Elsevier

Journal of Infection

Volume 62, Issue 2, February 2011, Pages 109-118
Journal of Infection

Review
Aeromonas spp. clinical microbiology and disease

https://doi.org/10.1016/j.jinf.2010.12.003Get rights and content

Summary

Members of the genus Aeromonas inhabit various aquatic environments and are responsible for, and are implicated in, a number of intestinal and extra-intestinal infections in humans as well as other animals. This review focuses on invasive human infection and disease and summarizes available findings regarding the microbiology and detection of Aeromonas spp., with emphasis on successful identification and diagnosis, and the control of disease in the population. Antimicrobial resistance and therapy of Aeromonas spp. is also discussed.

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).

References (141)

  • R. Duthie et al.

    Aeromonas septicaemia in Hong Kong species distribution and associated disease

    J Infect

    (1995)
  • Y. Shiina et al.

    An Aeromonas veronii biovar sobria infection with disseminated intravascular gas production

    J Infect Chemother

    (2004)
  • S.H. Lin et al.

    Fatal Aeromonas hydrophila bacteremia in a hemodialysis patient treated with deferoxamine

    Am J Kidney Dis

    (1996)
  • F. Carta et al.

    Corneal ulcer caused by Aeromonas species

    Am J Ophthalmol

    (1994)
  • A. Kelleher et al.

    Rattus norvegicus: not a model for Aeromonas-associated gastroenteritis in man

    FEMS Immunol Med Microbiol

    (2000)
  • B. Ardehali et al.

    Delayed leech-borne infection with Aeromonas hydrophilia in escharotic flap wound

    J Plast Reconstr Aesthet Surg

    (2006)
  • M.R. Whitlock et al.

    The medicinal leech and its use in plastic surgery: a possible cause for infection

    Br J Plast Surg

    (1983)
  • K.Y. Mumcuoglu et al.

    Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis, using ciprofloxacin feeding

    Clin Microbiol Infect

    (2010)
  • F.H. Caselitz

    How the Aeromonas story started in medical microbiology

    Med Microbiol Lett

    (1996)
  • G.J. Holt

    Aeromonas

  • R.R. Colwell et al.

    Proposal to recognise the family Aeromonadaceae fam. nov

    Int J Syst Bacteriol

    (1986)
  • A.J. Martinez-Murcia

    Phylogenetic positions of Aeromonas encheleia, Aeromonas popoffii, Aeromonas DNA hybridization group 11 and Aeromonas group 501

    Int J Syst Bacteriol

    (1999)
  • J.M. Janda et al.

    The genus Aeromonas: taxonomy, pathogenicity, and infection

    Clin Microbiol Rev

    (2010)
  • A. Alperi et al.

    Aeromonas fluvialis sp. nov., isolated from a Spanish river

    Int J Syst Evol Microbiol

    (2010)
  • A. Alperi et al.

    Aeromonas taiwanensis sp. nov. and Aeromonas sanarellii sp. nov., clinical species from Taiwan

    Int J Syst Evol Microbiol

    (2010)
  • J.M. Janda

    Recent advances in the study of the taxonomy, pathogenicity, and infectious syndromes associated with the genus Aeromonas

    Clin Microbiol Rev

    (1991)
  • J.M. Janda et al.

    Evolving concepts regarding the genus Aeromonas: an expanding Panorama of species, disease presentations, and unanswered questions

    Clin Infect Dis

    (1998)
  • M. Jose Figueras

    Clinical relavence of Aeromonas sM503

    Rev Med Microbiol

    (2005)
  • A. Martin-Carnahan et al.

    Genus I. Aeromonas. Bergey’s manual of systematic bacteriology

    (2005)
  • A. Alperi et al.

    Human isolates of Aeromonas possess Shiga toxin genes (stx1 and stx2) highly similar to the most virulent gene variants of Escherichia coli

    Clin Microbiol Infect

    (2010)
  • J.G. Shaw et al.

    Invasion of tissue culture cells by Aeromonas caviae

    Med Microbiol Lett

    (1995)
  • S. Vilches et al.

    Complete type III secretion system of a mesophilic Aeromonas hydrophila strain

    Appl Environ Microbiol

    (2004)
  • M.R. Chacon et al.

    Type III secretion system genes in clinical Aeromonas isolates

    J Clin Microbiol

    (2004)
  • S. Pukatzki et al.

    Identification of a conserved bacterial protein secretion system in Vibrio cholerae using the Dictyostelium host model system

    Proc Natl Acad Sci U S A

    (2006)
  • M. Altwegg et al.

    Aeromonas as a human pathogen

    Crit Rev Microbiol

    (1989)
  • M.L. Hanninen et al.

    Association of Aeromonas spp. with travellers’ diarrhoea in Finland

    J Med Microbiol

    (1995)
  • J. Vila et al.

    Aeromonas spp traveler’s diarrhea: clinical features and antimicrobial resistance

    Emerg Infect Dis

    (2003)
  • M.H. Wilcox et al.

    Aeromonas spp as a potential cause of diarrhoea in children

    J Clin Pathol

    (1992)
  • W.A. Agger et al.

    Clinical and microbiological features of Aeromonas hydrophila-associated diarrhea

    J Clin Microbiol

    (1985)
  • J.M. Janda et al.

    Mesophilic aeromonads in human disease: current taxonomy, laboratory identification, and infectious disease spectrum

    Rev Infect Dis

    (1988)
  • F. Parras et al.

    Meningitis due to Aeromonas species: case report and review

    Clin Infect Dis

    (1993)
  • Wakabongo M. Motile Aeromonas as agent of infections of the foot. 1995;85:pp....
  • J.D. Semel et al.

    Aeromonas hydrophila water-associated traumatic wound infections: a review

    J Trauma

    (1990)
  • P.S. Heckerling et al.

    Aeromonas hydrophila myonecrosis and gas gangrene in a nonimmunocompromised host

    Arch Intern Med

    (1983)
  • K.R. Hill et al.

    A case of acute, metastatic, myositis caused by a new organism of the family: Pseudomonadaceae; a preliminary report

    West Indian Medical Journal

    (1954)
  • F.H. Caselitz et al.

    Biological studies on microorganism of the genus Aeromonas

    Zentralbl Bakteriol

    (1958)
  • G. Bras et al.

    Abdominal actinomycosis associated with idiopathic gangrene of scrotum

    West Indian Medical Journal

    (1954)
  • G.L. Gilardi

    Morphological and biochemical characteristics of Aeromonas punctata (hydrophila, liquefaciens) isolated from human sources

    Appl Microbiol

    (1967)
  • H. Vally et al.

    Outbreak of Aeromonas hydrophila wound infections associated with mud football

    Clin Infect Dis

    (2004)
  • N.C. Cheng et al.

    Nosocomial infection of Aeromonas hydrophila presenting as necrotizing fasciitis

    J Formos Med Assoc

    (2004)
  • Cited by (313)

    View all citing articles on Scopus
    View full text