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correspondence

Indian Pediatr 2013;50: 969-970

Cholera-like Illness Due to Aeromonas caviae


K Jagadish Kumar and *G S Vijaya Kumar

Departments of Pediatrics and *Microbiology, JSS Medical College and Hospital, Mysore, Karnataka,  India.
Email: [email protected]

 


A 2-year-old girl presented with rice watery stools and vomiting for 12 hours. There was no blood in the stools. On examination she had some dehydration. Stool microscopy and hanging drop revealed darting motile bacilli morphologically resembling Vibrio cholera. Her blood count and renal function tests were normal. Dehydration was corrected with IV Ringer lactate and she was commenced on Azithromicin. Her HIV status was non-reactive. Stool culture grew Aeromonas caviae, which was sensitive to doxycycline, chloramphenicol, furazolidine and resistant to nalidixic acid, ceftraixone, co-trimaxazole and ampicillin. She was discharged after three days.

Aeromonas species are ubiquitous water borne medically important, Gram-negative, rod-shaped micro-organisms [1]. Today, they are regarded not only as disease-causing pathogen of fish but are also responsible for variety of complications in both immunocompetent and immunocompromised humans [2]. Aeromonas have gained importance as human pathogens causing gastrointestinal infections. They also cause extraintestinal infections such as cellulitis, wound infections, sepsis and urinary tract infections [1]. Deodhar, et al. [3] isolated Aeromonas from 45 (1.8%) of 2,480 patients with acute gastroenteritis. Out of 863 traveller’s diarrhea patients returning from Asia, Africa, and Latin America, 2% of cases were caused by Aeromonas [4]. Studies have shown that three Aeromonas (A. hydrophila, A. caviae and A. veronii bv Sobria) are responsible for 85% of human infections [2]. Clinical spectrum of Aeromonas-induced diarrhoea varies from toxigenic diarrhea to colitis and in developing countries it is predominantly toxigenic [3]. The most common presentation for  Aeromonas gastroenteritis is secretory(watery) enteritis suggesting the toxigenic nature of the organism [2]. Aeromonas strains are almost universally susceptible to fluoroquinolones and exhibited multidrug resistance [2]. Bhowmika, et al. [1] isolated potentially pathogenic and multi-drug-resistant strains of  A. hydrophila from natural surface waters, and showed its ability to produce virulence-associated factors similar to that in clinical isolates thereby indicating a significant risk to public health [1]. To conclude, Aeromonas associated gastroenteritis in children mimics cholera and the presence of this emerging organism should be kept in mind while treating acute gastroenteritis.

References

1. Bhowmik P, Bag PK,  Hajra TK, Rituparna De,  Sarkar P, Ramamurthy T. Pathogenic potential of Aeromonas hydrophila isolated from surface waters in Kolkata, India. J Med Microbiol.2009; 58:1549-58.

2. Janda JM, Abbott SL. The genus Aeromonas: Taxonomy, pathogenicity, and infection. Clin Microbiol Rev. 2010;23:35-73.

3. Deodhar LP, Saraswathi K, Varudkar A. Aeromonas spp. and their association with human diarrheal disease. J Clinical Microbiol.1991;29:853-6.

4. Vila J, Ruiz J, Gallardo F,Vargas M, Soler L,Figueras MJ, et al. Aeromonas spp. and traveler’s diarrhea: clinical features and antimicrobial resistance. Emerg Infect Dis. 2003;9:552-5.

 

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