ReviewAeromonas spp. clinical microbiology and disease
Introduction
The first time Aeromonas was considered as a human pathogen was in 1954 where it was isolated from the blood, lungs, liver, spleen, urine, cerebrospinal fluid (CSF), and necrotic parts of some striated muscles of an immune-compromised woman now known to be suffering from acute fulminating metastatic myositis. The woman died as a result of the infection.1 Over subsequent years there have been many more confirmed cases of Aeromonas infection in humans, with varying severity, the most common being gastroenteritis. This review summarizes available (including very recent) information regarding the microbiology, clinical presentation, detection, and treatment of Aeromonas spp. with emphasis on successful identification and diagnosis, and the control of disease in the population.
Section snippets
Microbiology
The 9th edition of Bergey’s Manual of determinative Bacteriology classified Aeromonas into two main groups; the psychrophilic non motile Aeromonas, designated Aeromonas salmonicida with optimal growth temperatures of 22–25 °C that infects reptiles and fish, and the much larger group of motile mesophilic aeromonads with an optimal growth temperature of 35–37 °C.2 The motile mesophilic aeromonads are responsible for and are associated with a range of human diseases. The genera Aeromonas,
Gastroenteritis
Aeromonads have been described as the causative agents of a variety of infections, with gastroenteritis being the disease most commonly associated with aeromonads. In some cases there can be advancement of the infection to cause peritonitis, colitis and cholangitis.21 The most common species identified are A. hydrophila, A. caviae and A. veronii biovar sobria which cause 85% of Aeromonas gastrointestinal infections.10 A. veronii biovar sobria and A. caviae are the Aeromonas species most
Epidemiology
Aeromonas are ubiquitous to water, with the ability to form biofilms in and subsequently colonise water systems.76 The heterotrophic plate count (HPC) calculated that Aeromonas can make up 1–27% of total bacteria in samples of finished drinking water, implicating drinking water as a possible source of infection.77 The number of cases of Aeromonas-associated gastroenteritis increases during the summer months correlating with increased numbers of Aeromonas in the water systems.78 As well as
Clinical microbiology and detection
Aeromonas spp. grow well on common laboratory media, including Luria Bertani, MacConkey’s, Heckteon enteric agar, nutrient, and blood agar. Aeromonas grown on blood agar form circular colonies of 1–3 mm in diameter. The colonies start off greyish in colour as a result of β-haemolysis and after three days growth the colonies turn dark green.37 By Gram stain, aeromonads appear singly or in pairs and on occasions in short chains.105 Most aeromonads can grow at a range of temperatures (4–42 °C),
Treatment
Very few studies have been undertaken that focus on the susceptibility of Aeromonas species to antimicrobial agents. Those that have been undertaken will be discussed in this section.
Fluoroquinolones such as ciprofloxacin have been shown to be active against clinical isolates of A. hydrophila,125 A. caviae and A. veronii bv sobria.23, 126 In both in vitro studies and in mouse models, MICs of the fluoroquinolones (ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin) were calculated at
Conclusions
It has become clear from a number of studies that Aeromonas is an emerging player in infectious disease, particularly in developing nations and in immunocompromised individuals suffering with conditions such as malignancy, liver cirrhosis, and diabetes. The ubiquitous nature of Aeromonas in aquatic environments indicates that their interactions with humans are continual and unavoidable enabling their opportunistic pathogenicity, with aeromonads confirmed as an undisputed cause of wound
Acknowledgements
JL Parker is funded by the Wellcome Trust (grant number 089550MA).
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