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Objective: To determine whether a preexisting Helicobacter pylori infection increases the risk for developing duodenal or gastric ulcer., Design: A nested case-control study based on a cohort of 5443 Japanese-American men who had a physical examination and a phlebotomy from 1967 to 1970., Setting: All 10 general hospitals on the Hawaiian island of Oahu., Patients: 150 patients with gastric ulcer and 65 patients with duodenal ulcer identified in the cohort of study participants after a hospital surveillance period of more than 20 years., Measurements: Stored serum specimens from patients and from matched controls were tested for the presence of serum IgG antibody to H. pylori using enzyme-linked immunosorbent assay., Results: 93% of the 150 patients with gastric ulcer and 78% of the matched controls had a positive antibody level for H. pylori-specific IgG, yielding an odds ratio of 3.2 (95% CI, 1.6 to 6.5). For duodenal ulcer, 92% of the 65 patients and 78% of the matched controls had a positive test result, yielding an odds ratio of 4.0 (CI, 1.1 to 14.2). As the level of antibody to H. pylori increased, a statistically significant increase was noted in the risk for gastric and duodenal ulcer. The association with H. pylori infection was statistically significant for both types of ulcer, even when the diagnosis was made 10 or more years after the serum sample had been obtained., Conclusion: Preexisting H. pylori infection increases the risk for subsequent development of either duodenal or gastric ulcer disease. more...

Objective: To determine if patients with the Guillain-Barré syndrome are likely to have had Campylobacter jejuni infection before onset of neurologic symptoms., Design: A case-control study., Setting: Several university medical centers., Patients: Case patients met clinical criteria for the Guillain-Barré syndrome between 1983 and 1990 and had a serum sample collected and frozen within 3 weeks after onset of neurologic symptoms (n = 118). Disease controls were patients with other neurologic illnesses (n = 56); healthy controls were hospital employees or healthy family members of patients (n = 47)., Measurements: Serum IgA, IgG, and IgM antibodies to C. jejuni were determined by enzyme-linked immunosorbent assays. Assays were done in a blinded manner., Results: Optical density ratios > or = 2 in two or more immunoglobulin classes were seen in 43 (36%) of patients with the Guillain-Barré syndrome and in 10 (10%) of controls (odds ratio, 5.3; 95% CI, 2.4 to 12.5; P < 0.001). Increasing the optical density ratio or the number of immunoglobulin classes necessary to yield a positive result increased the strength of the association. The number of patients with the Guillain-Barré syndrome who had positive serologic responses was greatest from September to November (P = 0.02). Male patients were three times more likely to have serologic evidence of C. jejuni infection (P = 0.009); the proportion of patients with the syndrome who had a positive serologic response increased with age., Conclusions: Patients with the Guillain-Barré syndrome are more likely than controls to have serologic evidence of C. jejuni infection in the weeks before onset of neurologic symptoms. Campylobacter jejuni may play a role in the initiation of the Guillain-Barré syndrome in many patients. more...

During the summers of 1980 and 1981 Campylobacter jejuni was isolated from 23% and Giardia lamblia was isolated from 8% of persons with diarrheal disease acquired in the area of Grand Teton National Park, Wyoming. Campylobacter enteritis occurred most frequently in young adults who had been hiking in wilderness areas and was significantly associated with drinking untreated surface water in the week before illness (p less than 0.02 in 1980; p less than 0.005 in 1981). Penner serotype 4 was the commonest serotype isolated from humans and the only serotype isolated from an implicated mountain stream. These studies show that backcountry surface water can be an important source of C. jejuni and that infection with Campylobacter, as well as G. lamblia, should be considered as a cause of diarrhea in those who have recently returned from wilderness areas. more...

The Legionnaires' disease (LD) bacterium can now be readily cultured on artificial media. Studies were done to define the growth and survival of the LD bacterium in these media and ascertain its susceptibility to disinfecting agents. Growth-curve studies of the Philadelphia 1 strain using Mueller-Hinton broth with ferric pyrophosphate and L-cysteine (Feeley-Gorman broth) showed a lag phase of less than 24 h, a generation time of 3.8 h during the logarithmic phase, a plateau of 2 x 10(7) organisms per millilitre, and continued viability for as long as 110 d. Viability on chocolate agar with 1% hemoglobin and 2% IsoVitaleX added reached 150 d. This strain was susceptible to a variety of commonly recommended hospital and laboratory disinfectants, often in low concentrations. These investigations suggest that prolonged survival may occur in natural as well as artificial milieus and that low concentrations of phenolics, quaternary ammonium compounds, glutaraldehyde, formaldehyde, and hypochlorite could eradicate potential reservoirs for human infection. more...

Recurrent bacteremia and enteritis due to a specific serotype of Campylobacter jejuni occurred over a 12-month period in a patient on hemodialysis with systemic lupus erythematosus who was also deficient in serum IgA and IgM. A bactericidal defect in the patient's sera for C. jejuni was shown. A role for immunoglobulins in the host response to C. jejuni is suggested, in that the IgA deficiency may have predisposed the patient to chronic gastrointestinal carriage and because the resolution of the bacteremia corresponded with the delayed appearance in the blood of IgG specific for the infecting strain. more...

Study Objective: To determine the diagnostic value of assays to measure serum antibodies to Campylobacter pylori, and to use these assays to determine the prevalence of C. pylori infection in a healthy population., Design: A survey of patients having endoscopies for upper gastrointestinal symptoms, patients with other gastrointestinal illnesses, and healthy controls., Setting: Outpatients attending endoscopy suites in two university-affiliated medical centers., Patients: One hundred and twenty patients who had gastroduodenoscopies, 61 patients with lower intestinal illnesses, and 166 healthy controls., Intervention: Assay to detect serum IgA, IgG, and IgM antibodies specific for C. pylori., Measurements and Main Results: Absorption with other gram-negative pathogens showed that IgG and IgA assays, but not IgM assays, were specific for C. pylori. In patients in whom C. pylori had been isolated and who had gastritis diagnosed by histologic methods, significantly higher mean IgA and IgG levels were seen compared with patients without demonstrable C. pylori or gastritis. The sensitivity and specificity of a positive value in both IgA and IgG assays were more than 93%. Among healthy persons, IgG and IgA antibodies were rarely seen in patients less than 20 years old, but antibody prevalence progressed with age, reaching 50% in patients more than 60 years old. High IgA and IgG levels to C. pylori in five persons tested remained stable for more than 1 year, suggesting the organism persists for at least that period. In 61 patients with acute bacterial enteritis, acute pancreatitis, Crohn disease, or ulcerative colitis, prevalence of antibodies to C. pylori was consistent with age and unrelated to current disease., Conclusions: Campylobacter pylori infection, which is highly associated with active gastritis, may be diagnosed by serologic assay. Acquisition of infection begins in adult life, and prevalence increases with age. more...

We identified Campylobacter jejuni infections in four patients infected with the human immunodeficiency virus (HIV); three had persistent and severe C. jejuni infections. Multiple isolates obtained from each patient had the same biochemical and serotypic characteristics, indicating recurrent infection rather than reinfection with unrelated strains. Serum antibody responses to C. jejuni group antigens by enzyme-linked immunosorbent assay were markedly impaired in the three patients with persistent infection compared with forty-two immunocompetent C. jejuni-infected controls and with the HIV-infected patient who readily cleared the organism. One patient was bacteremic; his blood isolate was killed by normal serum but was resistant to his own serum, whereas a simultaneous stool isolate of a different serotype was sensitive. Failure of two patients to eradicate the organism and long-term administration of erythromycin therapy led to the in-vivo development of resistance to this antibiotic, which is most frequently used to treat C. jejuni infections. more...

Campylobacter fetus subspecies (ssp.) jejuni has been recently recognized to cause diarrheal disease in man. To assess its importance as an enteric pathogen, we prospectively studied 514 patients with diarrhea. Campylobacter fetus ssp. jejuni was isolated from the feces of 26 patients (5%) and seven of 11 of their symptomatic household contacts. This organism was isolated from the feces of only one of 18 asymptomatic household contacts and not at all from 157 other healthy persons. Seventeen of 20 patients from whom C. fetus ssp. jejuni was isolated from fecal culture showed at least a fourfold rise in specific IgG titers. Review of 35 cases of campylobacter enteritis identified a typical clinical syndrome with acute onset of diarrhea, abdominal pain, fever, and constitutional symptoms. Stool examination revealed blood in 60% and polymorphonuclear leukocytes in 78% of patients. Epidemiologic investigation strongly suggested an external source for the infection in 22 of 35 patients. more...

During a 15-month study, 8097 fecal specimens submitted to clinical microbiology laboratories at eight hospitals in different parts of the United States were examined. Campylobacter jejuni was isolated from 4.6%, Salmonella from 2.3%, and Shigella from 1.0%. Isolation rates for each pathogen were highest from stool specimens that were watery, bloody, or contained leukocytes. The peak isolation rate for C. jejuni was in persons ages 10 to 29 years; for Salmonella, in children younger than age 10 years; and for Shigella, in children ages 5 to 9 years. The clinical features of the three infections were nearly identical. In contrast, abdominal pain, bloody diarrhea, fever, tenesmus, and abnormal sigmoidoscopy findings were present significantly more often in patients infected with C. jejuni than in a control group of patients with diarrhea. Of patients with leukocytes in their stools and a history of fever, 45.9% were infected with one of the three pathogens. Use of laboratory and clinical findings defined groups with high or low risk of these three infections but could not accurately predict isolation. Fecal cultures had the highest yields when obtained from patients within 7 days from the onset of symptoms. more...