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J Med Microbiol 55 (2006), 741-746; DOI: 10.1099/jmm.0.46422-0
© 2006 Society for General Microbiology
ISSN 1473-5644

Investigating vomiting and/or bloody diarrhoea in Campylobacter jejuni infection

Iain A. Gillespie1, Sarah J. O'Brien2, Jennifer A. Frost3, Clarence Tam1, David Tompkins4, Keith R. Neal5, Qutub Syed6, Michael J. G. Farthing7 and The Campylobacter Sentinel Surveillance Scheme Collaborators{dagger}

1 Environmental and Enteric Diseases Department, Health Protection Agency (HPA) Centre for Infections, 61 Colindale Avenue, London NW9 5EQ, UK

2 Division of Medicine and Neuroscience, Manchester University, Clinical Sciences Building, Hope Hospital, Stott Lane, Salford M6 8HD, UK

3 Welsh Assembly, Cardiff CF99 1NA, UK

4 HPA Yorkshire and the Humber Regional Microbiology, Bridle Path, York Road, Leeds LS15 7TR, UK

5 Division of Epidemiology and Public Health, School of Community Health Sciences, University of Nottingham Medical School, Nottingham NG7 2UH, UK

6 HPA North West, Rooms 103–112, First Floor, DBH House, 105 Boundary Street, Liverpool L5 9YJ, UK

7 St George's Hospital Medical School, University of London, Cranmer Terrace, London SW17 0RE, UK

Correspondence
Iain A. Gillespie
Iain.Gillespie{at}hpa.org.uk

Received 18 November 2005
Accepted 30 January 2006

Campylobacter jejuni infection frequently presents as acute enteritis with diarrhoea, malaise, fever and abdominal pain. Vomiting and bloody diarrhoea are reported less frequently. To investigate potential host, micro-organism or environmental factors that might explain the different clinical presentations, the features of laboratory-confirmed Campylobacter jejuni cases presenting with vomiting and/or bloody diarrhoea were compared with cases who did not report either clinical manifestation. Single variable analysis and logistic regression were employed. Explanatory variables included food, water and environmental risks. Cases who reported vomiting and/or bloody diarrhoea tended to suffer a longer illness and were more likely to require hospital admission. Independent risks identified were being a child, female gender, consumption of poultry other than chicken, pre-packed sandwiches and sausages, and reported engineering work or problems with drinking-water supply. A dose-response relationship with vomiting and/or bloody diarrhoea and increasing daily consumption of unboiled tap water was observed also. Vomiting and/or bloody diarrhoea characterized the more severe end of the disease spectrum and might relate to host susceptibility and/or infective dose. The role of unboiled tap water as a potential source of C. jejuni infection in England and Wales requires further investigation.

Abbreviations: CI, confidence interval; HPA, Health Protection Agency; OR, odds ratio.

{dagger}The Campylobacter Sentinel Surveillance Scheme Collaborators are public health, environmental health and laboratory staff who serve the populations of the following health authorities: Birmingham, Bradford, Bro Taf, Bury and Rochdale, Dyfed Powys, East Kent, Barnet, Enfield and Haringey, Herefordshire, Leeds, Leicestershire, Manchester, North Cumbria, North Essex, North West Lancashire, Nottingham, Salford and Trafford, South and West Devon, South Lancashire, Southampton and South West Hampshire, Stockport, West Pennine, Wigan and Bolton. In association with: HPA Laboratory of Enteric Pathogens, Campylobacter Reference Unit; HPA Centre for Infections, Environmental and Enteric Diseases Department; HPA Local and Regional Services; HPA Statistics Unit.






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