title: Campylobacter infection in children in Malawi is common and is frequently associated with enteric virus co-infections.
abstract: BACKGROUND
  Campylobacter species are the most common cause of bacterial gastroenteritis in the developed world. However, comparatively few studies have determined the epidemiological features of campylobacteriosis in resource-poor settings.
  
  
  METHODS
  A total of 1,941 faecal specimens collected from symptomatic (diarrhoeic) children and 507 specimens from asymptomatic (non-diarrhoeic) children hospitalised in Blantyre, Malawi, between 1997 and 2007, and previously tested for the presence of rotavirus and norovirus, was analysed for C. jejuni and C. coli using a real time PCR assay.
  
  
  RESULTS
  Campylobacter species were detected in 415/1,941 (21%) of diarrhoeic children, with C. jejuni accounting for 85% of all cases. The median age of children with Campylobacter infection was 11 months (range 0.1-55 months), and was significantly higher than that for children with rotavirus and norovirus (6 months and 7 months respectively; P<0.001). Co-infection with either rotavirus or norovirus was noted in 41% of all cases in the diarrhoeic group. In contrast, the detection rate of Campylobacter in the non-diarrhoeic group was 14%, with viral co-infection identified in 16% of children with Campylobacter. There was no association between Campylobacter detection rate and season over the 10 year period.
  
  
  CONCLUSIONS
  Using molecular detection methodology in hospitalised Malawian children, we have demonstrated a high prevalence of Campylobacter infection, with frequent viral co-infection. The burden of Campylobacter infection in young African children may be greater than previously recognised.
authors.affiliation: Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Jenifer
authors.initials: J
authors.lastname: Mason
authors.forename: Miren
authors.initials: M
authors.lastname: Iturriza-Gomara
authors.forename: Sarah J
authors.initials: SJ
authors.lastname: O'Brien
authors.forename: Bagrey M
authors.initials: BM
authors.lastname: Ngwira
authors.forename: Winifred
authors.initials: W
authors.lastname: Dove
authors.forename: Martin C J
authors.initials: MC
authors.lastname: Maiden
authors.forename: Nigel A
authors.initials: NA
authors.lastname: Cunliffe
mesh_terms: D017677:Age Distribution; D002167:Campylobacter / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology; D002169:Campylobacter Infections / Q000453:epidemiology* / Q000821:virology*; D002675:Child, Preschool; D060085:Coinfection / Q000821:virology*; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology / Q000821:virology; D005243:Feces / Q000382:microbiology / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008295:Malawi / Q000453:epidemiology; D008297:Male; D015995:Prevalence; D060888:Real-Time Polymerase Chain Reaction; D012401:Rotavirus / Q000235:genetics / Q000302:isolation & purification / Q000502:physiology*; D012621:Seasons
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