Clinical manifestations of campylobacter enteritis in Calcutta.
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Biomedical subjects
Publications and source records attributed to S C Pal.
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Of the 245 acute paediatric diarrhoea cases admitted to the Infectious Diseases Hospital, Calcutta between July, 1979 and June, 1981, rotavirus was detected in the faeces of 55 (22.4%) patients either as the sole aetiological agent or in association with other enteropathogens. Children aged six months to two years were most commonly infected. The virus was detected throughout the year with higher incidence during the winter months of both years. The frequency of detection of major enteropathogens other than rotavirus was Vibrio cholerae biotype El Tor (31.0%), enteropathogenic Escherichia coli (8.2%) and enterotoxigenic E. coli (6.5%).
The prevalence of different types of diarrhoea-producing Escherichia coli among 240 patients with acute diarrhoea in hospital was investigated. The 25 patients (10.4% of the total) from whose faeces we isolated enteropathogenic E. coli (EPEC) were all less than 5 years old but the 29 (12.1%) from whom we isolated enterotoxigenic E. coli (ETEC) were of various ages, most of them greater than 12 years old. No enteroinvasive E. coli (EIEC) strains were isolated. ETEC strains that produced heat-labile toxin (LT) were encountered more often than those that produced either heat-stable toxin (ST) alone or both LT and ST. The ETEC isolates were distributed among eight different serotypes, the commonest being O148:H28 (38%). Correlations between enterotoxin production, serotype pattern and possession of colonisation factor antigens I and II were observed.
Three simple immunological tests, the modified Elek (Biken) test, the modified staphylococcal coagglutination test, and the rapid GM1-horseradish peroxidase-enzyme-linked immunosorbent assay have been evaluated for detection of heat-labile enterotoxin of enterotoxigenic Escherichia coli. Of the 100 coded E. coli strains tested, 94 gave consistent results with all the three immunological tests; a discrepancy was observed in only 6 strains. Identical results were obtained when the Biken test was conducted with complete and incomplete Biken kits (Meguro Institute Ltd., Osaka, Japan). All three immunological tests evaluated in this study were found to be sensitive and simple and can be easily adopted by any laboratory for detection of heat-labile enterotoxins of enterotoxigenic E. coli strains.
An egg-based medium was found to be superior to the conventional Wang transport medium and the recently developed biphasic medium for the preservation of Campylobacter jejuni in the laboratory. Strains of C. jejuni preserved in egg-based medium maintained at 4 degrees C were viable for over 3 months. The survival of C. jejuni in egg-based medium held at room temperature (27 +/- 2 degrees C) was also relatively longer than in Wang transport medium and biphasic medium.
B-galactosidase activity in presence and absence of inducer lactose was examined in eight different strains of both toxigenic and nontoxigenic Vibrio cholerae (V. cholerae). In lactose (0.25 gm%) containing cultures of toxigenic strains, B-galactosidase activity was higher in stationary culture than that of logarithmic. In nontoxigenic strains, B-galactosidase activity was only 1/6th of the toxigenic strains and remained unaltered throughout growth period. While wild strains (toxigenic V. cholerae) showed B-galactosidase activity at reduced rate when grown in the medium containing both lactose and glucose, the rate of activity of B-galactosidase in nontoxigenic strains remained unchanged whether the cells were grown in lactose or lactose plus glucose. The respressive effect of higher concentration of glucose could be reversed by the addition of exogenous cyclic AMP. Low level of B-galactosidase activity in nontoxigenic strains was due to low level of intracellular cyclic AMP, compared to toxigenic strain. Furthermore, induction of enzyme activity occurred in nontoxigenic strains of V. cholerae when cyclic AMP was added exogenously.
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Bacterial enteropathogens and rotavirus were sought in 356 cases with acute diarrhoea admitted to the Infectious Diseases Hospital, Calcutta. One or more pathogens were isolated from 74.7% of the cases. Single enteropathogens could be detected from 66% and multiple enteropathogens from 8.7% of the patients. Vibrio cholerae biotype El Tor, rotavirus, V. parahaemolyticus, and enteropathogenic and enterotoxigenic Escherichia coli were the major pathogens detected. Rotavirus was detected from 7.6% of the cases. A higher rate of detection of rotavirus was seen in children younger than two years. Campylobacter jejuni could be isolated from the faeces of six (15%) of 40 cases either as a single pathogen or in association with V. cholerae biotype El Tor.