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Journal of Clinical Microbiology, May 2009, p. 1614-1615, Vol. 47, No. 5
0095-1137/09/$08.00+0     doi:10.1128/JCM.00310-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

LETTER TO THE EDITOR

Campylobacter concisus: a New Character in the Crohn's Disease Story?

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I read with extreme interest the article by Zhang et al. (7) about a high prevalence of Campylobacter concisus DNA as well as of immunoglobulin G antibodies to C. concisus in children with Crohn's disease. The role of bacteria in the pathogenesis of inflammatory bowel disease is well recognized, but an individual responsible microorganism had not been singled out so far (3). The finding that this particular bacterium, already pinpointed as an emerging pathogen in enteric infections (4), may have a pathogenic role in Crohn's disease provides further evidence of the possible therapeutic role of antibiotics and probiotics for that disorder (3).

In this respect, rifaximin, a nonadsorbable antibiotic endowed with strong activity against Campylobacter species (2) and devoid of systemic side effects, appears to be a very promising agent.

The results of both open-label (6) and double-blind, placebo-controlled (5) studies have suggested that rifaximin can be effective for active Crohn's disease, although very high doses, up to 1,600 mg daily, may be necessary (5). A case series has recently reported that a short-term rifaximin course followed by long-term administration of probiotics can induce and maintain remission of Crohn's disease (1).

Similarly, my coworkers and I observed that in patients intolerant to mesalamine and for whom immunosuppressants were not indicated, a 3-month combined therapy with rifaximin at 400 mg in the evening and Saccharomyces boulardii at 500 mg in the morning was able to effectively prevent clinical relapses (M. Guslandi, A. Cella, and P. A. Testoni, unpublished results).

Obviously, further studies are needed to confirm and expand the data from Zhang et al. before it can be claimed that C. concisus represents for Crohn's disease what Helicobacter pylori (formerly known as Campylobacter pylori, incidentally) is for peptic ulcer disease. Nevertheless, I believe that the identification of this new pathogen constitutes an important step in the understanding of the mechanisms involved in Crohn's disease and of a more suitable therapeutic approach.

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1
1. Doman, D. B., H. J. Goldberg, and M. I. Golding. 2008. "Ecological niche" therapy for Crohn's disease with adjunctive rifaximin antibiotic treatment followed by Flora-Q probiotic maintenance therapy. Am. J. Gastroenterol. 103:251-252.[Medline]
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2. Gillis, J. C., and R. N. Brogden. 1995. Rifaximin. A review of its antibacterial activity, pharmacokinetic properties and therapeutic potential in conditions mediated by gastrointestinal bacteria. Drugs 49:467-484.[Medline]
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3. Guslandi, M. 2005. Antibiotics for inflammatory bowel disease: do they work? Eur. J. Gastroenterol. Hepatol. 17:145-147.[CrossRef][Medline]
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4. Newell, D. G. 2005. Campylobacter concisus: an emerging pathogen? Eur. J. Gastroenterol. Hepatol. 17:1013-1014.[CrossRef][Medline]
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5. Prantera, C., H. Lochs, M. Campieri, M. L. Scribano, G. C. Sturniolo, F. Castiglione, and M. Cottone. 2006. Antibiotic treatment in Crohn's disease: results of a multicentre, double-blind, randomized, placebo-controlled trial with rifaximin. Aliment. Pharmacol. Ther. 23:1117-1125.[CrossRef][Medline]
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6. Shafran, I., and L. K. Johnson. 2005. An open-label evaluation of rifaximin in the treatment of Crohn's disease. Curr. Med. Res. Opin. 21:1165-1169.[CrossRef][Medline]
7
7. Zhang, L., S. M. Man, A. S. Day, S. T. Leach, D. A. Lemberg, S. Dutt, M. Stormon, A. Otley, E. V. O'Loughlin, A. Magoffin, P. H. Y. Ng, and H. Mitchell. 2009. Detection and isolation of Campylobacter species other than C. jejuni from children with Crohn's disease. J. Clin. Microbiol. 47:453-455.[Abstract/Free Full Text]

						Mario Guslandi Gastroenterology Unit S. Raffaele University Hospital Via Olgettina 60 20132 Milan, Italy
						Phone: 39-02-26432744, Fax: 39-02-26433491, E-mail: guslandi.mario{at}hsr.it

Authors' Reply

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We would like to thank Dr. Mario Guslandi for his comments on our study "Detection and Isolation of Campylobacter Species Other than C. jejuni from Children with Crohn's Disease" (1). As pointed out by Dr. Guslandi, our findings of a significantly higher prevalence of Campylobacter concisus in intestinal biopsy specimens from children with Crohn's disease (CD) than in controls are indeed interesting results. However, while this study provides important preliminary data regarding a possible role for C. concisus in CD, it does not, as yet, prove a causative role for C. concisus in CD. Further studies are clearly required.

In his letter, Dr. Guslandi presents some interesting data showing that rifaximin is beneficial in the treatment of CD and suggests that this efficacy may relate to the eradication of Campylobacter species. While this may be possible, given that rifaximin is a broad-spectrum antimicrobial agent, it can also target a range of other susceptible intestinal bacteria in addition to Campylobacter species.

To prove a causative role for C. concisus, a well-designed clinical trial that examines not only clinical outcomes but also the effects of rifaximin on the intestinal flora, including C. concisus, is required.

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1
1. Zhang, L., S. M. Man, A. S. Day, S. T. Leach, D. A. Lemberg, S. Dutt, M. Stormon, A. Otley, E. V. O'Loughlin, A. Magoffin, P. H. Y. Ng, and H. Mitchell. 2009. Detection and isolation of Campylobacter species other than C. jejuni from children with Crohn's disease. J. Clin. Microbiol. 47:453-455.[Abstract/Free Full Text]

						Li Zhang Si Ming Man School of Biotechnology and Biomolecular Sciences University of New South Wales Sydney, Australia Andrew S. Day Department of Gastroenterology Sydney Children's Hospital Sydney, Australia Steven T. Leach School of Women's and Children's Health University of New South Wales Sydney, Australia Daniel A. Lemberg Department of Gastroenterology Sydney Children's Hospital Sydney, Australia Shoma Dutt Michael Stormon Department of Gastroenterology Children's Hospital at Westmead Sydney, Australia Anthony Otley IWK Health Centre Division of Gastroenterology Faculty of Medicine Dalhousie University Halifax, Nova Scotia, Canada Edward V. O'Loughlin Annabel Magoffin Department of Gastroenterology Children's Hospital at Westmead Sydney, Australia Patrick H. Y. Ng Hazel Mitchell* School of Biotechnology and Biomolecular Sciences University of New South Wales Sydney, Australia
						* Phone: 61 (2) 9385 2040 Fax: 61 (2) 9385 1591 E-mail: h.mitchell{at}unsw.edu.au

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Journal of Clinical Microbiology, May 2009, p. 1614-1615, Vol. 47, No. 5
0095-1137/09/$08.00+0     doi:10.1128/JCM.00310-09
Copyright © 2009, American Society for Microbiology. All Rights Reserved.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints and Permissions Copyright Information Books from ASM Press MicrobeWorld Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Guslandi, M. Articles by Mitchell, H. Search for Related Content PubMed PubMed Citation Articles by Guslandi, M. Articles by Mitchell, H.