacters
C. jejuni subsp. jejuni infection is
usually acquired from contaminated
food, particularly poultry, beef, sheep,
and unpasteurized milk. Reservoirs of
newly described emerging Campylobacter spp. have been found in production
animals, such as pigs, sheep, cattle, and
poultry. Emergent campylobacteria have
also been isolated from pets and wild
animals, such as dogs, cats, hamsters,
foxes, monkeys, rodents, and seals. However, non-mammalian species, such as
wild birds and shellfish, have recently
been implicated as reservoirs for these
organisms (3). Whether emerging
Campylobacter spp., if present in the
food chain, are a potential health hazard
Clinical Microbiology Newsletter 28:7,2006
must still be determined. This question
is currently being addressed. Information in this regard can be obtained on
the website http://www.campycheck.org.
Humans appear to be the only known
reservoir of C. concisus and C. gracilis.
Rivers, seawater, and groundwater are
known to harbor Campylobacter and
Arcobacter spp. (2). Moore et al. (5)
have provided a brief but informative
review of emerging Campylobacter
spp., including the recently described
C. hominis, C. lanienae, and C. sputorum bv. paraureolyticus, all of which
have been isolated from human and
animal feces.
Little is known about virulence factors in emerging campylobacteria, as
almost all studies on Campylobacter
spp. have been done on C. jejuni subsp.
jejuni. Pathogenic mechanisms associated with acute intestinal infection in
campylobacteriosis are poorly understood but most probably involve adherence, invasion of intestinal cells, and
toxin production.
Sylvester et al. (6) demonstrated that
C. upsaliensis is capable of binding to
Chinese hamster ovary (CHO) cells in
cell culture. These authors also detected
50- to 90-kDa surface proteins on C.
upsaliensis isolates that were capable of
binding to phosphatidylethanolamine, a
putative cell membrane receptor. Fouts
et al. (7) have discovered a novel putative licABCD virulence locus in C.
upsaliensis with significant similarity
to genes present in Streptococcus,
Haemophilus, and Neisseria spp. Genes
in these microorganisms encode proteins
© 2006 Elsevier
0196-4399/00 (see frontmatter)
Virulence Factors of Emergent
Campylobacteria
51
involved in the acquisition of choline,
the synthesis of phosphocholine (PCho),
and finally, the transfer of PCho to the
teichoic and lipoteichoic acids of lipooligopolysaccharide (a component of
the outer membrane of some gramnegative bacteria that is similar to lipopolysaccharide in structure but with a
shorter O antigen carbohydrate chain)
to facilitate bacterial attachment to
host cells.
Cytolethal distending toxins from
enteropathogenic Escherichia coli disrupt the barrier function of host intestinal epithelial tight junctions. Pickett et
al. (8) confirmed the presence of a cytolethal distending toxin homologue in C.
upsaliensis. However, the appropriate
cdt genes have yet to be cloned.
Efficient Isolation of Emergent
Campylobacter spp.
The Cape Town protocol for the isolation of Campylobacter spp. from stool
(Table 2) uses filtration through a membrane filter onto an antibiotic-free blood
agar plate (Fig. 1D) and subsequent
incubation at 37°C in an H2-enriched
microaerobic atmosphere. This protocol
has dramatically increased both the
number of strains and the number of
Campylobacter spp. and species of the
related genera Arcobacter and Helicobacter isolated from diarrheic stools of
pediatric patients (3). By using antibiotic-containing selective media at the
Red Cross Children’s Hospital (RXH)
in Cape Town, South Africa, 7.1% of
diarrheic stools from pediatric patients
were positive for Campylobacter spp.
After the implementation of the Cape
Town protocol, the number of Campylobacter-positive stools rose to 21.8%
(4). For the first time, C. upsaliensis, C.
concisus, C. hyointestinalis, C. rectus,
Helicobacter fennelliae, Helicobacter
cinaedi, and Arcobacter butzleri were
isolated from the diarrheic stools and
blood cultures of pediatric patients.
A modification of the Cape Town
protocol (no filter is used) has proved
to be efficient in isolating species of
Campylobacter and related genera from
blood, pleural aspirates, and other clinical material, as well as Helicobacter
pylori from gastric biopsy specimens.
The Cape Town protocol has been evaluated recently at the International Center for Diarrhoeal Diseases Research,
B: Center for Health and Population
52
0196-4399/00 (see frontmatter)
Table 2. Essential features of the Cape Town protocol for the isolation of Campylobacter
and the related genera Arcobacter and Helicobacter from stoola
1. Stool: prepare a watery emulsion in sterile saline. Mucoid samples should be vortexed.
2. Aseptically place a 0.6-µm-pore-size membrane filter (Schleicher & Schuell ME 26) directly
onto a triptose blood agar (TBA) plate (Oxoid CM233, 10% unlysed horse or sheep blood).
3. Flood the central area of filter with the suspension using a transfer pipette.
4. Reflood two or three times.
5. Remove and discard filter (±15 min). Incubate the plate as soon as possible under H2enriched microaerobic conditions at 37ºC.b
6. Incubate plate for 6 days, examining every 2 days. Do not discard or ignore the primary
plate once growth has been obtained, as more than one species may be present which have
different growth rates. Morphologically different colonies (size, color, time of appearance,
etc.) may indicate mixed infections. If so, subculture to purify.
7. Subculture single colonies and use the L-ALA test as a prescreen (Table 3).
8. A single colony should be subcultured on TBA and aerobically cultured for 2 days to
establish whether there is growth, which would indicate that it is an Arcobacter strain.
9. Follow the biochemical flowchart (Fig. 2) for identification.
a
This protocol may be modified to use blood or other clinical samples. Gastric biopsy material: gently spread the
biopsy sample on the surface of a TBA plate using a swab moistened with sterile saline. Blood cultures: Apply
~0.2 ml of the mixture taken from the blood culture bottle over the surface of a TBA plate. DO NOT USE A FILTER.
b
H2–enriched microaerobic conditions are obtained by using anaerobic sachets (Oxoid BR38 or BBL 70304) with
NO CATALYST.
Research, in Dhaka, Bangladesh. As
a result, the number of species and
the number of Campylobacter strains
(including C. jejuni subsp. jejuni) isolated in their laboratory has increased
dramatically (9). As outlined in Table 2,
the use of the Cape Town protocol is
simple, as is the subsequent identification by means of the biochemical flowchart (Fig. 2). As species of Helicobacter
and Arcobacter are often co-isolated
with Campylobacter spp. from clinical
specimens, and as they are morphologically similar to Campylobacter, it is
necessary to differentiate these organisms from Campylobacter. The use of
the biochemical flow chart in Fig. 2
readily does this.
Campylobacter, Helicobacter, and
Arcobacter strains can easily be differentiated from other gram-negative
and gram-positive bacteria. L-Alanine
aminopeptidase (L-ALA) is found in
most gram-negative bacteria, but not in
gram-positive bacteria or in Campylobacter, Helicobacter or Arcobacter
species (10). The Oxoid Biochemical
Identification System (O.B.I.S.; Oxoid,
Ltd., Basingstoke, Hampshire, U.K.)
uses L-alanyl-7-amino-4-methylcoumarin as a substrate, while the Fluka
detection system (Fluka GmbH,
Buchs, Switzerland) uses L-alanine4-nitroanilide. Test results from both
© 2006 Elsevier
detection systems were identical (10).
For laboratories without Gram-staining
ability, an alternative test is the potassium hydroxide test, which lyses the
cell wall of gram-negative bacteria,
releasing DNA. Gram-positive bacteria
are not lysed in this test. Table 3 illustrates the results of the application of
the L-alanine aminopeptidase test and
the potassium hydroxide DNA “string”
test for determining the Gram stain
reactions of bacteria (10). These two
simple tests provide an easy and rapid
means of differentiating Campylobacter, Helicobacter, and Arcobacter from
other gram-negative and gram-positive
bacteria.
While Campylobacter and Helicobacter strains require microaerophilic
or H2-enriched microaerophilic growth
conditions, strains of Arcobacter will
grow under these conditions, as well as
aerobically. Aerobic growth is a defining characteristic of the genus Arcobacter. Incubation under aerobic conditions
will readily and simply differentiate
Arcobacter from Campylobacter and
Helicobacter strains. These preliminary
tests are useful before starting biochemical species identification of presumptive Campylobacter strains (Fig. 2).
Clinical Associations
In contrast to the statement on the
CDC website quoted in the introduction,
Clinical Microbiology Newsletter 28:7,2006
C. jejuni subsp. jejuni has not been the
major Campylobacter species isolated
from pediatric patients with enteritis
and septicemia in Cape Town over the
last 15 years (Table 4). Two-thirds of
the Campylobacter isolates from the
diarrheic stools of pediatric patients at
RXH were species other than C. jejuni
subsp. jejuni. When directly compared
to those of the recognized pathogen, C.
jejuni subsp. jejuni, clinical associations
of emerging campylobacteria are strikingly similar (Fig. 3). Among pediatric
clinical isolates, the percentages of C.
concisus, C. upsaliensis, and C. jejuni
subsp. doylei were similar to those of C.
jejuni subsp. jejuni for patients with diarrhea (80 to100%), vomiting (3 to12%),
and fever (4 to 9%) (1). Comparing the
frequency of Campylobacter spp. isolated from pediatric blood and stool
cultures (Fig. 4), the recognized pathogen C. jejuni subsp. jejuni is isolated
almost equally as often as the emerging
pathogen C. upsaliensis. However,
another emerging Campylobacter, the
infrequently isolated C. jejuni subsp.
doylei, is three times more likely to be
isolated from blood than stool culture.
Also of note is the over-representation
of Helicobacter fennelliae and H. cinaedi as blood culture isolates, implying
a pathogenic, possibly invasive function
for these organisms. H. fennelliae and
H. cinaedi are seldom isolated, possibly
because they are H2 requiring and slow
growing and produce very fine colonies
or even confluent growth on the culture
plate, making isolation and subsequent
identification extremely difficult.
The literature has ample clues to
the pathogenic or putative pathogenic
potentials of emerging campylobacteria.
Maher et al. (11) evaluated a 16S/23S
PCR/DNA probe membrane-based
colorimetric assay for the detection of
Campylobacter species from the feces
of 127 patients with symptoms of acute
gastroenteritis. Using selective agar,
enrichment, and incubation for 48 h at
37ºC, 18 fecal samples were culture
positive for Campylobacter. The 16S/
23S PCR/DNA probe assay detected
Campylobacter DNA in 17 of the 18
culture-positive specimens and in 41
of the 109 culture-negative specimens.
The presence of Campylobacter DNA
in the culture-negative samples was
confirmed by a16S PCR/DNA probe
assay. DNA sequence analysis of seven
Clinical Microbiology Newsletter 28:7,2006
Table 3. Prescreen tests for the identification of Campylobacter and related organisms
O.5 M KOH DNA “string” test
L-ALA testa
Gram-negative bacteria
+
+
Gram-positive bacteria
–
–
Campylobacter/Helicobacter/ Arcobacter
+
–
Organisms
a
Oxoid Biochemical Identification system (O.B.I.S.) or Fluka 75554.
Table 4. Distribution of Campylobacter species and related organisms isolated from pediatric
diarrheic stools at the Red Cross Children’s Hospital, Cape Town, South Africa, 1 Oct. 1990
through 31 May 2005
Species
No.
%
C. jejuni subsp. jejuni
C. concisus
C. upsaliensis
C. jejuni subsp. doylei
H. fennelliae
C. coli
H. cinaedi
C. hyointestinalis
CLO/HLOa
Arcobacter butzleri
C. fetus subsp. fetus
“H. rappini”
C. lari
C. curvus
C. rectus
C. sputorum bv. sputorum
1,759
1,340
1,280
417
314
159
53
52
27
19
9
5
3
2
2
2
32.30
24.63
23.52
7.70
5.76
2.93
0.97
0.96
0.48
0.36
0.16
0.09
0.06
0.04
0.04
0.04
Total
5,443
100.00
a
CLO/HLO: Campylobacter or Helicobacter organisms that died before being fully characterized.
of the 16S/ 23S and five of the 16S
PCR products amplified from a selection of these specimens confirmed the
presence of C. jejuni subsp. jejuni, C.
concisus, C. curvus, and C. gracilis
DNA. The finding of Campylobacter
sp. DNA in a large number of fecal
specimens from patients with no other
identified cause of diarrhea suggests
that Campylobacter sp. other than C.
jejuni subsp. jejuni may account for
some cases of acute gastroenteritis in
which no etiological agent is identified
at present.
Campylobacter species found in the
oral cavity have rarely been reported
to cause extraoral infections. However,
Han et al. (12) recently reported three
cases of extraoral abscesses caused by
oral Campylobacter spp. The spread
was most likely by means of the lympohematogenous system. Significantly,
these Campylobacter species were all
isolated anaerobically and not by the
conventional microaerophilic proce© 2006 Elsevier
Figure 3. Diarrheal characteristics of
Campylobacter infections. CC, Campylobacter concisus; CJJ, C. jejuni subsp.
jejuni; CJD, C. jejuni subsp. doylei; CU,
C. upsaliensis; HF, Helicobacter fennelliae.
dures usually used for Campylobacter
isolation. These organisms were identified by sequencing analysis of the 16S
rRNA gene. The cases included a breast
abscess caused by Campylobacter
0196-4399/00 (see frontmatter)
53
Conclusion
New species of Campylobacter and
the related genera Arcobacter and Helicobacter are being identified on a regular basis. Emerging Campylobacter
species may play a much greater role
in human and animal disease than has
been previously recognized. Because
methods originally formulated for the
isolation of C. jejuni subsp. jejuni often
54
0196-4399/00 (see frontmatter)
40
Blood n = 110
35
Stool n = 2,802
30
Percent
rectus in a lymphoma patient, a liver
abscess caused by C. curvus in an ovarian cancer patient, and a post-obstructive
bronchial abscess caused by C. curvus in
a lung cancer patient. All three patients
were treated with antibiotics with complete resolution of the lesions. This
report is an example of the increasingly
frequent clinical reports involving
emerging campylobacters.
C. fetus was previously considered a
cause of bacteremia in elderly men with
chronic underlying illness, but AIDS
patients are now the most typically
infected population. C. fetus, while not
an emerging Campylobacter species, is
definitely an under-isolated and underappreciated one. This organism may
occur in unexpected sites in the body
that are usually not known to be linked
with bacterial infection (3). Occasional
seeding to an organ may occur, which
can lead to complications. C. fetus can
remain latent after bacteremic seeding
in a bony focus of an immunocompromised host, only to be reactivated years
later. It has been responsible for infection in a postoperative prosthetic hip
joint, chronic osteomyelitis of the ankle,
and pyrogenic vertebral osteomyelitis
(1). C. fetus exhibits an affinity for vascular tissue, and infections have been
associated with cellulitis, thrombophlebitis, and mycotic aneurysms (3). The
central nervous system may be affected
by C. fetus, and meningoencephalitis is
the most common presentation in both
children and adults.
Subarachnoid hemorrhages, brain
abscesses, and cerebral infarctions can
occur (1). Emergent campylobacters are
occasionally isolated from non-enteric
body sites. C. sputorum bv. sputorum is
normally found in the human oral cavity and gastrointestinal tract, but it has
been isolated from abscesses of the
groin and perianal and axillary areas.
C. upsaliensis has been isolated from
a breast abscess (3).
25
20
15
10
5
0
C jj
C jd
C up
H cin
H fen
Cc
C co
Other
Figure 4. Comparative prevalences of Campylobacter spp. isolated from pediatric blood
and stool cultures at the Red Cross Children’s Hospital, Cape Town, South Africa. C jj,
Campylobacter jejuni subsp. jejuni; C jd, C. jejuni subsp. doylei; C up, C. upsaliensis;
H. cin, Helicobacter cinaedi; H fen, H. fennelliae; C c, C. concisus; C co, C. coli; Other,
various other Campylobacter spp.
fail to support the growth of fastidious
emergent campylobacteria, these organisms are largely under-detected in clinical specimens. Membrane filtration onto
antibiotic-free media and incubation in
an H2-enriched microaerobic atmosphere
at 37°C is a simple, efficient, and costeffective isolation protocol for the isolation of all known Campylobacter,
Arcobacter, and Helicobacter spp. and
is the only method presently available
for the isolation of some hydrogendependent Campylobacter spp., such
as C. concisus, C. rectus, and C. curvus.
Use of the Cape Town protocol also
increases the yield of C. jejuni subsp.
jejuni strains.
At present, the roles that emergent
Campylobacter spp. play in the disease
process are not fully understood. This is
unlikely to change until the correct protocols essential for the isolation and
identification of emerging Campylobacter spp. are used in microbiology laboratories involved in the performance of
routine diagnosis, surveillance, epidemiologic, and other studies. Additional
research is essential for a better definition of the prevalence, persistence, and
range of infection associated with these
very much under-isolated and underrated organisms. What is currently
known of emergent campylobacters is
truly only the tip of the iceberg.
Acknowledgement
This research is being funded by the
© 2006 Elsevier
Department of Science and Technology
(South Africa) as a partner in the European Commission’s Fifth Framework
Programme “Quality of Life and
Management of Living Resources”
CAMPYCHECK Project (QLK1
CT 2002 02201). The South African
Medical Research Council provided
additional funding.
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for the isolation and characterization
of Campylobacter species. A1, p. 2. In
Abstr. CHRO 2005. 13th Int. Workshop
Campylobacter, Helicobacter and
related organisms. Griffith University,
Queensland, Australia.
10. Hoosain, N. and A.J. Lastovica. 2005.
Evaluation of the Oxoid Biochemical
Identification System (O.B.I.S.) for the
differentiation of Campylobacter and
Arcobacter from other gram-negative
organisms. A36, p. 13. In Abstr. CHRO
2005. 13th Int. Workshop Campylobacter, Helicobacter and related
organisms. Griffith University,
Queensland, Australia.
11. Mahler, M. et al. 2003. Evaluation of
culture methods and a DNA probe-based
PCR assay for the detection of Campylobacter species in clinical specimens of
feces. J. Clin. Microbiol. 41:2980-2986.
12. Han, X.Y., J.J. Tarrand, and D.C. Rice.
2005. Oral Campylobacter species
involved in extraoral abscess: a report
of three cases. J. Clin. Microbiol.
43:2513-2515.
Call for Submissions
Case Reports
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Clinical Microbiology Newsletter 28:7,2006
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permission for the citation. Some typical examples of references are listed
below.
1. Petts, D.N. 1999. Evaluation of the
Oxoid Dryspot streptococcal grouping
kit for grouping beta-hemolytic strepto© 2006 Elsevier
cocci. J. Clin. Microbiol. 37:255-257.
2. Reich, K.A. and G.K. Schoolnik. 1996.
Halovibrin, secreted from the light organ
symbiont Vibrio fischeri, is a member of
a new class of ADP-ribosyltransferases.
J. Bacteriol. 178:209-215.
3. Walls, J.J., K.M. Asanovich, and J.S.
Dumler. 1998. Comparison of Ehrlichia
equi and human granulocytic ehrlichiosis
(HGE) agent strains for IFA serodiagnosis
of HGE. C-208, p. 165. In Abstracts of
the 98th General Meeting of the
American Society for Microbiology
1998. ASM Press, Washington, D.C.
4. McGough, D.A. et al. 1994. Fungi and
fungal infections, p. 1169-1196. In K.D.
McClatchey (ed.), Clinical laboratory
medicine. Williams & Wilkins,
Baltimore, MD.
6. Bennish, M.L. 1994. Cholera: pathophysiology, clinical features, and treatment, p. 229-255. In I.K. Wachsmuth,
P.A. Blake, and O. Olsvik (ed.), Vibrio
cholerae and cholera, molecular to global
perspectives. ASM Press, Washington, D.C.
5. Jones, T. Personal communication.
Address for Submissions
Send the original typescript (double
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750 E. Adams St.
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0196-4399/00 (see frontmatter)
55
Erratum
... Susceptibility Report (S = Susceptible, I = Intermediate, R = Resistant).........
Clinical Microbiology Newsletter,
February 15, 2006 issue,
Vol. 28, No.4, p. 28
An error occurred in the reproduction of Figure 4 that appeared
in the article authored by Dr. Joan
Barenfanger entitled “Quality
Assurances: Decreasing Clinically
Irrelevant Testing from Clinical
Microbiology Laboratories, Part II”
that was published in CMN vol. 28,
no.4, p.28. The original format of
Figure 4 appears to the right. The original intent was to show how poorly
the example report was configured.
The published figure was incorrectly
formatted to make the report appear
clear and easily comprehensible.
S AUREUS
P AERUG
MIC INTERP
KB
AZTREONAM
S
CEFEPIME
S
LEVOFLOXACIN
S
CEFTAZIDIME
S
CIPROFLOXACIN
S
ERYTHROMYCIN
R
GENTAMICIN
I
IMIPENEM
OXACILLIN
S
S
PIP/TAZOBACTAM
PENICILLIN G
TOBRAMYCIN
S
R
S
Figure 4. Replica of actual report configuration of a major LIS vendor in a hospital.
56
0196-4399/00 (see frontmatter)
© 2006 Elsevier
Clinical Microbiology Newsletter 28:7,2006