Campylobacteriosis, Shigellosis and Salmonellosis in Hospitalized Children with Acute Inflammatory Diarrhea in Georgia

Abstract

This is the first study on campylobacteriosis carried out in Georgia. It targeted 382 hospitalized children with acute inflammatory diarrhea. The study was conducted between July 2020 to July 2021 based on the main infection clinic of the capital city. Culture-based bacteriological methods were followed by phenotypic and Real-time PCR tests for bacterial confirmation and identification. The data revealed recent epidemiologic prevalences of the three main causative bacteria in the target population. Shigella sonnei with 19.1% (95% CI: 15.2%−23.4%) was the most frequently detected pathogen followed by Campylobacter spp. with 12.3% (95% CI: 9.2%−16.0%) and Salmonella spp. with 4.9% (95% CI: 3.0%−7.6%). However, in 63.6% of the samples, the causative agent remained unknown. Species differentiation of Campylobacter spp. revealed 81% Campylobacter jejuni and 19% Campylobacter coli. An epidemiological pyramid with estimated magnification factors may give more insights into the burden of campylobacteriosis among the studied population, resulting in a putative annual incidence of 6 per 1000 children in Tbilisi. Children with campylobacteriosis were younger (median age 40 months (interquartile range (IQR) 22−95)) than with shigellosis (median age 92 months (interquartile range (IQR) 52−140)). However, no statistically significant difference was found with the age range of patients with campylobacteriosis and salmonellosis as well as with salmonellosis and shigellosis. In conclusion, Campylobacter spp. may be suspected to be the second most frequent bacterial causative agent of acute inflammatory diarrhea in hospitalized children and the primary cause in the 0–3 age group in Georgia. In addition, Campylobacter CROMagar showed better selectivity in comparison to mCCDA selective agar of stool samples in our study.

Comparison of Antimicrobial Susceptibility Profiles of Thermotolerant Campylobacter spp. Isolated from Human and Poultry Samples in Georgia (Caucasus)

“…Those chickens were “standardized” with an age between 38 and 42 days. In addition, human stool isolates had been previously collected from hospitalized children with diarrhea from July 2020 to July 2021 [ 12 ]. Hence, the samples correlated in time and space.…”

“…From the isolates of backyard chicken, 25.8% were identified as C. jejuni ( n = 25/97) and 74.2% ( n = 72/97) as C. coli ; in cecal samples from industrial chicken, C. coli was even more dominant with 90% ( n = 45/50). In contrast, out of 57 clinical strains of children stool samples, 82.5% ( n = 47/57) were identified as C. jejuni and 17.5% ( n = 10/57) as C. coli ( Figure 1 ) [ 12 ].…”

“…In addition, 382 human stool samples had been previously collected from July 2020 to July 2021 at the Tbilisi Children Infectious Diseases Clinical Hospital from hospitalized children with diarrhea, from which 60 were positive for Campylobacter spp. [ 12 ]. Human stool samples were transported on Cary-Blair medium (Biolife Italiana srl, Milan, Italy) at cooling temperatures without microaerobic conditions and analyzed within 24 h. Chicken cecal samples were transported in plastic bags on ice and analyzed within 3–6 h after sampling.…”

“…Campylobacter detection was performed according to ISO 10272-1:2017 part C on modified charcoal cefoperazone deoxycholate agar (mCCDA) (Thermo Fisher Specialty Diagnostics Ltd., Hampshire, UK). For the clinical samples, Campylobacter Chromogenic agar Campylobacter (CHROMagar, France) was applied as an additional second selective medium to increase sensitivity [ 12 ]. Less than 20% of the clinical samples were also enriched with Preston broth (Biolife Italiana S.r.l., Milan, Italy) [ 13 ], but the results showed no enhanced detection [ 12 ].…”

“…For the clinical samples, Campylobacter Chromogenic agar Campylobacter (CHROMagar, France) was applied as an additional second selective medium to increase sensitivity [ 12 ]. Less than 20% of the clinical samples were also enriched with Preston broth (Biolife Italiana S.r.l., Milan, Italy) [ 13 ], but the results showed no enhanced detection [ 12 ].…”