IDENTIFICATION AND CONFIRMATION THROUGH MULTIPLEX PCR OF THE SPECIES OF ARCOBACTER IN ISOLATES FROM HUMAN AND ANIMAL FECAL SAMPLES IN LIMA, PERU

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and 35.9-71.1 % in Asia. Between 1993 and 2010, globally, continued
feeding for children with diarrhea appears to be unchanged (β=0.15,
p=0.82). Likewise, no significant improvements in continued feeding
were observed in Latin America (β= -0.10, p=0.78) or Sub-Saharan Africa
(β= -0.15, p=0.27). Prevalence of continued feeding in Asia appears to
be increasing significantly at 0.25% increase rate per year (p=0.05).
Sub-Saharan Africa has the highest diarrhea-associated mortality of any
region in the world but has seen no improvements in continued feeding
for children with diarrhea since 1993.These findings indicate the need for
quantitative and qualitative research to understand barriers to continued
feeding on the part of caregivers, and renewed efforts to promote
continued feeding as a core component of diarrhea case management in
settings where the burden of diarrhea is high.
1053
TRENDS IN ANTIBIOTIC RESISTANCE AND DIARRHEAL
DISEASE EPIDEMIOLOGY IN A MILITARY POPULATION IN THE
PERUVIAN AMAZON, 2003-2011
Kristen Heitzinger1
, Ryan C. Maves2
, Eric R. Hall2
, Claudio
Rocha2
, Rene C. Guzman3
, Franca R. Jones2
, Drake H. Tilley2
1
University of Washington, Seattle, WA, United States, 2
U.S. Naval Medical
Research Unit - 6, Lima, Peru, 3
Vargas Guerra Army Base, Iquitos, Peru
In Peru, where antibiotic use is unregulated, the effective treatment of
diarrheal disease is often complicated by the development of antibiotic
resistant organisms. We aimed to investigate the trends in diarrheal
disease etiology and antibiotic resistance in a military population in the
Peruvian Amazon in order to guide diarrhea treatment. From 2003 to
2011, diarrheal disease surveillance was conducted among personnel at
the Vargas-Guerra Army Base in Iquitos, Peru. All individuals experiencing
diarrhea were requested to present to the army health post where a stool
sample was taken for culture. Diarrheagenic bacteria were isolated from
34.5% of the 638 cases. From the 215 samples in which a single bacterial
pathogen was isolated, Shigella flexneri, Enterotoxigenic E. coli (ETEC) and
Enteroinvasive E. coli (EIEC), were the most common pathogens and were
identified in 47.0%, 30.2%, and 5.6% of samples, respectively. There
were no trends in the prevalence of Shigella flexneri or EIEC over the study
period, however, the prevalence of ETEC decreased significantly (Odds
Ratio= 0.86, 95% CI=0.75, 0.97; p=0.02). Of 101 isolates of Shigella
flexneri cultured, 95.0% demonstrated resistance to tetracycline, 89.1%
to chloramphenicol, 84.2% to ampicillin, and 80.2% to cotrimoxazole.
Resistance of Shigella flexneri to ciprofloxacin and azithromycin remained
low (0% and 8.9%, respectively). There were no significant trends in
resistance to any other antibiotics over time. These data demonstrate
a high prevalence of Shigella flexneri and diarrheagenic E. coli among
diarrhea cases in a military population in the Peruvian Amazon. Although
antibiotic resistance to penicillins and sulfa antibiotics remains high in this
population, more appropriate or less frequent use of certain antibiotics
may have led to decreasing resistance.
1054
CLUSTER OF GUILLAIN-BARRÉ SYNDROME DUE TO A
WATERBORNE OUTBREAK OF CAMPYLOBACTER JEJUNI
INFECTION -- SAN LUIS RIO COLORADO, SONORA, MEXICO
AND YUMA, ARIZONA, UNITED STATES, 2011
José Alomia1
, Brendan Jackson2
1
Sonora SubDirectorate of Epidemiological Intelligence, for the Binational
GBS Investigation Team, Hermosillo, Mexico, 2
Centers for Disease Control
and Prevention, for the Binational GBS Investigation Team, Atlanta, GA,
United States
From May 31-June 16, 2011, a cluster of 15 suspected cases of Guillain-
Barré Syndrome (GBS) which sometimes follows Campylobacter jejuni
infection, was reported in San Luis Rio Colorado (SLRC), Sonora, Mexico
and Yuma County (YC), Arizona. Epidemiological teams from Mexico
and the United States conducted a binational outbreak investigation
to confirm this cluster and determine the etiology. We performed
additional case-finding and classified GBS cases through interviews and
medical record review. To investigate exposures, we reviewed disease
surveillance data, performed C. jejuni stool culture, conducted a case-
control study examining food and water exposures of cases with GBS or
C. jejuni infection, and performed an environmental assessment of water
systems. From May 4-July 21, 2011, 16 SLRC residents and 8 YC residents
developed GBS, far exceeding the expected number of cases. Twenty-
one GBS patients (81%) reported antecedent diarrhea. Approximately
two weeks before this cluster, weekly YC C. jejuni reports doubled
compared with the 3 previous years. Though C. jejuni diagnostics were
limited, 2 GBS patients had stool cultures yielding C. jejuni and 4 others
had positive serologic or stool antigen tests. In the case-control study,
all 7 GBS case-patients from YC traveled to SLRC during the exposure
period versus 37% of 19 matched controls (mOR: 10.2; CI: 1.4-inf.). Few
case-patients or controls (<20%) drank tap water, but >95% reported
exposure through other routes. Case-patients consumed more washable,
uncooked produce items than controls (Median: 7 vs. 5; P = 0.04). The
SLRC municipal water system had a history of inadequate chlorination and
pipe disruptions. Inadequately disinfected tap water contaminated with C.
jejuni was the likely source of this first mainland North American outbreak
of GBS. Improved water treatment practices were implemented and the
institution of new epidemiological surveillance strategies in SLRC since
this investigation will improve early detection of diarrheal outbreaks and
facilitate public health actions.
1055
IDENTIFICATION AND CONFIRMATION THROUGH MULTIPLEX
PCR OF THE SPECIES OF ARCOBACTER IN ISOLATES FROM
HUMAN AND ANIMAL FECAL SAMPLES IN LIMA, PERU
Rito Zerpa1
, Maritza Puray-Chavez1
, Carlos R. Sevilla1
, Paolo A.
Wong1
, Percy Lezama2
, Lilian Patiño3
, Jorge O. Alarcon1
1
Instituto de Medicina Tropical, Universidad Nacional Mayor de San
Marcos, Lima, Peru, 2
Frigorifico La Colonial SAC, Callao, Peru, 3
Instituto
Nacional de Salud del Niño, Lima, Peru
A multiplex PCR was used to confirm the identity of isolates that are
phenotypically suggestive of Arcobacter from human and animal stool
samples in Lima, Peru. We evaluated 57 bacterial isolates from human
fecal samples (3), pigs (52), lion (1) and rabbit (1), with the following
phenotypic characteristics suggestive of Arcobacter: gram-negative rods,
curve-shaped C or S, mobile, aerobic and microaerophilic, circular colonies
1 to 2mm in diameter at 18-24 hours of incubation in microaerophilic
conditions on blood agar, non-hemolytic and lactose negative colonies on
MacConkey agar, oxidase and catalase positive. The study of genotype
was performed by multiplex PCR, as reported previously, using primers
targeting the 16S and 23S rRNA genes for the detection of three species:
A. butzleri, A. cryaerophilus, A. skirrowi, with a molecular weight of
401-bp, 257-bp, 641-bp, respectively. It was confirmed molecularly that
Arcobacter was in 87.7% (50/57) of the isolates studied, 90% (45/50) of
which corresponded to A. butzler, 8.0% (4/50) to A. cryaerophilus and
2% (2/50) to A. skirrowi. A proportion of 12.3% were negative with the
primers used. Of the three human samples, two isolates corresponded to
A. butzleri and one to A. cryaerophilus. The rabbit and lion isolates were
A. butzleri. Of the pig isolates, 91.1% (41/45) A. butzler, 6.7% (3/45)
were A. cryaerophilus, and 2.2% (1/45) A. skirrowi. The presence of A.
butzler, A. cryaerophilus and A. skirrowi were confirmed in 87.7% of the
total isolates of human, pig, rabbit and lion fecal samples. The remaining
12.3% of the isolates are likely composed of other species of Arcobacter.

3. A-471
The number(s) following author name refers to the abstract number.
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Abstract Author Index
Kuschner, Robert A. 418
Kushner, Adam L. 286
Kuzmin, Ivan 566
Kwak, Byung Hyung 676
Kwambai, Titus 271
Kwambana, Brenda 1419
Kwarteng, Alexander 522
Kwarteng, Anthony 1176
Kweza, Patience 1252
Kwiatkowski, Dominic 503, 999
Kwityn, Clifford 1034
Kwofie, Kofi D. 256
Kwon, Chang-hee 580
Kyabayinze, Daniel 463, 1307,
1309, 1020
Kyari, Fatima 1274
Kyebambe, Peterson S. 656
Kyelem, Carole G. 377
Kyelem, D. 483
Kyle, Dennis E. 431, 866, 867,
989
Kyobutungi, Catherine 1360
L
LaBaer, Josh 41
Labbé, Pierrick 1205
LaBeaud, A. Desiree 50, 423, 721
Laclette, Juan P. 98, 1076, 99
Lacoste, Maryjane 880
LaCrue, Alexis N. 431
Lafferty, Kevin 757
LaForce, Marc 1408
Lafosse, Elsie 47
Lafuente-Monasterio, Maria
Jose 1325
Lage, Regina C. G. 529
Laguna-Torres, Victor A. 1135,
942, 1400
Lai, Chih-Yun 1394
Lakwo, Tom L. 520
Lal, Sham 340, 341
Lalji, Shabbir 546, 918
Lalloo, David 362, 1441
Lam, Felix 1345
Lam, Polo C. H.. 24
Lambert, Lynn 1423
Lamberton, Poppy H. L. 479
Lamine, Diakité Moussa 1337
Lammie, Patrick 482, 645
Lampah, Daniel A. 155, 1424
Lan, Nguyen T. P. 637
Lanata, Claudio F. 516, 941,
1248, 1258
Laney, Sandra J. 1489
Lang, Jean 110, 630
Lanou, Herman 292
Lantagne, Daniele S. 1252
Lanteri, Charlotte A. 837, 1063
Lantz, Chris 438
Laquer, Kari 176
Larbi, Irene A. 1109
Larissa Aurore Tobola,
Bouyoukou Hounkpatin 703
LaRocque, Regina C. 42, 43, 45,
1410, 41, 1041
Larrauri, Luis 446
Larsen, David 1180
Larsen, David A. 12, 468, 694,
1435
Larson, Erik 629
Larson, Nick 1213
Larson, Peter S. 915, 917
Larsson, Catherine 1011
Lasanajak, Yi 761
Laserson, Kayla 513, 514, 515,
952, 961, 453, 1403
Latourette, Matthew 1427
Lau, Colleen 118
Lau, Louis 1395
Lau, Rachel 862
Lauby-Secretan, Beatrice 141
Laucella, Susana A. 1153
Laufer, Miriam K. 871, 1438,
857, 857
Laurens, Matthew B. 5, 7, 1335
Laver, Susan M. L.. 1252
Law, Charity W. 1167
Lawal, Ismail 958
Lawrie, Alison 3
Lazo, John S. 537
Le, Binh 1209
Le, Christy 1002
Le, Huu Tho 246
Le, Minh Nhat 246
Le Bras, Jacques 862, 863, 863,
864, 868
Le Nagard, Hervé 868
Ledermann, Jeremy P. 1377, 566
Lee, Angela 1357
Lee, Andrew H. 439
Lee, Bi-Yao 1119
Lee, Bruce Y. 127, 296
Lee, Ming-Chieh 877
Lee, Marcus C. S. 439
Lee, Patricia J. 683
Lee, Sue 548, 1269
Lee, Susan Shin-Jung 1119
Leed, Susan E. 683
Leeds, Janet M. 103
Leepitakrat, Surachai 578
Legac, Jenny 677
Legros, Mathieu 872
Lehane, Michael 71, 76
Leiby, David A. 905, 905
Leitner, Gabriel 797
Leitner, Wolfgang W. 611, 611
Lekpor, Cecilia E. 333
Lele, Albertine K. 337
Lemey, Philippe 17, 119
Lemma, Seblewengel 903
Lemnge, Martha M. 861
Lemos, Larissa S. 250
Lengeler, Christian 1328
Lenhart, Audrey 281, 724, 786
Lennon, Niall J. 429
Lennox, Gayle 1254
Leon, Juan S. 1255
Leontsini, Elli 774, 775, 963, 965
Leow, Kak S. 560
Lepore, Timothy 60
Lepore S.R., Timothy J. 59
Lerdprom, Rujira 877
Leroy, Didier 681, 986
Lesage, Pierre-Loup 1345
Lescano, Andrés G. 227, 259,
445, 640, 929, 1196, 1223
Lescuyer, Arlette 1451
Leshem, Eyal 829
Leslie, Toby 454, 461
Lesser, Adriane 1353
Lessler, Justin 1082
Letizia, Andrew 951
Leung, Daniel T. 42, 43, 45, 518,
1041, 1410
Leung, Zachary 1470
Leutner, Silke 980
Levens, Joshua 592
Levin, Joshua Z. 429
Levine, Jessica 54
Levine, Myron M. 236, 513, 515,
961, 1288, 514, 1059, 1060
Levine, Rebecca 563
Levy, Danielle 1275
Levy, Karen 1042
Levy, Michael Z. 275, 825
Lewallen, Susan 1268, 1271
Lewis, Kayla 1240
Lewis, Michael D. 981
Lezama, Percy 1055
Lhermitte-Vallarino, Nathaly 40
Li, Hongmin 1071
Li, Jianyong 24
Li, Jian 665
Li, Lixin 103
Li, Li 1104
Li, Qigui 840, 841
Li, Shanping 389
Li, Tao 189, 449
Li, Tiger 1099
Li, Xiangming 1461
Li, Yu 455
Li, Yuexin 834, 834
Liang, Ai Wei 110
Liang, Li 719
Liang, Song 960
Liang, Yousheng 532
Liao, Hua-Xin 632
Libraty, Daniel H. 15
Lichtner, Franz 1459
Lieberman, Marya 1240
Lieshout, L. V. 1434
Lietman, Tom M. 29
Lievens, Marc 188
Liles, W. C. 1449
Lillebø, Kristine 1278, 1279,
1280
Lilue, Jingtao 1499
Lim, Burton K. 53
Lim, Chang-kweng 1392
Lim, Jacqueline K. 1016, 1017
Lim, Kee-Chong 1035
Lim, Pharath 985
Lim, Yvonne A. L. 248
Lima, Aldo A. M. 517, 1049
Lima, Helena C. A. V. 19
Lima, Marcelo d. Lima. 265, 266
Noélia L. Lima. 517
Limbach, Keith 495
Limkittikul, Kriengsak 1016,
1017, 1101
Lin, Feng-Chang 363
Lin, Jingwen 978
Lin, Jessica T. 357, 689, 689, 889
Lin, Ren-Yong 449
Lin, Zhaoting 983
Linares-Perez, Nivaldo 944, 1249
Lindblade, Kim 485, 626, 938,
1124, 1125, 1243, 391
Lindh, Jenny 191, 214, 217
Lindo, John F. 1130
Lindquist, Susan 1297
Lindroth, Erica 67
Lindsay, Robbin 1090, 1287
Lindsay, Steve 191, 214, 217,
1220, 1388, 464, 1419
Lindsay, Thomas 1419
Lindsley, Craig W. 730
Lingam, Raghu 804
Linser, Paul 1362
Linthicum, Kenneth K. 211
Liomba, Mike 857, 857
Liong, Kek-Yee 983
Lipkin, W. Ian 1103
Lissandrin, Raffaella 448, 1067
Little, Kristen M. 485, 1124,
1125, 1478
Littrell, Megan 1021, 1299, 1300
Liu, Canhui 1113, 1487
Liu, Jenny 342, 684, 1174
Liu, Jie 512, 1380
Liu, Kun 1464
Liu, Lucy 60
Liu, Mingli 313, 663
Liu, Mingshun 625
Liu, Shiping 23
Liu, Xia 175
Liu, Yunhua 23
Liu, Yue 1027
Livengood, Jill A. 619, 1013,
1014
Liyanage, Jayantha 410
Llanos, Fernando 446
Llanos, Fiorella 1341
Llanos-Cuentas, Alejandro 885,
887, 1270, 1341
Llergo, Jose L. 1320
Llewellyn, Martin S. 981
Llinás, Manuel 439
Lloyd, Bradley 790