Correlating pathogen prevalence in food surveillance to the risk of disease acquisition is difficult, and this study is unable to make definitive conclusions about human disease acquisition risk. A major hamper to drawing a definitive conclusion is that the pathogenicity of Arcobacter XL184 mw is still being elucidated. Arcobacter is a recently reclassified genera from the family Campylobacteracea, first identified in 1992. Arcobacter spp. differ from Campylobacter spp. by their ability to grow at lower temperatures and in air. Of the six Arcobacter spp., A butzleri has predominantly been
associated with human enteritis. The major focus of human acquisition risk is on raw meat products, specifically chicken.32,33 In 2000, Morita and colleagues34 identified A butzleri in 100% of retail chicken and canal water samples in Bangkok. Arcobacter as a human pathogen has not
been identified in TD etiology studies but has been described in five case series/case reports: two bacteremia cases in patients with underlying disease in Taiwan and Hong Kong, an outbreak among 10 patients in Italy, bacteremia in a newborn in the UK, and two cases of severe diarrhea in Germany.35–39 Taylor and colleagues40 isolated Campylobacter butzleri (now known as A butzleri) in 3% of 631 diarrheal stool samples collected from Thai children in 1991. Samie and colleagues41 compared the prevalence of A butzleri in 322 stool samples from patients with and without diarrhea in South Africa, and Neratinib 70% of the 20 A butzleri isolates found were associated with diarrhea but the p value was not significant at 0.198. The most compelling evidence comes from Vendenberg and colleagues who compared the prevalence of Campylobacter and Arcobacter among 67,599 stool specimens (12,413 solid stools
and 55,186 diarrheal stools). Arcobacter butzleri was more frequently isolated in diarrheic stool [odds ratio (OR) 2.48, 95% confidence interval (CI) 1.10–5.86, p = 0.0175]. Clinical course was also compared, and A butzleri was more frequently associated with a persistent and watery diarrhea and less associated with bloody diarrhea.42 Because Arcobacter spp. prevalence is not routinely assessed and there is a lack of standard isolation methods, the true occurrence of this emerging pathogen is largely unknown. Arcobacter may be misclassified as Campylobacter GBA3 in many studies due to their microbiologic similarities.32,33,40 This severely limits the ability to compare field data, and may partially explain why Campylobacter spp. was not identified in this study (ie, the Arcobacter isolated would have been misclassified as Campylobacter spp. if Arcobacter was not specifically assessed via the oxygen tolerance test which was not utilized in the previous Thailand TD etiology studies). The scientific community agrees current evidence points to Arcobacter spp. being pathogenic in humans, but further research is required to make conclusive assessments.