Campylobacter jejuni has been recognized as an important cause of diarrhoeal illness over the globe. According to CDC Atlanta C. jejuni is number one food borne pathogen.11 Frequent infections have been reported from Europe12,13 Africa14,15 South East Asia16,17 and China.18 The prevalence of infection is much greater in developing countries than in the developed world.12,13
Among the studies carried out in Europe 17.5% isolation rate has been reported from France19, 12% from Czechoslovakia20 and 8.3% from Turkey.21 In the African countries 18% isolation rate has been reported from Tanzania22, 16.5% from Nigeria14 and 9.3% from Zimbabwe.15 In India a study carried out among the rural population in Calcutta revealed a frequency of 11.5% while in another study from Northern India an isolation rate of 5% was reported.16,17 Studies from Bangladesh and China revealed an isolation rate of 25.5 % and 11.8%.18,23 A study carried out in Lahore, Pakistan during 1983-1989 has reflected an isolation rate of 12%.24 The frequency of C. jejuni 18% observed in our study is similar to the frequency reported from Tanzania and France and is little higher than what was reported from Lahore, Pakistan. The difference in frequency of C. jejuni in different parts of the world is probably due to varying standards of living conditions, water supply and feeding habits as the infection occurs through water and food especially the consumption of poultry and even association with animals is a significant factor in the acquisition of disease.
Poultry is the primary food vehicle for transmission of C. jejuni. Some case control studies indicate that up to 70% of sporadic cases of campylobacteriosis are associated with eating chicken.25 Domestic and wild animals have been considered to be the most common reservoir of Campylobacter for human infection.24 C. jejuni is commonly present in the GIT of healthy chicken, cattle, pigs, turkeys, ducks and geese and direct animal exposure can lead to infection. Pets that may carry Campylobacter include birds, cats, dogs, hamsters and turtles.11The organism is occasionally isolated from streams, lakes and ponds. In United States, poultry is the most common source of sporadic infection.26,27 Epidemiological investigation have implicated raw milk28, eggs, beef29 contaminated water30 and contact with infected animals including cats and puppies.26,31 In our study there was either history of chicken meat consumption or contact with cattle and pets in most of the cases and both in some of them. All were taking untreated water most often from wells.
Mean age of the children suffering from C. jejuni infection in our study was 18 months with peak incidence from 12 to 21 months (Figure 1). The maximum age at which the organism was isolated was 48 months and the minimum 3 months. Peak incidence in a study carried out in Tanzania was less than 18 months.18 In China it was between 12-24 months.23,32 In Bangladesh, the highest infection rate was reported from children up to one year of age.22,33 In Riyadh, Saudi Arabia the maximum incidence of C. jejuni was seen in children 2 years and younger.34 The preponderance of infection in younger children is probably due to lack of immunity. Our results are comparable with Tanzania and China whereas early acquisition in Bangladesh and rural population of China could be due to different eating habits and living environments as early exposure to domestic animals may be a contributory factor in rural population in these countries. Male female ratio in our study was found to be 1.7:1 (Figure 1). In a study carried out in Kaulampur slight male to female preponderance was noted.35 In another study from India Calcutta no sex difference was observed.36 A study carried out in Nigeria reported a male to female ratio 2:1.14 These findings reflect that males are more likely to get infected, reasons for which are not established.
All the children with C. jejuni infection (n =18) had loose motions. Thirteen out of 18 (72.22%) had pain in abdomen alone or in combination with other symptoms. Eleven out of 18 (61.11%) had fever with or without other symptoms. Seven out of 18 (39%) had a combination of symptoms of loose motions, vomiting and pain abdomen and those having fever with or without other complaints constituted 11 out of 18 (61.11%) i.e., more than 50% of all the children yielding C. jejuni (Figure 2). Similar findings have been reported from Kaulampur34, Riyadh, Saudi Arabia.34 In another study from Chicago, USA diarrhoea, fever and chills were the most frequent symptoms.37 Most of children were passing 6-10 stools/day.
About 90 % of stools in our study had blood and fifty percent also had mucous. Majority (27%) of our children with C. jejuni had blood, mucous and pus in their stools (Figure 3). This was expected since stools containing blood, mucous and pus were preferred. A small percentage presented with pure watery diarrhoea and a few presented only with frank blood in their stools. About half of the patients studied in Turkey had blood and mucous in their stools21 whereas a study from North India reflects watery diarrhoea as the commonest symptom.38
More studies and facilities for special media for stool culture are required on the subject in a developing country like Pakistan where diarrhoea and dysentery are common not only in children but also in adults.
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