Incidence and clinical manifestations of Campylobacter enteritis in central Taiwan

Campylobacter species are recognized as a major cause of acute gastroenteritis in humans throughout the world and are increasingly associated with the development of Guillain-Barré syndrome. The age distribution of persons and the seasonal patterns of Campylobacter infection are different in many developed and developing countries. The present study reports the investigation of the clinical and epidemiologic features of Campylobacter infections in central Taiwan.

From January 1994 to December 1996, stool specimens from patients with diarrhea or gastroenteritis were cultured for the Campylobacter species at the China Medical College Hospital. Data collected and evaluated included the type of Campylobacter species isolated, date of report, age and sex of the person from whom the isolate came, and clinical symptoms.

Of 6,540 patients with diarrhea or gastroenteritis, 162 Campylobacter isolates were identified, yielding an isolation rate of 2.5% from the population studied. One hundred and fifty-four patients (95%) with Campylobacter infection were younger than five years old, which was significantly different from the population studied (p < 0.001). The Campylobacter infection was significantly higher in males (62.3%) than females (37.7%) (p = 0.0017). In central Taiwan, the incidence of Campylobacter enteritis is higher during the winter (35.2%) than during the spring (19.1%), summer (24.1%) or fall (21.6%) (35.2 vs 24.1%, p = 0.021). Campylobacter jejuni was found to comprise 81% (132 strains) of 162 Campylobacter isolates, and its isolation rate was significantly higher than Campylobacter lari (10%) and Campylobacter coli (9%) (p < 0.001). From 1994 to 1996, isolation rates of Campylobacter species increased from 1.9 to 2.8% of the population studied (34/1, 754 vs 57/2, 187) and the positive isolation rate ratio of Campylobacter species to Salmonella species also increased from 15.4 to 27.8% (34/221 vs 57/205). However, no significant difference was found between these results (p > 0.05). Watery diarrhea is the most characteristic manifestation of illness, and fever occurs in more than half of the patients.

In central Taiwan, the incidence of Campylobacter enteritis in patients with diarrhea or gastroenteritis is lower than those in China and Tanzania, but the highest prevalence occurs before five years of age in central Taiwan as well as these countries. The Campylobacter infection rate was significantly higher in males than females, and occurred primarily in winter. We conclude that Campylobacter cultures should be performed for fecal specimens of all diarrheal children aged up to five years.