Clinical and Epidemiologic Features of Diarrheal Disease due to Aeromonas hydrophila and Plesiomonas shigelloides Infections Compared with Those due to Vibrio cholerae Non-O1 and Vibrio parahaemolyticus in Bangladesh

Erik H Klontz,Stephen P Luby,Abu S G Faruque,Zhahirul Islam,Mohammed A Malek,Sumon K Das,Karl C Klontz

doi:10.5402/2012/654819

Abstract

Using data from the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) from 1996 to 2001, we compared the clinical features of diarrhea in patients with stool specimens yielding only A. hydrophila (189 patients; 1.4% of 13,970 patients screened) or P. shigelloides (253 patients) compared to patients with sole V. cholerae non-O1 infection (99 patients) or V. parahaemolyticus infection (126 patients). Patients exhibited similar frequencies of fever (temperature >37.8°C), stools characterized as watery, and stools containing visible mucus. Dehydration was observed more often among patients with V. parahaemolyticus or V. cholerae non-O1 infection. Compared to patients infected with V. parahaemolyticus, those with A. hydrophila, P. shigelloides, or V. cholerae non-O1 infection were less likely to report visible blood in the stool and, on microscopic examination, less likely to exhibit stool red blood cell and white blood cell counts exceeding 20 cells per high power field. The proportion of patients reporting subjective cure at the time of discharge was significantly smaller for those infected with V. parahaemolyticus. These findings suggest that A. hydrophila and P. shigelloides produce diarrheal disease that is less severe than that resulting from infection with V. cholerae non-O1 or V. parahaemolyticus.

Highlights

Aeromonas hydrophila and Plesiomonas shigelloides are Gramnegative bacilli within the families Aeromonadaceae and Enterobacteriaceae, respectively
Pairwise assessments of responses for patients infected with A. hydrophila or P. shigelloides were compared with those for patients infected with V. cholera non-O1 or V. parahaemolyticus using a chi-square or Fisher’s exact test to assess differences of statistical significance (P value
Patients with A. hydrophila infection were younger than those infected by P. shigelloides, V. cholerae nonO1, or V. parahaemolyticus infections

Summary

Introduction

Aeromonas hydrophila and Plesiomonas shigelloides are Gramnegative bacilli within the families Aeromonadaceae and Enterobacteriaceae, respectively. The two bacteria occupy separate taxonomic niches, they share attributes in being widely distributed in freshwater, estuarine, and marine environments, and both have been recognized to cause systemic infection in immunocompromised hosts and to be possible causes of diarrheal disease [1, 2]. Aeromonads are not universally accepted as true enteropathogens [1]. While some reports have ascribed [3] or refuted [4] an etiologic role to aeromonads in diarrheal disease, others [5, 6] have postulated that only certain subsets of aeromonads equipped with genes for enterotoxicity are significantly associated with diarrhea. Several factors have contributed to uncertainty regarding the enteropathogenicity of aeromonads: the lack of recognized outbreaks with clonally distinct isolates recovered from patients and an implicated source [1]; infrequent documentation of personto-person transmission; a paucity of evidence demonstrating

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Conclusion