pullorum. This organism was first described in 1994 selleck chemicals after clinically derived CLO isolates were examined by various methods, and within 387 samples, six strains of H. pullorum were identified (including NCTC 12826, NCTC 12827, UB3166, UB3659) all associated with gastrointestinal
illness (Burnens et al., 1994; Stanley et al., 1994). One of the patients was a 27-year-old man with diarrhoea, 30 kg weight loss and deranged liver enzymes. No gastrointestinal histology or clinical progress was reported on this case; hence, the similarity of his disease to IBD cannot be commented upon further. One patient was HIV-positive. Helicobacter pullorum (NCTC 13155) has also been associated with diarrhoeal illness in humans in a German study describing two cases with diarrhoea (without blood), one of whom also had common variable immunodeficiency (Steinbrueckner et al., 1997). Both cases apparently resolved spontaneously. The first (immunosuppressed) case was treated once asymptomatic with roxythromycin after which stools were negative for H.
pullorum; however, the second case continued to have positive stools and went on to have a second episode of diarrhoeal illness during which the organism was again cultured. This suggests the possibility of chronic carrier status. Interestingly, in one case, the organism was first identified as C. jejuni/coli based on its selleck kinase inhibitor appearance, growth conditions and oxidase/catalase tests. As we shall see, standard laboratory methods of identification may underestimate the burden of lower gastrointestinal Helicobacter (and indeed novel Campylobacter) disease. One study has potentially contradicted the possibility of H. pullorum being a pathogenic agent resulting in diarrhoeal disease in humans. The work of Ceelen
et al. (2005) examined 531 stool samples from patients with gastroenteritis alongside stool from 100 healthy individuals by H. pullorum-specific PCR. This study demonstrated a strikingly similar prevalence within the two cohorts. The gastroenteritis group were PCR-positive for H. pullorum in 4.3% of cases and the controls in 4.0%. The authors rightly state that DNA positivity may come from ingested foodstuffs and that it does not necessarily infer replication of the organisms within the gastrointestinal tract. Other possibilities explored included a PI-1840 variable pathogenicity within the organisms themselves or variable host factors (which may include immunodeficiency or genetic susceptibility). The PCR primers designed by Stanley et al. (1994), which were apparently utilized in this study, have since been revised (Fox et al., 2000). It is not clear what effect, if any, this may have had on the prevalence data provided by the work of Ceelen. The pathogenicity of H. pullorum was recently studied in vitro by Varon et al. (2009) utilizing human gastric (AGS) and intestinal (CaCo-2 and HT-29) epithelial cell lines.