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Journal of Clinical Microbiology, April 2008, p. 1418-1425, Vol. 46, No. 4
0095-1137/08/$08.00+0     doi:10.1128/JCM.02168-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Diagnostic Approach to Acute Diarrheal Illness in a Military Population on Training Exercises in Thailand, a Region of Campylobacter Hyperendemicity{triangledown}

David R. Tribble,1* Shahida Baqar,1 Lorrin W. Pang,2 Carl Mason,2 Huo-Shu H. Houng,3 Chittima Pitarangsi,2 Carlos Lebron,4 Adam Armstrong,5 Orntipa Sethabutr,2 and John W. Sanders5

Enteric Diseases Department, Naval Medical Research Center, Silver Spring, Maryland,1 Armed Forces Research Institute of Medical Sciences, Bangkok, Thailand,2 Walter Reed Army Institute of Research, Silver Spring, Maryland,3 Naval Environmental Preventive Medicine Unit 6, Pearl Harbor, Hawaii,4 National Naval Medical Center, Bethesda, Maryland5

Received 8 November 2007/ Returned for modification 1 January 2008/ Accepted 22 January 2008

High rates of Campylobacter fluoroquinolone resistance highlight the need to evaluate diagnostic strategies that can be used to assist with clinical management. Diagnostic tests were evaluated with U.S. soldiers presenting with acute diarrhea during deployment in Thailand. The results of bedside and field laboratory diagnostic tests were compared to stool microbiology findings for 182 enrolled patients. Campylobacter jejuni was isolated from 62% of the cases. Clinical and laboratory findings at the time of presentation were evaluated to determine their impact on the posttest probability, defined as the likelihood of a diagnosis of Campylobacter infection. Clinical findings, the results of tests for inflammation (stool occult blood testing [Hemoccult], fecal leukocytes, fecal lactoferrin, plasma C-reactive protein), and the numbers of Campylobacter-specific antibody-secreting cells in peripheral blood failed to increase the posttest probability above 90% in this setting of Campylobacter hyperendemicity when these findings were present. Positive results by a Campylobacter-specific commercial enzyme immunoassay (EIA) and, less so, a research PCR were strong positive predictors. The negative predictive value for ruling out Campylobacter infection, defined as a posttest probability of less than 10%, was similarly observed with these Campylobacter-specific stool-based tests as well the fecal leukocyte test. Compared to the other tests evaluated, the Campylobacter EIA is a sensitive and specific rapid diagnostic test that may assist with diagnostic evaluation, with consideration of the epidemiological setting, logistics, and cost.

* Corresponding author. Mailing address: Infectious Disease Clinical Research Program, Preventive Medicine & Biometrics Department, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814-5119. Phone: (301) 295-1422. Fax: (301) 295-1812. E-mail: dtribble{at}usuhs.mil

{triangledown} Published ahead of print on 30 January 2008.

Journal of Clinical Microbiology, April 2008, p. 1418-1425, Vol. 46, No. 4
0095-1137/08/$08.00+0     doi:10.1128/JCM.02168-07
Copyright © 2008, American Society for Microbiology. All Rights Reserved.





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