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Bacteriological examinations of faecal samples, obtained from 321 infants and children with acute enteritis, were carried out in the pediatric clinic of the University of Occupational and Environmental Health, Japan from January 1983 to December 1985. Campylobacter jejuni were isolated in 48 infants and children (15%), while Salmonella species in 6 (1.9%), and enteropathogenic Escherichia coli in 11 (3.4%). Of 48 infants and children with Campylobacter enteritis (C. enteritis), 20 cases (42%) were under 2 years old, 17 (35%) from 2 to 6 years old, 8 (17%) from 7 to 12 years old, and 3 (6%) above 13 years old, suggesting the higher incidence in the younger infants and children. There were 30 males and 18 females, male:female ratio of 5:3. No seasonal variations in the frequency of C. enteritis were noticed. Major symptoms were diarrhea (94%), fever (50%), bleeding in stools (44%), abdominal pain (31%), and vomiting (10%). All strains of C. jejuni were highly sensitive to gentamicin, amikacin, kanamycin, erythromycin, josamycin, and chloramphenicol. We also report two typically mild cases of C. enteritis, a newborn infant with monosymptomatic bleeding in stools and diarrhea, and another 11-month-old, Wiskott-Aldrich syndrome infant with asymptomatic bloody stools.

Since a few years, Campylobacter jejuni has been identified as an important cause of acute enteritis in man. Various studies showed that Campylobacter enteritis is as common as salmonellosis, and that the symptoms often are even more severe. That this species of bacterium was not discovered until recently, was due in part to the fact that unusual methods of isolation are required; for instance, Campylobacter jejuni will only grow in a micro-aerophilic atmosphere. Campylobacteriosis was found to be a foodborne infection in the majority of cases. The organism was isolated from a large number of species of wild and domesticated animals, which, as in the case of Salmonella, are mainly asymptomatic carriers. Of farm animals, poultry and pigs are most frequently infected. The most important sources of human infection are poultry meat, unpasteurized milk, inadequately treated drinking water and, as a direct source, dogs with enteritis. Only poultry was found to play a role in the Netherlands. Pork is mostly not contaminated as Campylobacter dies during cooling of pig carcasses, death being due to the drying effect of forced ventilation. The sensitivity of Campylobacter to dry conditions, in conjunction with its inability to multiply below 30 degrees C, means that the mechanism of cross contamination, which is such an important factor in the epidemiology of Salmonella, is of minor significance in Campylobacter.

Thirty-three, 10-week-old, specific-pathogen-free pigs were randomly allotted to 3 treatment groups: group 1--intragastrically given homogenized intestinal mucosa (crude inoculum) from pigs with naturally occurring proliferative enteritis; group 2--given cultures of Campylobacter sputorum subsp mucosalis; and group 3--controls. One pig from each group was killed 4, 7, 10, 14, 18, 21, 24, 28, 31, 36, and 38 days after inoculation. The earliest intestinal lesion observed in groups 1 and 2 was leukocytic exudate within crypt lumina and focal inflammation of the surrounding lamina propria. The lesions occurred primarily over ileal aggregated lymphoid nodules (Peyer's patches). These changes were followed by focal proliferation of immature crypt epithelial cells and infiltration of increasing numbers of macrophages into the lamina propria. Campylobacter sp-like organisms were observed within the cytoplasm of affected epithelial cells by light and electron microscopies. Lesions progressed to diffuse crypt cell proliferation, elongation of crypts, and loss of villi. Mucosal necrosis was not a prominent feature.

Enteritis by Campylobacter jejuni/coli is by far the most frequent clinical entity of campylobacter-infection. It may be compared to salmonella-enteritis as for its epidemiologic importance. The course of the disease may be dramatic, but can be successfully treated as soon as the pathogen is known. In prematures and newborn babies infections with Campylobacter fetus ssp. fetus are life-threatening and early diagnosis is of life-saving importance. Five observations of campylobacter-enteritis in children aged 2, 8, and 10 years are reported. They were characterized by high fever frequent loose, watery stools with blood, leucocytosis or leucopenia and elevated BSR. All children became asymptomatic with symptomatic treatment, without specific antibacterial therapy. The importance of campylobacter-infections, their diagnosis and course of disease in children are discussed.

Pure cultures of an isolate of Campylobacter coli obtained from small intestinal lesions in a seven-day-old piglet were used to inoculate hysterectomy derived, colostrum deprived piglets, conventional sucking piglets and conventional weaned pigs in three separate controlled experiments. Rectal temperatures rose to 40 degrees C in inoculated hysterectomy derived, colostrum deprived pigs within four days of infection and a mucoid yellowish diarrhoea containing occasional flecks of blood developed. C coli was isolated only from the faeces of the infected pigs and from all levels of their intestines at post mortem examination 12 days after inoculation. The small intestine was flaccid, pale and thickened in all cases, the contents were mucoid, the mucosa was hyperaemic and the mesenteric lymph nodes were enlarged. Mild villous atrophy and inflammatory changes were seen in the small intestines of the inoculated pigs. Mild colitis was present in both inoculated animals and controls. Agglutinating antibody to the inocular strain of C coli was present only in sera from the inoculated pigs at titres of up to 1:640. Similar changes were seen in conventional sucking piglets but in the weaned pigs no definite clinical signs were observed although the pathological changes were present. Both C coli and other enteric pathogens were present in the herd of origin of the conventional pigs.

There are adhesive and invasive species among enteropathogenic bacteria for animals. Most frequently isolated adhesive bacteria are enterotoxigenic E. coli (ETEC). Salmonella, T. hyodysenteriae, M. paratuberculosis, Y. enterocolitica, Cl. perfringens and C. jejuni bacteria represent the most important invasive germs. The main clinical finding connected with bacterial enteritis is diarrhoea resp. dysentery. Evaluation of feces consistency, time of appearance and accompanying symptoms (e.g. fever, colic) allow a clinical suspective diagnosis, however a definitive diagnosis must be based on the demonstration of the causative agent. In addition to known cultural, microscopic, biochemical and serological diagnostic methods, the demonstration of virulence factors (enterotoxin formation, adhesive pili) plays an important role in diagnosis of enteropathogenic bacteria.

Human isolates of the intestinal pathogen Campylobacter jejuni have been shown to colonize mucus on the outer surface and deep within the intestinal crypts of gnotobiotic or germfree mice. The cecal crypts are preferentially colonized. A model of mucus colonization by C. jejuni in the mouse cecum has been developed, using antibiotic- and magnesium sulfate-treated specific-pathogen-free animals. These spiral-shaped bacteria colonize the mucus in a similar manner to the normal spiral-shaped microbiota. No evidence of adhesion to the intestinal surface was found with a wide variety of microscopic techniques. The campylobacters were seen to be highly motile in living preparations of gut tissue and rapidly tracked along intestinal mucus. Just as many of the normal spiral-shaped bacteria of intestinal surfaces can achieve close association with the epithelium through mucus association and do not adhere to the surface, C. jejuni colonizes the intestinal mucosa via mucus colonization. Thus, a major determinant of pathogenicity in intestinal infection with C. jejuni is proposed to be an ability to colonize intestinal mucus. The possession of specific adhesins is unlikely to be a significant determinant of pathogenicity. Better understanding of the mechanism of mucus association and the properties of the bacterium that are responsible will provide a basis for the rational selection of preventative measures. The model of mucus association in adult antibiotic-treated mice provides an opportunity for colonization studies with variant organisms and immunization studies.