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Plesiomonas shigelloides infections

J Glenn Morris, Jr, MD, MPHTM
Amy Horneman, PhD, MS, SM (ASCP)
Section Editor
Stephen B Calderwood, MD
Deputy Editor
Allyson Bloom, MD


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 [4].


Molecular phylogenetic studies have shown that the ancestry of Plesiomonas is most closely aligned with the family Enterobacteriaceae [5]. Therefore, Plesiomonas has been re-categorized from the family Vibrionaceae to the family Enterobacteriaceae, in which it is the only oxidase-positive member [6].

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 [3]. 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 [1,2,9,10]. 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 [11]. 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 [17]. The organism requires a minimum temperature of 8ºC and the absence of salt for growth, which limits its aquatic habitats [3]. 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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Literature review current through: Sep 2016. | This topic last updated: Sep 11, 2015.
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  1. Brenden RA, Miller MA, Janda JM. Clinical disease spectrum and pathogenic factors associated with Plesiomonas shigelloides infections in humans. Rev Infect Dis 1988; 10:303.
  2. Janda JM, Abbott SL, Morris JG Jr. Aeromonas, Plesiomonas, and Edwardsiella. In: Infections of the Gastrointestinal Tract, Blaser, Smith, Ravdin, Greenberg, Guerrant (Eds), Raven Press, Ltd, New York 1995. p.905.
  3. Abbot SL. Klebsiella, Enterobacter, Citrobacter, Serratia, Plesiomonas, and Other Enterobacteriaceae. In: Manual of Clinical Microbiology, Tenth Ed, Versalovic J, Carroll KC, Funke G, et al. (Eds), ASM Press, Washington, DC 2011.
  4. Chida T, Okamura N, Ohtani K, et al. The complete DNA sequence of the O antigen gene region of Plesiomonas shigelloides serotype O17 which is identical to Shigella sonnei form I antigen. Microbiol Immunol 2000; 44:161.
  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. Janda JM. Plesiomonas. Bergey's Manual of Systematic Bacteriology. In: Aeromonadacea, Second Ed, Garrity GM (Ed), Springer-Verlag, New York 2005. p.740.
  7. Tsukamoto T, Kinoshita Y, Shimada T, Sakazaki R. Two epidemics of diarrhoeal disease possibly caused by Plesiomonas shigelloides. J Hyg (Lond) 1978; 80:275.
  8. Rutala WA, Sarubi FA Jr, Finch CS, et al. Oyster-associated outbreak of diarrhoeal disease possibly caused by Plesiomonas shigelloides. Lancet 1982; 1:739.
  9. Herrington DA, Tzipori S, Robins-Browne RM, et al. In vitro and in vivo pathogenicity of Plesiomonas shigelloides. Infect Immun 1987; 55:979.
  10. Farmer JJ III, Arduino MJ, Hickman-Brenner FW, et al. The Genera Aeromonas and Plesiomonas. In: The Prokaryotes, Second Ed, Balows A, Truper HG, Sworkin M, et al (Eds), Springer-Verlag, New York 1992. Vol III, p.3028.
  11. Escobar JC, Bhavnani D, Trueba G, et al. Plesiomonas shigelloides infection, Ecuador, 2004-2008. Emerg Infect Dis 2012; 18:322.
  12. Okawa Y, Ohtomo Y, Tsugawa H, et al. Isolation and characterization of a cytotoxin produced by Plesiomonas shigelloides P-1 strain. FEMS Microbiol Lett 2004; 239:125.
  13. Ciznár I, Hostacka A, Gonzalez-Rey C, Krovacek K. Potential virulence-associated properties of Plesiomonas shigelloides strains. Folia Microbiol (Praha) 2004; 49:543.
  14. Tsugawa H, Ono T, Murakami H, Okawa Y. Invasive phenotype and apoptosis induction of Plesiomonas shigelloides P-1 strain to Caco-2 cells. J Appl Microbiol 2005; 99:1435.
  15. Tsugawa H, Ito H, Ohshima M, Okawa Y. Cell adherence-promoted activity of Plesiomonas shigelloides groEL. J Med Microbiol 2007; 56:23.
  16. González-Rodríguez N, Santos JA, Otero A, García-López ML. Cell-associated hemolytic activity in environmental strains of Plesiomonas shigelloides expressing cell-free, iron-influenced extracellular hemolysin. J Food Prot 2007; 70:885.
  17. Miller ML, Koburger JA. Plesiomonas shigelloides: an opportunistic food and waterborne pathogen. J Food Protect 1985; 48:449.
  18. Jönsson I, Monsen T, Wiström J. A case of Plesiomonas shigelloides cellulitis and bacteraemia from northern Europe. Scand J Infect Dis 1997; 29:631.
  19. Medema G, Schets C. Occurrence of Plesiomonas shigelloides in surface water: relationship with faecal pollution and trophic state. Zentralbl Hyg Umweltmed 1993; 194:398.
  20. Islam MS, Alam MJ, Khan SI. Distribution of Plesiomonas shigelloides in various components of pond ecosystems in Dhaka, Bangladesh. Microbiol Immunol 1991; 35:927.
  21. Janda JM, Abbott SL. The Genus Plesiomonas. In: The Enterobacteria, Second Ed, AMS Press, Washington, DC 2006.
  22. Arai T, Ikejima N, Itoh T, et al. A survey of Plesiomonas shigelloides from aquatic environments, domestic animals, pets and humans. J Hyg (Lond) 1980; 84:203.
  23. Horneman A, Josko D. Vibrio, Aeromonas, Plesiomonas, and Campylobacter species. In: Textbook of Diagnostic Microbiology, Third Ed, Mahon, Lehman, Manuselis (Eds), WB Saunders Co, Philadelphia 2007.
  24. Davis WA 2nd, Chretien JH, Garagusi VF, Goldstein MA. Snake-to-human transmission of Aeromonas (Pl) shigelloides resulting in gastroenteritis. South Med J 1978; 71:474.
  25. Kinzelman J, McLellan SL, Amick A, et al. Identification of human enteric pathogens in gull feces at Southwestern Lake Michigan bathing beaches. Can J Microbiol 2008; 54:1006.
  26. Hori M, Hayashi K, Maeshima K, et al. Food poisoning caused by Aeromonas shigelloides with an antigen common to Shigella dysenteriae. J Jpn Assoc Infect Dis 1966; 39:433.
  27. Bai Y, Dai YC, Li JD, et al. Acute diarrhea during army field exercise in southern China. World J Gastroenterol 2004; 10:127.
  28. Wouafo M, Pouillot R, Kwetche PF, et al. An acute foodborne outbreak due to Plesiomonas shigelloides in Yaounde, Cameroon. Foodborne Pathog Dis 2006; 3:209.
  29. Khan AM, Hossain MS, Khan AI, et al. Bacterial enteropathogens of neonates admitted to an urban diarrhoeal hospital in Bangladesh. J Trop Pediatr 2009; 55:122.
  30. Chen X, Chen Y, Yang Q, et al. Plesiomonas shigelloides infection in Southeast China. PLoS One 2013; 8:e77877.
  31. Shah N, DuPont HL, Ramsey DJ. Global etiology of travelers' diarrhea: systematic review from 1973 to the present. Am J Trop Med Hyg 2009; 80:609.
  32. Ahmad M, Aggarwal M, Ahmed A. Bloody diarrhea caused by Plesiomonas shigelloides proctitis in a human immunodeficiency virus-infected patient. Clin Infect Dis 1998; 27:657.
  33. Suthienkul O, Aiumlaor P, Siripanichgon K, et al. Bacterial causes of AIDS-associated diarrhea in Thailand. Southeast Asian J Trop Med Public Health 2001; 32:158.
  34. Meyer AM, Ramzan NN, Loftus EV Jr, et al. The diagnostic yield of stool pathogen studies during relapses of inflammatory bowel disease. J Clin Gastroenterol 2004; 38:772.
  35. Mylonaki M, Langmead L, Pantes A, et al. Enteric infection in relapse of inflammatory bowel disease: importance of microbiological examination of stool. Eur J Gastroenterol Hepatol 2004; 16:775.
  36. Khan AM, Faruque AS, Hossain MS, et al. Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study. J Trop Pediatr 2004; 50:354.
  37. Lee AC, Yuen KY, Ha SY, et al. Plesiomonas shigelloides septicemia: case report and literature review. Pediatr Hematol Oncol 1996; 13:265.
  38. Woo PC, Lau SK, Yuen KY. Biliary tract disease as a risk factor for Plesiomonas shigelloides bacteraemia: a nine-year experience in a Hong Kong hospital and review of the literature. New Microbiol 2005; 28:45.
  39. Terpeluk C, Goldmann A, Bartmann P, Pohlandt F. Plesiomonas shigelloides sepsis and meningoencephalitis in a neonate. Eur J Pediatr 1992; 151:499.
  40. Alcañiz JP, de Cuenca Morón B, Gómez Rubio M, et al. Spontaneous bacterial peritonitis due to Plesiomonas shigelloides. Am J Gastroenterol 1995; 90:1529.
  41. Marshman WE, Lyons CJ. Congenital endophthalmitis following maternal shellfish ingestion. Aust N Z J Ophthalmol 1998; 26:161.
  42. Schneider F, Lang N, Reibke R, et al. Plesiomonas shigelloides pneumonia. Med Mal Infect 2009; 39:397.
  43. Herve V, Bigaillon C, Duhamel P, et al. [Cutaneous abscess due to Plesiomonas shigelloïdes consecutive to a trauma in fresh water]. Med Mal Infect 2007; 37:840.
  44. Klatte JM, Dastjerdi MH, Clark K, et al. Hyperacute infectious keratitis with Plesiomonas shigelloides following traumatic lamellar corneal laceration. Pediatr Infect Dis J 2012; 31:1200.
  45. Delforge ML, Devriendt J, Glupczynski Y, et al. Plesiomonas shigelloides septicemia in a patient with primary hemochromatosis. Clin Infect Dis 1995; 21:692.
  46. Riley PA, Parasakthi N, Abdullah WA. Plesiomonas shigelloides bacteremia in a child with leukemia. Clin Infect Dis 1996; 23:206.
  47. Ozdemir O, Sari S, Terzioglu S, Zenciroglu A. Plesiomonas shigelloides sepsis and meningoencephalitis in a surviving neonate. J Microbiol Immunol Infect 2010; 43:344.
  48. Auxiliadora-Martins M, Bellissimo-Rodrigues F, Viana JM, et al. Septic shock caused by Plesiomonas shigelloides in a patient with sickle beta-zero thalassemia. Heart Lung 2010; 39:335.
  49. Bonatti H, Sifri C, Sawyer RG. Successful liver transplantation from donor with Plesiomonas shigelloides sepsis after freshwater drowning: case report and review of literature on gram-negative bacterial aspiration during drowning and utilization of organs from bacteremic donors. Surg Infect (Larchmt) 2012; 13:114.
  50. Woo PC, Lau SK, Wong SS, Yuen KY. Two cases of continuous ambulatory peritoneal dialysis-associated peritonitis due to Plesiomonas shigelloides. J Clin Microbiol 2004; 42:933.
  51. Kain KC, Kelly MT. Clinical features, epidemiology, and treatment of Plesiomonas shigelloides diarrhea. J Clin Microbiol 1989; 27:998.
  52. Visitsunthorn N, Komolpis P. Antimicrobial therapy in Plesiomonas shigelloides-associated diarrhea in Thai children. Southeast Asian J Trop Med Public Health 1995; 26:86.
  53. Avison MB, Bennett PM, Walsh TR. beta-lactamase expression in Plesiomonas shigelloides. J Antimicrob Chemother 2000; 45:877.
  54. Wong TY, Tsui HY, So MK, et al. Plesiomonas shigelloides infection in Hong Kong: retrospective study of 167 laboratory-confirmed cases. Hong Kong Med J 2000; 6:375.
  55. Kain KC, Kelly MT. Antimicrobial susceptibility of Plesiomonas shigelloides from patients with diarrhea. Antimicrob Agents Chemother 1989; 33:1609.
  56. Clark RB, Lister PD, Arneson-Rotert L, Janda JM. In vitro susceptibilities of Plesiomonas shigelloides to 24 antibiotics and antibiotic-beta-lactamase-inhibitor combinations. Antimicrob Agents Chemother 1990; 34:159.