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Aeromonas infections
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Aeromonas infections
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Literature review current through: Sep 2017. | This topic last updated: Mar 03, 2017.

INTRODUCTION — The genus Aeromonas consists of gram-negative rods widely distributed in freshwater, estuarine, and marine environments [1,2]. Aeromonas species grow at a range of temperatures, although they are isolated with increasing frequency during warmer months (May through October in the Northern hemisphere). Aeromonas species cause a wide spectrum of disease syndromes among warm- and cold-blooded animals, including fish, reptiles, amphibians, mammals, and humans [3,4].

MICROBIOLOGY — The genus Aeromonas was re-categorized from the family Vibrionaceae to the family Aeromonadaceae in the mid-1980s, when phylogenetic evidence from molecular studies became available to support this distinction [2,5,6].

The genus Aeromonas has been divided into two major groups [7]:

Motile, mesophilic species, including eight that can cause disease in humans (table 1).

Non-motile, psychrophilic species that generally cause disease only in fish.

Aeromonas species are oxidase positive and ferment glucose. The organisms grow at a range of temperatures from 0 to 42ºC.

PATHOGENICITY AND PATHOGENESIS — Several observations have raised questions about the role of Aeromonas as a gastrointestinal pathogen. Stool isolation rates among individuals with diarrhea are variable, ranging from <1 to >60 percent. In addition, Aeromonas is a common isolate from asymptomatic individuals [8,9]. There has been only one major outbreak in which Aeromonas has been implicated as the etiologic agent of disease [10]. Efforts to induce illness in volunteers with selected Aeromonas strains were unsuccessful in one trial, although selection of strains may not have been optimal [11].

Nonetheless, it is likely that certain strains of Aeromonas cause diarrheal disease [8,12,13]. Several minor outbreaks of traveler's diarrhea in adults have occurred [14]. One large study identified Aeromonas spp as a cause of traveler's diarrhea in 18 (2 percent) of 863 patients in Spain [15]. Another study of 3500 stool samples from patients hospitalized for diarrhea in India found 164 (4.7 percent) were positive for Aeromonas spp [16].

It is not possible to predict whether a particular Aeromonas strain is capable of inducing diarrheal illness. Possible virulence factors of Aeromonas species include toxins (cytotoxic and cytotonic), proteases, hemolysins, lipases, adhesins, agglutinins, pili, enterotoxins, various enzymes, and outer membrane arrays, such as an S-layer and capsule. Other factors that may contribute to virulence include VacB [17], enolase [18], and the presence of a Type VI secretion system [19-26]. In one study, whole genome sequencing and comparative genomics were used to characterize a virulent subtype of Aeromonas hydrophila isolated from aquatic wounds that has genes for toxin production, toxin secretion, and bacterial motility [27]. It is uncertain how many aeromonads contain these putative virulence factors. In addition to the presence of virulence factors in the organism, the host immune response to infection influences the severity of infection [14].

EPIDEMIOLOGY — Mesophilic aeromonads have a global distribution [1,2] and have been isolated from a variety of aquatic environments, including [28-31]:

Fresh water

Estuarine (brackish) water

Surface water, especially recreational

Drinking water, including treated, well, and bottled

Polluted waters

Waste water effluent sludge [32].

Aeromonads are not generally considered marine organisms, but can be found in marine systems that interface with fresh waters and can survive at all but the most extreme salt concentrations [28]. Usually they are not part of the groundwater bacterial population, which is generally poor in nutrients.

In nutrient-rich waters, Aeromonas species can grow to large numbers and generally peak in the warmer temperatures of the summer months in temperate freshwater lakes and chlorinated drinking water [33,34]. Aeromonas species appear to tolerate polluted environments, including chemical pollution, although they are not considered to be of fecal origin [29]. The organism has also been isolated from retail produce sources and meat products [35].

Contact with any fresh or brackish water body is the most common source of human infection. The risk of infection can be reduced by caution in the setting of natural water sources (lakes, rivers, streams, ponds, bays), including minimizing the risk of traumatic wounds and avoiding oral ingestion, particularly during warmer summer months.

ASSOCIATED DISEASES — Diarrheal disease is the most common manifestation of Aeromonas infection. The organism has also been associated with a variety of extraintestinal presentations [4,8,12,36-38].

Diarrhea — Aeromonas spp are associated with a range of diarrheal presentations including:

Acute, secretory diarrhea, often accompanied by vomiting

Acute, dysenteric diarrhea with blood and mucus

Chronic diarrhea, lasting more than 10 days

Choleric diarrhea with "rice-water" stools

Traveler's diarrhea (probably the most commonly recognized presentation in the United States)

There have been two reports of A. hydrophila enterocolitis associated with the hemolytic uremic syndrome (HUS) [39-41]. (See "Acquired TTP: Clinical manifestations and diagnosis".)

Wound infections — Aeromonas can cause mild to severe wound infections. Infection typically occurs on the extremities following traumatic aquatic injury. Such wound infections affect men three times more commonly than women. The most typical presentation is cellulitis [42], although myonecrosis (with and without gas production), rhabdomyolysis, and lesions mimicking ecthyma gangrenosum have been reported [43-46]. A case of nearly fatal necrotizing fasciitis from a traumatic leg wound incurred from contact with a fresh water river highlights the virulence potential of aeromonads to cause serious disease [47].

A. hydrophila, Aeromonas veronii, and Aeromonas schubertii are the species most commonly isolated from wound infections [4,8,20,48]. Aeromonas was a common wound isolate among tsunami victims in southeast Asia in 2004, and elevated numbers of Aeromonas spp were recorded in floodwater samples in New Orleans following Hurricane Katrina in 2005 [49,50]. Additionally, several reports have documented aeromonad necrotizing fasciitis associated with species other than A. hydrophila, such as A. veronii biovar sobria, A. schubertii, and Aeromonas caviae [51,52]. A former arabinose-negative biovar of A. hydrophila is now known as Aeromonas dhakensis and has a high association with more serious human infections, especially in Taiwan, Malaysia, and Australia [53].

Serious wound infections and sepsis have also been reported following the medicinal use of leeches [54-56]. Aeromonads reside in the gut of the leech Hirudo medicinalis, where they assist in the enzymatic digestion of the blood ingested by the leech [54,55,57,58]. Patients undergoing leech therapy often receive systemic chemoprophylaxis with ciprofloxacin to prevent such infection. Emerging reports of ciprofloxacin-resistant strains of Aeromonas isolated from leeches may limit the utility of this practice [56,59-61].

Bacteremia — Sepsis with Aeromonas species is strongly associated with infection with A. veronii biovar sobria. These patients present with the classic signs and symptoms of gram-negative sepsis and may have gastrointestinal symptoms, including abdominal pain, nausea, vomiting, and diarrhea [4,62].

Sepsis tends to occur in older patients with hematologic malignancy, serious hepatobiliary disease, other immunocompromising conditions, or traumatic injuries. One case report described recurrent Aeromonas bacteremia over two years in an elderly man who had repeated exposure through contaminated well water [63]. Pediatric case reports of sepsis due to A. hydrophila have been reported, including one case of a patient with diarrhea and pneumonia and one case of acute renal failure [64,65]. Cases have also been rarely reported among pregnant women; in 2011, three cases of bacteremia with Aeromonas spp were identified in pregnant women at the Thailand-Myanmar Border [66].

It is not always possible to identify the source of the organism in cases of sepsis; in such cases, it is reasonable to surmise that it was acquired from the gastrointestinal tract.

Miscellaneous extraintestinal sites — Aeromonas spp have been implicated in cases of ocular infections, osteomyelitis, meningitis, respiratory infections following "near drowning," pelvic abscesses, otitis, cystitis, endocarditis, peritonitis, cholecystitis, and joint infections [4,8,20,67-69]. Necrotizing fasciitis and folliculitis due to A. hydrophila strain have also been reported [70-72].

DIAGNOSIS — Aeromonads are not routinely identified in most microbiology laboratories as part of the normal protocol for isolating stool pathogens. For cases in which Aeromonas is suspected, the laboratory should be advised to look for the organism. It is readily identified in routine wound or blood cultures. Automated identification systems can identify most true Aeromonas isolates to the level of A. hydrophila group or A. hydrophila/A. caviae. However, these identifications are often incomplete or erroneous due to insufficient discriminatory markers to detect interspecies differences [73-75]. A study evaluating the ability of six commercial systems to identify clinical Aeromonas isolates noted that accuracy of these systems was limited by outdated databases and taxonomy, weak algorithms, and the need for impractical tests [76]. Certain algorithms, however, performed well, such as the Aerokey II [77], which correctly identified 95.5 percent of 87 isolates to the species level. This dichotomous algorithm can differentiate the emerging virulent species known as A. dhakensis, which has been linked with severe infection, including septicemia [78].

Hemolysis is variable on blood agar media; most species display beta hemolysis. Although aeromonads grow on nearly all enteric media, they often are overlooked on MacConkey agar because A. caviae is lactose-positive just like Escherichia coli. Ampicillin-containing medium should not be used to suppress normal enteric flora, since a substantial portion of A. caviae isolates and all Aeromonas trota isolates are sensitive to ampicillin and therefore will not grow on such a medium [79,80]. This is especially important in light of reports implicating A. trota in pancreatic abscess and septic shock with cirrhosis, and A. caviae in cystitis [81-83].

Aeromonas spp are oxidase-positive, polar flagellated, glucose-fermenting, facultatively anaerobic, gram-negative rods that are resistant to the vibriostatic agent O/129 and unable to grow in 6.5 percent NaCl. The presumptive identification of an isolate involves the initial separation from other oxidase-positive genera such as Vibrio and Plesiomonas to avoid misidentification. This can be accomplished with simple tests such as O/129 susceptibility, tolerance to various NaCl broth concentrations, and the ability to ferment inositol [80].

Antimicrobial resistance markers and susceptibility studies should be determined by either the standard agar dilution method or by Kirby-Bauerdisk diffusion method using the 2010 CLSI Standard M45-A2 for Aeromonas species [84]. Some automated MIC systems, such as BioMerieux Vitek, Inc. may not be reliable for detection of beta-lactam resistance [85].


Antimicrobial susceptibility — Clinical studies have demonstrated differences in antimicrobial susceptibility between species, highlighting the importance of both species identification and susceptibility testing for all isolates, particularly in the setting of serious infection. Most Aeromonas strains are resistant to penicillin, ampicillin, carbenicillin, and ticarcillin; most are susceptible to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, second and third generation cephalosporins, aminoglycosides, carbapenems, chloramphenicol, and tetracyclines [8,67,86-91]. However, there have been several reports of infection with fluoroquinolone-resistant A. hydrophila strains following leech therapy [56,59-61].

Most Aeromonas species produce an inducible chromosomal beta-lactamase, which may not be detected by rapid commercial susceptibility systems [85]. Aeromonads produce beta-lactamases from three different classes: a class C cephalosporinase, a class D penicillinase, and a class B metallo-beta-lactamase (MBL) of the "CphA" type [9]. Two other MBLs (VIM and IMP) in strains of A. hydrophila and A. caviae have also been detected, encoded on an integron and a plasmid, respectively [92,93]. One reported the emergence of multiple Aeromonas spp. displaying CphA-mediated carbapenem resistance in Australia; the predominant species found was A. dhakensis, previously known to be the cause of more serious human infections [94]. (See "Overview of carbapenemase-producing gram-negative bacilli", section on 'Class B beta-lactamases'.)

Regional resistance patterns have also been described, as follows:

An increase in antimicrobial resistance to tetracycline, TMP-SMX, some extended-spectrum cephalosporins, and aminoglycosides has been observed among some isolates in Taiwan (compared with isolates from the United States and Australia) [95].

Antimicrobial resistance to nalidixic acid has been observed in Spain; a surveillance study of 43 strains reported that 26 percent of A. caviae, 20 percent of A. hydrophila, and 88 percent of A. veronii biotype sobria were resistant to nalidixic acid. Although still susceptible to ciprofloxacin, these strains had a mutation in the A subunit of DNA gyrase and could easily develop a second mutation resulting in resistance to ciprofloxacin [88].

Clinical approach — Most cases of Aeromonas-associated diarrhea are self-limited and can be managed with supportive therapy, including oral and intravenous rehydration. Based on anecdotal data, antibiotics may be of value in patients with severe diarrhea and/or a history of immunosuppression [87]. Antibiotic therapy is also indicated in the setting of wound infection and bacteremia [88]. Given emerging antimicrobial resistance, antimicrobial susceptibility testing of isolates is essential. Pending species identification and susceptibility testing, initial empiric therapy of suspected Aeromonas spp infections with a fluoroquinolone, third generation cephalosporin, or TMP-SMX would provide reasonable antimicrobial coverage.

If the infection is acquired following travel to Taiwan or Spain, TMP-SMX should not be the empiric choice for treatment [88,95]. In addition, therapy with ampicillin or first generation cephalosporins is not appropriate. All species of clinical aeromonads are resistant to ampicillin except for A. trota and sometimes A. caviae. A. veronii biovar sobria (formerly Aeromonas sobria) is uniformly resistant to first generation cephalosporins, but in vitro testing suggests that it is susceptible to third and fourth generation cephalosporins. (See 'Antimicrobial susceptibility' above.)

There are no clinical trial data to guide the duration of therapy; therefore, treatment should be guided by clinical response. Reasonable courses of therapy include three days of therapy for treatment of diarrhea, 7 to 10 days of therapy for treatment of wound infections, and two weeks of therapy for treatment of bacteremia. The course of therapy may need to be adjusted depending on individual circumstances, including immunosuppression or other underlying conditions.


The genus Aeromonas consists of gram-negative rods widely distributed in freshwater, estuarine, and marine environments. Aeromonas species have been isolated with increasing frequency during warmer months. The organisms cause a wide spectrum of disease syndromes among warm and cold-blooded animals. (See 'Microbiology' above.)

Diarrheal disease is the most common manifestation of Aeromonas infection. The organism has also been associated with a variety of extraintestinal presentations, including wound infections and bacteremia. Necrotizing fasciitis has been reported with species such as Aeromonas hydrophila, Aeromonas veronii biovar sobria, Aeromonas schubertii, and Aeromonas caviae. Aeromonas dhakensis is also associated with severe infections. (See 'Associated diseases' above.)

Aeromonads are not routinely identified in most microbiology laboratories as part of the normal protocol for isolating stool pathogens. For cases in which Aeromonas is suspected, the laboratory must be advised to look for this organism. (See 'Diagnosis' above.)

Clinical studies have demonstrated differences in antimicrobial susceptibility between species, highlighting the importance of both species identification and susceptibility testing for all isolates, particularly in the setting of serious infection. (See 'Antimicrobial susceptibility' above.)

Pending species identification and susceptibility testing, we suggest initial empiric therapy of suspected Aeromonas infections (severe diarrhea, wound infections, bacteremia) with a fluoroquinolone, third generation cephalosporin, or TMP-SMX (Grade 2C).

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  1. Holmes P, Niccolls LM, Sartory DP. The ecology of mesophilic Aeromonas in the aquatic environment. In: The Genus: Aeromonas, First Edition, Austin B, Altwegg M, Gosling PJ, Joseph SW (Eds), John Wiley & Sons, Ltd, Chicester 1996. p.127.
  2. Martin-Carnahan A, Joseph SW. Aeromonas. In: Bergey's Manual of Systematic Bacteriology, Second Edition, Brenner, Krieg, Staley, Garrity (Eds), Williams and Wilkins, New York 2005. Vol 2.
  3. Gosling PJ. Aeromonas species in diseases of animals. In: The Genus: Aeromonas, First Edition, Austin B, Altwegg M, Gosling PJ, Joseph SW (Eds), John Wiley & Sons, Ltd, Chicester 1996. p.175.
  4. Janda JM, Abbott SL. Human pathogens. In: The Genus: Aeromonas, First Edition, Austin B, Altwegg M, Gosling PJ, Joseph SW (Eds), John Wiley & Sons, Ltd, Chicester 1996. p.175.
  5. MacDonell MT, Colwell RR. Phylogeny of the family Vibrionaceae and recommendation for two new genera: Listonella and Shewanella. Syst Appl Microbiol 1985; 6:171.
  6. Colwell RR, MacDonell MR, De Ley J. Proposal to recognize the family Aeromonadaceae. Int J Syst Bacteriol 1986; 36:473.
  7. Horneman AJ, Ali A, Abbott S. Aeromonas. In: Manual of Clinical Microbiology, Ninth Edition, Murray P (Ed), ASM Press, 2006.
  8. Janda JM, Abbott SL. Evolving concepts regarding the genus Aeromonas: an expanding Panorama of species, disease presentations, and unanswered questions. Clin Infect Dis 1998; 27:332.
  9. Janda JM, Abbott SL. The genus Aeromonas: taxonomy, pathogenicity, and infection. Clin Microbiol Rev 2010; 23:35.
  10. Hofer E, Reis CM, Theophilo GN, et al. [Aeromonas associated with an acute diarrhea outbreak in São Bento do Una, Pernambuco]. Rev Soc Bras Med Trop 2006; 39:217.
  11. Morgan DR, Johnson PC, DuPont HL, et al. Lack of correlation between known virulence properties of Aeromonas hydrophila and enteropathogenicity for humans. Infect Immun 1985; 50:62.
  12. Joseph SW. Aeromonas gastrointestinal disease: A case study in causation?. In: The Genus: Aeromonas, First Edition, Austin B, Altwegg M, Gosling PJ, Joseph SW (Eds), John Wiley & Sons, Ltd, Chichester 1996. p.311.
  13. Figueras MJ, Aldea MJ, Fernández N, et al. Aeromonas hemolytic uremic syndrome. A case and a review of the literature. Diagn Microbiol Infect Dis 2007; 58:231.
  14. Galindo CL, Sha J, Fadl LL, et al. Host immune responses to aeromonas virulence factors. Curr Immunol Rev 2006; 2:13.
  15. Vila J, Ruiz J, Gallardo F, et al. Aeromonas spp. and traveler's diarrhea: clinical features and antimicrobial resistance. Emerg Infect Dis 2003; 9:552.
  16. Sinha S, Shimada T, Ramamurthy T, et al. Prevalence, serotype distribution, antibiotic susceptibility and genetic profiles of mesophilic Aeromonas species isolated from hospitalized diarrhoeal cases in Kolkata, India. J Med Microbiol 2004; 53:527.
  17. Erova TE, Kosykh VG, Fadl AA, et al. Cold shock exoribonuclease R (VacB) is involved in Aeromonas hydrophila pathogenesis. J Bacteriol 2008; 190:3467.
  18. Sha J, Erova TE, Alyea RA, et al. Surface-expressed enolase contributes to the pathogenesis of clinical isolate SSU of Aeromonas hydrophila. J Bacteriol 2009; 191:3095.
  19. Cahill MM. Virulence factors in motile Aeromonas species. J Appl Bacteriol 1990; 69:1.
  20. Janda JM. Recent advances in the study of the taxonomy, pathogenicity, and infectious syndromes associated with the genus Aeromonas. Clin Microbiol Rev 1991; 4:397.
  21. Gosling PJ. Pathogenic mechanisms. In: The Genus: Aeromonas, First Edition, Austin B, Altwegg M, Gosling PJ, Joseph SW (Eds), John Wiley & Sons, Ltd, Chichester 1996. p.245.
  22. Sha J, Kozlova EV, Fadl AA, et al. Molecular characterization of a glucose-inhibited division gene, gidA, that regulates cytotoxic enterotoxin of Aeromonas hydrophila. Infect Immun 2004; 72:1084.
  23. Kirov SM. Bacteria that express lateral flagella enable dissection of the multifunctional roles of flagella in pathogenesis. FEMS Microbiol Lett 2003; 224:151.
  24. Seshadri R, Joseph SW, Chopra AK, et al. Genome sequence of Aeromonas hydrophila ATCC 7966T: jack of all trades. J Bacteriol 2006; 188:8272.
  25. Erova TE, Sha J, Horneman AJ, et al. Identification of a new hemolysin from a diarrheal isolate SSU of Aeromonas hydrophila. FEMS Microbiology Letters.
  26. Suarez G, Sierra JC, Sha J, et al. Molecular characterization of a functional type VI secretion system from a clinical isolate of Aeromonas hydrophila. Microb Pathog 2008; 44:344.
  27. Grim CJ, Kozlova EV, Sha J, et al. Characterization of Aeromonas hydrophila wound pathotypes by comparative genomic and functional analyses of virulence genes. MBio 2013; 4:e00064.
  28. Hazen TC, Fliermans CB, Hirsch RP, Esch GW. Prevalence and distribution of Aeromonas hydrophila in the United States. Appl Environ Microbiol 1978; 36:731.
  29. Seidler RJ, Allen DA, Lockman H, et al. Isolation, enumeration, and characterization of Aeromonas from polluted waters encountered in diving operations. Appl Environ Microbiol 1980; 39:1010.
  30. Kaper JB, Lockman H, Colwell RR, Joseph SW. Aeromonas hydrophila: ecology and toxigenicity of isolates from an estuary. J Appl Bacteriol 1981; 50:359.
  31. van der Kooij D. Properties of aeromonads and their occurrence and hygienic significance in drinking water. Zentralbl Bakteriol Mikrobiol Hyg B 1988; 187:1.
  32. Monfort P, Baleux B. Distribution and survival of motile Aeromonas spp. in brackish water receiving sewage treatment effluent. Appl Environ Microbiol 1991; 57:2459.
  33. Burke V, Robinson J, Gracey M, et al. Isolation of Aeromonas spp. from an unchlorinated domestic water supply. Appl Environ Microbiol 1984; 48:367.
  34. Burke V, Robinson J, Gracey M, et al. Isolation of Aeromonas hydrophila from a metropolitan water supply: seasonal correlation with clinical isolates. Appl Environ Microbiol 1984; 48:361.
  35. Palumbo SA. The Aeromonas hydrophila group in food. In: The Genus: Aeromonas, First Edition, Austin B, Altwegg M, Gosling PJ, Joseph SW (Eds), John Wiley & Sons, Ltd, Chichester 1996. p.287.
  36. Kelly KA, Koehler JM, Ashdown LR. Spectrum of extraintestinal disease due to Aeromonas species in tropical Queensland, Australia. Clin Infect Dis 1993; 16:574.
  37. Figueras MJ. Clinical relevance of Aeromonas. Rev Med Microbiol 2005; 16:145.
  38. Parker JL, Shaw JG. Aeromonas spp. clinical microbiology and disease. J Infect 2011; 62:109.
  39. Robson WL, Leung AK, Trevenen CL. Haemolytic-uraemic syndrome associated with Aeromonas hydrophila enterocolitis. Pediatr Nephrol 1992; 6:221.
  40. Bogdanović R, Cobeljić M, Marković M, et al. Haemolytic-uraemic syndrome associated with Aeromonas hydrophila enterocolitis. Pediatr Nephrol 1991; 5:293.
  41. Figueras MJ, Horneman AJ, Martinez-Murcia A, Guarro J. Controversial data on the association of Aeromonas with diarrhoea in a recent Hong Kong study. J Med Microbiol 2007; 56:996.
  42. Hanson PG, Standridge J, Jarrett F, Maki DG. Freshwater wound infection due to Aeromonas hydrophila. JAMA 1977; 238:1053.
  43. Tena D, González-Praetorius A, Pérez-Pomata MT, Bisquert J. [Rapidly progressive myonecrosis by Aeromonas veronii biotype sobria]. An Med Interna 2006; 23:540.
  44. Adamski J, Koivuranta M, Leppänen E. Fatal case of myonecrosis and septicaemia caused by Aeromonas hydrophila in Finland. Scand J Infect Dis 2006; 38:1117.
  45. Easow JM, Tuladhar R. Aeromonas hydrophila wound infection following a tiger bite in Nepal. Southeast Asian J Trop Med Public Health 2007; 38:867.
  46. Tena D, Aspiroz C, Figueras MJ, et al. Surgical site infection due to Aeromonas species: report of nine cases and literature review. Scand J Infect Dis 2009; 41:164.
  47. Grim CJ, Kozlova EV, Ponnusamy D, et al. Functional genomic characterization of virulence factors from necrotizing fasciitis-causing strains of Aeromonas hydrophila. Appl Environ Microbiol 2014; 80:4162.
  48. Vally H, Whittle A, Cameron S, et al. Outbreak of Aeromonas hydrophila wound infections associated with mud football. Clin Infect Dis 2004; 38:1084.
  49. Maegele M, Gregor S, Steinhausen E, et al. The long-distance tertiary air transfer and care of tsunami victims: injury pattern and microbiological and psychological aspects. Crit Care Med 2005; 33:1136.
  50. Presley SM, Rainwater TR, Austin GP, et al. Assessment of pathogens and toxicants in New Orleans, LA following Hurricane Katrina. Environ Sci Technol 2006; 40:468.
  51. Park SY, Jeong WK, Kim MJ, et al. Necrotising fasciitis in both calves caused by Aeromonas caviae following aesthetic liposuction. J Plast Reconstr Aesthet Surg 2010; 63:e695.
  52. Kao TL, Kao ML. A fatal case of necrotizing Aeromonas schubertii fasciitis after penetrating injury. Am J Emerg Med 2012; 30:258.e3.
  53. Figueras MJ and Beaz-Hidalgo R. Aeromonas infections in humans. In: Aeromonas, Graf J (Ed), Caister Academic Press, 2014. p.65-108.
  54. Snower DP, Ruef C, Kuritza AP, Edberg SC. Aeromonas hydrophila infection associated with the use of medicinal leeches. J Clin Microbiol 1989; 27:1421.
  55. Sartor C, Limouzin-Perotti F, Legré R, et al. Nosocomial Infections with Aeromonas hydrophila from Leeches. Clin Infect Dis 2002; 35:E1.
  56. Sartor C, Bornet C, Guinard D, Fournier PE. Transmission of Aeromonas hydrophila by leeches. Lancet 2013; 381:1686.
  57. Graf J. Symbiosis of Aeromonas veronii biovar sobria and Hirudo medicinalis, the medicinal leech: a novel model for digestive tract associations. Infect Immun 1999; 67:1.
  58. Mumcuoglu KY, Huberman L, Cohen R, et al. Elimination of symbiotic Aeromonas spp. from the intestinal tract of the medicinal leech, Hirudo medicinalis, using ciprofloxacin feeding. Clin Microbiol Infect 2010; 16:563.
  59. Patel KM, Svestka M, Sinkin J, Ruff P 4th. Ciprofloxacin-resistant Aeromonas hydrophila infection following leech therapy: a case report and review of the literature. J Plast Reconstr Aesthet Surg 2013; 66:e20.
  60. Giltner CL, Bobenchik AM, Uslan DZ, et al. Ciprofloxacin-resistant Aeromonas hydrophila cellulitis following leech therapy. J Clin Microbiol 2013; 51:1324.
  61. Wang EW, Warren DK, Ferris VM, et al. Leech-transmitted ciprofloxacin-resistant Aeromonas hydrophila. Arch Otolaryngol Head Neck Surg 2011; 137:190.
  62. Tulsidas H, Ong YY, Chan KC. Aeromonas hydrophila bacteraemia and portal pyaemia. Singapore Med J 2008; 49:346.
  63. Katz MJ, Parrish NM, Belani A, Shah M. Recurrent Aeromonas Bacteremia Due to Contaminated Well Water. Open Forum Infect Dis 2015; 2:ofv142.
  64. Rodríguez CN, Campos R, Pastran B, et al. Sepsis due to extended-spectrum beta-lactamase-producing Aeromonas hydrophila in a pediatric patient with diarrhea and pneumonia. Clin Infect Dis 2005; 41:421.
  65. Filler G, Ehrich JH, Strauch E, Beutin L. Acute renal failure in an infant associated with cytotoxic Aeromonas sobria isolated from patient's stool and from aquarium water as suspected source of infection. J Clin Microbiol 2000; 38:469.
  66. Turner P, Willemse C, Phakaudom K, et al. Aeromonas spp. bacteremia in pregnant women, Thailand-Myanmar border, 2011. Emerg Infect Dis 2012; 18:1522.
  67. Altwegg M. Aeromonas. In: Manual of Clinical Microbiology, Seventh Edition, Murray PR, Baron EJ, Pfaller MA, et al (Eds), ASM Press, Washington, DC 1999. p.507.
  68. Ouderkirk JP, Bekhor D, Turett GS, Murali R. Aeromonas meningitis complicating medicinal leech therapy. Clin Infect Dis 2004; 38:e36.
  69. Choi JP, Lee SO, Kwon HH, et al. Clinical significance of spontaneous Aeromonas bacterial peritonitis in cirrhotic patients: a matched case-control study. Clin Infect Dis 2008; 47:66.
  70. Fosse T, Giraud-Morin C, Madinier I, et al. Aeromonas hydrophila with plasmid-borne class A extended-spectrum β-lactamase TEM-24 and three chromosomal class B, C, and D β-lactamases, isolated from a patient with necrotizing fasciitis. Antimicrob Agents Chemother 2004; 48:2342.
  71. Monaghan SF, Anjaria D, Mohr A, Livingston DH. Necrotizing fasciitis and sepsis caused by Aeromonas hydrophila after crush injury of the lower extremity. Surg Infect (Larchmt) 2008; 9:459.
  72. Mulholland A, Yong-Gee S. A possible new cause of spa bath folliculitis: Aeromonas hydrophila. Australas J Dermatol 2008; 49:39.
  73. Abbott SL, Seli LS, Catino M Jr, et al. Misidentification of unusual Aeromonas species as members of the genus Vibrio: a continuing problem. J Clin Microbiol 1998; 36:1103.
  74. Israil AM, Balotescu MC, Alexandru I, Dobre G. [Discordancies between classical and API 20E microtest biochemical identification of Vibrio and Aeromonas strains]. Bacteriol Virusol Parazitol Epidemiol 2003; 48:141.
  75. Soler L, Marco F, Vila J, et al. Evaluation of two miniaturized systems, MicroScan W/A and BBL Crystal E/NF, for identification of clinical isolates of Aeromonas spp. J Clin Microbiol 2003; 41:5732.
  76. Lamy B, Laurent F, Verdier I, et al. Accuracy of 6 commercial systems for identifying clinical Aeromonas isolates. Diagn Microbiol Infect Dis 2010; 67:9.
  77. Carnahan AM, Behram S, Joseph SW. Aerokey II: a flexible key for identifying clinical Aeromonas species. J Clin Microbiol 1991; 29:2843.
  78. Wu CJ, Chen PL, Hsueh PR, et al. Clinical implications of species identification in monomicrobial Aeromonas bacteremia. PLoS One 2015; 10:e0117821.
  79. Carnahan AM, Chakraborty T, Fanning GR, et al. Aeromonas trota sp. nov., an ampicillin-susceptible species isolated from clinical specimens. J Clin Microbiol 1991; 29:1206.
  80. Carnahan AM, Andrews G. Vibrio, Aeromonas, Plesiomonas and Campylobacter species. In: Textbook of Diagnostic Microbiology, Second Edition, Mahon, Manuselis (Eds), WB Saunders Co, Philadelphia 2000. p.524.
  81. De Gascun CF, Rajan L, O'Neill E, et al. Pancreatic abscess due to Aeromonas hydrophila. J Infect 2007; 54:e59.
  82. Lai CC, Ding LW, Hsueh PR. Wound infection and septic shock due to Aeromonas trota in a patient with liver cirrhosis. Clin Infect Dis 2007; 44:1523.
  83. Al-Benwan K, Abbott S, Janda JM, et al. Cystitis caused by Aeromonas caviae. J Clin Microbiol 2007; 45:2348.
  84. CLSI. Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated Fastidious Bacteria; Approved Guideline—Second Edition. CLSI document M45-A2. Wayne, PA: Clinical and Laboratory Standards Institute; 2010.
  85. Schadow KH, Giger DK, Sanders CC. Failure of the Vitek AutoMicrobic system to detect beta-lactam resistance in Aeromonas species. Am J Clin Pathol 1993; 100:308.
  86. Motyl MR, McKinley G, Janda JM. In vitro susceptibilities of Aeromonas hydrophila, Aeromonas sobria, and Aeromonas caviae to 22 antimicrobial agents. Antimicrob Agents Chemother 1985; 28:151.
  87. Overman TL, Janda JM. Antimicrobial susceptibility patterns of Aeromonas jandaei, A. schubertii, A. trota, and A. veronii biotype veronii. J Clin Microbiol 1999; 37:706.
  88. Vila J, Marco F, Soler L, et al. In vitro antimicrobial susceptibility of clinical isolates of Aeromonas caviae, Aeromonas hydrophila and Aeromonas veronii biotype sobria. J Antimicrob Chemother 2002; 49:701.
  89. Cattoir V, Poirel L, Aubert C, et al. Unexpected occurrence of plasmid-mediated quinolone resistance determinants in environmental Aeromonas spp. Emerg Infect Dis 2008; 14:231.
  90. Sánchez-Céspedes J, Figueras MJ, Aspiroz C, et al. Development of imipenem resistance in an Aeromonas veronii biovar sobria clinical isolate recovered from a patient with cholangitis. J Med Microbiol 2009; 58:451.
  91. Aravena-Román M, Inglis TJ, Henderson B, et al. Antimicrobial susceptibilities of Aeromonas strains isolated from clinical and environmental sources to 26 antimicrobial agents. Antimicrob Agents Chemother 2012; 56:1110.
  92. Libisch B, Giske CG, Kovács B, et al. Identification of the first VIM metallo-beta-lactamase-producing multiresistant Aeromonas hydrophila strain. J Clin Microbiol 2008; 46:1878.
  93. Neuwirth C, Siebor E, Robin F, Bonnet R. First occurrence of an IMP metallo-beta-lactamase in Aeromonas caviae: IMP-19 in an isolate from France. Antimicrob Agents Chemother 2007; 51:4486.
  94. Sinclair HA, Heney C, Sidjabat HE, et al. Genotypic and phenotypic identification of Aeromonas species and CphA-mediated carbapenem resistance in Queensland, Australia. Diagn Microbiol Infect Dis 2016; 85:98.
  95. Ko WC, Yu KW, Liu CY, et al. Increasing antibiotic resistance in clinical isolates of Aeromonas strains in Taiwan. Antimicrob Agents Chemother 1996; 40:1260.
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