Plesiomonas shigelloides infections
- J Glenn Morris, Jr, MD, MPHTM
J Glenn Morris, Jr, MD, MPHTM
- Professor of Medicine
- Director, Emerging Pathogens Institute
- University of Florida
- Amy Horneman, PhD, MS, SM (ASCP)
Amy Horneman, PhD, MS, SM (ASCP)
- Director, Microbiology and Molecular Diagnostics
- VA Maryland Health Care System
Plesiomonas shigelloides (formerly known Aeromonas shigelloides) is an oxidase-positive, facultatively anaerobic gram-negative bacillus found in soil and water. It has emerged as a cause of enteric disease in humans, especially following the consumption of raw seafood. It has also been isolated from a number of extraintestinal sites [1-3]. The species name "shigelloides" is derived from the fact that many strains crossreact antigenically with Shigella, particularly Shigella sonnei .
MICROBIOLOGY AND PATHOGENESIS
Molecular phylogenetic studies have shown that the ancestry of Plesiomonas is most closely aligned with the family Enterobacteriaceae . Therefore, Plesiomonas has been re-categorized from the family Vibrionaceae to the family Enterobacteriaceae, in which it is the only oxidase-positive member .
P. shigelloides grows readily on selective and nonselective media. The organism is a nonlactose fermenter and therefore should be identified readily with routine stool culture on MacConkey agar. Colonies are oxidase positive, which provides a rapid differentiation from Shigella (with which Plesiomonas may crossreact on serologic testing). Some strains can be isolated from cefsulodin-irgasan-novobiocin (CIN) medium, normally used to isolate Yersinia and Aeromonas species. On CIN agar, plesiomonads are opaque without a pink center; subculture on sheep blood agar is needed for oxidase testing . Once appropriate colonies are picked, the organism is readily identified in standard conventional and rapid identification systems.
Outbreaks of diarrheal disease have been associated with contaminated water and oysters containing P. shigelloides, and reduction in the severity and duration of symptoms following appropriate antimicrobial therapy has been observed [7,8]. However, efforts to confirm virulence in experimental settings (including one human volunteer study) have been inconclusive [1,3,9,10]. In a case-control study in Ecuador, detection of P. shigelloides alone was similar between patients with diarrhea and controls; co-infection with P. shigelloides and another gastrointestinal pathogen was associated with diarrhea . This finding is consistent with the concept that isolation of P. shigelloides sometimes reflects its status as a "fellow traveler" with known pathogens, rather than the causative agent for the observed illness. Nonetheless, it is likely that certain strains of P. shigelloides are capable of causing diarrhea. Host susceptibility also influences the risk of illness. Some virulence factors have been identified, although their role in causing disease remains uncertain [12-16].
P. shigelloides is primarily a freshwater aquatic organism, with increased rates of isolation in the warmer months of the year . The organism requires a minimum temperature of 8ºC and the absence of salt for growth, which limits its aquatic habitats . Thus, P. shigelloides is generally found in fresh or estuarine (brackish) waters rather than marine environments. It is most frequently observed in tropical or subtropical areas, although it has been isolated from surface waters in Europe as far north as Sweden [18-20].
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