Aeromonas spp. clinical microbiology and disease

Although the first Aeromonas strain was described by Zimmermann as early as in 1890, it took 60 years until Caselitz established human pathogenicity of strains then called "Vibrio jamaicensis". Since then, and especially in the last 10 years, there have been increasing numbers of reports on different infections caused by members of the genus Aeromonas. These include sepsis; meningitis; cellulitis; necrotizing fasciitis; ecthyma gangrenosum; pneumonia; peritonitis; conjunctivitis; corneal ulcer; endophthalmitis; osteomyelitis; suppurative arthritis; myositis; subphrenic abscess; liver abscess; cholecystitis and/or ascending cholangitis; urinary tract infection; endocarditis; ear, nose, and throat infections; balanitis; etc. The role of Aeromonas in gastrointestinal disease is very controversial. Increasing epidemiological data suggest that these organisms play a major role in enteric infections, but so far enteropathogenicity has not been demonstrable in experiments where volunteers were given high numbers of Aeromonas possessing different virulence factors. Virulence factors include hemolysin(s), enterotoxin(s), hemagglutinins, invasivity, and others; but these are not found more frequently in strains isolated from patients with diarrhea than from healthy controls. Whether there is a correlation between species and disease remains to be elucidated and requires more information about the taxonomy of this genus.

Aeromonas as a human pathogen.

The occurrence of Aeromonas spp. in the metropolitan water supply of Perth, Western Australia, Australia, was monitored at several sampling points during a period of 1 year. Water within the distribution system conformed to international standards for drinking water but contained Aeromonas spp. in numbers comparable to those in raw surface water, although this water was free of Escherichia coli. Coliforms and E. coli were found in raw surface waters, and Aeromonas spp. were found in raw water from surface and underground sources. Chemical treatment, followed by chlorination at service reservoirs, resulted in water free of E. coli and a decrease in the number of Aeromonas spp. Aeromonas spp. were found in the greatest numbers in summer. Multiple regression analysis showed that growth of Aeromonas spp. in chlorinated water was related to water temperature, residual chlorine, and interaction between these variables. The incidence of Aeromonas-associated gastroenteritis, determined from isolates referred to us for enterotoxin testing, paralleled the pattern of isolation of Aeromonas spp. in water within the distribution systems. We suggest that the presence of Aeromonas spp. in drinking water needs public health appraisal and that further work should be undertaken to permit reevaluation of standards for the quality of drinking water.

Isolation of Aeromonas hydrophila from a metropolitan water supply: seasonal correlation with clinical isolates.

A microbiological survey of Aeromonas hydrophila in Chesapeake Bay and its tributaries showed that this species is ubiquitous, occurring in numbers ranging from <0.3/l to 5 × 103/ml in the water column and ca. 4.6 × 102/g in sediment. It was recovered from water samples collected at several locations in Chesapeake Bay representing various salinity regimes, but the numbers of A. hydrophila in higher salinity water, i.e. 15O/OO, were low. Results of stepwise multiple linear regression analysis showed that concentrations of A. hydrophila were correlated with total, aerobic, viable, heterotrophic, bacterial counts, and, in addition, were inversely related to salinity and to concentration of dissolved oxygen. Seasonal occurrence was recorded, with fewer strains of A. hydrophila encountered during the winter months. The potential pathogenicity of A. hydrophila strains isolated from Chesapeake Bay was estimated by testing selected isolates for toxigenicity, using the Y-1 adrenal cell assay. Of 116 isolates tested, 83 (71%) produced a cytotoxic response, a characteristic found to be correlated with the lysine decarboxylase and Voges-Proskauer reactions. Eight of 11 strains tested, which elicited fluid accumulation in the rabbit ligated ileal loop assay, also provoked a cytotoxic reaction in the Y-l adrenal cell assay. Results of the study indicate that large numbers of toxigenic A. hydrophila can be found in an estuary and such strains may be pathogenic for man and/or animals.

Aeromonas hydrophila: ecology and toxigenicity of isolates from an estuary.

Fifteen Aeromonas isolates from various human infections and nine isolates from polluted water were identified as either Aeromonas hydrophila or Aeromonas sobria and examined for cytotoxigenicity, enterotoxigenicity, adherence to epithelial cells, and other virulence-associated factors, including proteases, lipases, elastases, and hemolysins. Two groups of organisms (I and II) were distinguishable based on differences in median lethal doses in mice and cytotoxicity for Y-1 adrenal cells. Group I clinical and environmental strains had median lethal doses of less than 10(7) colony-forming units, were cytotoxic, frequently possessed several virulence-associated factors, and had lysine decarboxylase-positive or Voges-Proskauer-positive phenotypes or both. Piliation of Aeromonas was associated strongly with ability to adhere to human buccal cells, and these characteristics were associated with group I strains. Group II clinical and environmental strains had median lethal doses of greater than or equal to 10(7) colony-forming units, were not cytotoxic, and usually were lysine decarboxylase negative or Voges-Proskauer negative or both. Clinical strains in group II exhibited enterotoxigenicity, which was not detected in group II environmental strains. A sobria was more frequently associated with human infections; 13 of the 15 clinical strains were A. sobria, and 2 were A. hydrophila. On the other hand, the majority of the environmental strains (seven of nine) were A. hydrophila. Images

Association of Aeromonas sobria with human infection.

A 62-year-old woman developed a fatal Aeromonas hydrophila infection of the skin after dropping a crab trap on her leg. The area surrounding the punctures was erythematous and had several flaccid bullae. A biopsy specimen of the involved skin showed necrosis and suppuration in the dermis and subcutaneous fat. The A hydrophila sepsis resolved after treatment with gentamicin, but the patient developed secondary wound infections and died three months after injury.

Taplin D

Papers

Fatal Aeromonas hydrophila infection of the skin.