Aeromonas hydrophila infection: clinical aspects and therapeutic options

Construction of an aerolysin-based multi-epitope vaccine against Aeromonas hydrophila: an in silico machine learning and artificial intelligence-supported approach

Aeromonas hydrophila, a gram-negative coccobacillus bacterium, can cause various infections in humans, including septic arthritis, diarrhea (traveler's diarrhea), gastroenteritis, skin and wound infections, meningitis, fulminating septicemia, enterocolitis, peritonitis, and endocarditis. It frequently occurs in aquatic environments and readily contacts humans, leading to high infection rates. This bacterium has exhibited resistance to numerous commercial antibiotics, and no vaccine has yet been developed. Aiming to combat the alarmingly high infection rate, this study utilizes in silico techniques to design a multi-epitope vaccine (MEV) candidate against this bacterium based on its aerolysin toxin, which is the most toxic and highly conserved virulence factor among the Aeromonas species. After retrieval, aerolysin was processed for B-cell and T-cell epitope mapping. Once filtered for toxicity, antigenicity, allergenicity, and solubility, the chosen epitopes were combined with an adjuvant and specific linkers to create a vaccine construct. These linkers and the adjuvant enhance the MEV's ability to elicit robust immune responses. Analyses of the predicted and improved vaccine structure revealed that 75.5%, 19.8%, and 1.3% of its amino acids occupy the most favored, additional allowed, and generously allowed regions, respectively, while its ERRAT score reached nearly 70%. Docking simulations showed the MEV exhibiting the highest interaction and binding energies (-1,023.4 kcal/mol, -923.2 kcal/mol, and -988.3 kcal/mol) with TLR-4, MHC-I, and MHC-II receptors. Further molecular dynamics simulations demonstrated the docked complexes' remarkable stability and maximum interactions, i.e., uniform RMSD, fluctuated RMSF, and lowest binding net energy. In silico models also predict the vaccine will stimulate a variety of immunological pathways following administration. These analyses suggest the vaccine's efficacy in inducing robust immune responses against A. hydrophila. With high solubility and no predicted allergic responses or toxicity, it appears safe for administration in both healthy and A. hydrophila-infected individuals.

Microplastic polymer properties as deterministic factors driving terrestrial plastisphere microbiome assembly and succession in the field

Environmental microplastic (MP) is ubiquitous in aquatic and terrestrial ecosystems providing artificial habitats for microbes. Mechanisms of MP colonization, MP polymer impacts, and effects on soil microbiomes are largely unknown in terrestrial systems. Therefore, we experimentally tested the hypothesis that MP polymer type is an important deterministic factor affecting MP community assembly by incubating common MP polymer types in situ in landfill soil for 14 months. 16S rRNA gene amplicon sequencing indicated that MP polymers have specific impacts on plastisphere microbiomes, which are subsets of the soil microbiome. Chloroflexota, Gammaproteobacteria, certain Nitrososphaerota, and Nanoarchaeota explained differences among MP polymers and time points. Plastisphere microbial community composition derived from different MP diverged over time and was enriched in potential pathogens. PICRUSt predictions of pathway abundances and quantitative PCR of functional marker genes indicated that MP polymers exerted an ambivalent effect on genetic potentials of biogeochemical cycles. Overall, the data indicate that (i) polymer type as deterministic factor rather than stochastic factors drives plastisphere community assembly, (ii) MP impacts greenhouse gas metabolism, xenobiotic degradation and pathogen distribution, and (iii) MP serves as an ideal model system for studying fundamental questions in microbial ecology such as community assembly mechanisms in terrestrial environments.

Chronic Diarrhea Due to Aeromonas hydrophila in an Immunosuppressed Patient with a Pancreas-Kidney Transplant

The genus Aeromonas belongs to the Aeromonadaceae family. A patient with a pancreas-kidney transplant had multiple episodes of abdominal sepsis after surgery. Aeromonas hydrophila was isolated in the ascitic and biliary fluid drains. After discharge, the patient had several diarrhea episodes, and A. hydrophila was isolated in four stool samples. We decided to test whether the one strain that we initially isolated in ascitic fluid was the same that appeared in the successive stool samples. Five isolates of A. hydrophila were found in the patient. Identification was performed using the MALDI-TOF system and confirmed via multiplex PCR. The analysis of the REP-PCR fingerprint patterns showed one cluster and confirmed that all isolates were related. We also demonstrated the virulent character of this species associated with genes encoding different toxins (act, alt, ast, hlyA, and aerA). The virulence of this species is associated with the expression of genes that encode different toxins, structural proteins, and metal-associated proteins. This case report highlights the severity of this disease, especially in immunocompromised patients, and its adequate treatment.

Detection of Antimicrobial and Heavy-Metal Resistance Genes in Aeromonas spp. Isolated from Hard-Shelled Mussel (Mytilus Coruscus)

Hard-shelled mussel (Mytilus coruscus) is a popular seafood in South Korea because of its delicacy and high nutritional value. Our study aimed to identify antimicrobial and heavy-metal resistance determinants in Aeromonas isolates from marketed hard-shelled mussel in South Korea. A total of 33 Aeromonas species were isolated, and antimicrobial disk diffusion test was done to observe antimicrobial resistance patterns. In addition, broth microdilution test was performed to determine resistance to heavy-metals. PCR amplification was done to detect resistance genes. High resistance to amoxicillin (100.0%), ampicillin (93.9%), rifampicin (78.8%), and cephalothin (48.5%) was observed where least resistance to other antimicrobials was also detected. In addition, the isolates showed high resistance to cadmium (Cd) (57.6%), and 42.4% and 27.3% were resistant to chromium (Cr) and copper (Cu). The occurrence of antimicrobial resistance genes, such as blaTEM, blaSHV, blaCTX-M, tetB, tetE, and intI1 genes, was observed in 9 (27.3%), 8 (24.2%), 8 (24.2%), 6 (18.2%), 5 (15.2%), and 9 (27.3%) isolates, respectively. Also, heavy-metal resistance genes, czcA, copA, and merA were detected in 17 (51.5%), 11 (33.3%), and 7 (21.2%) of the isolates, respectively. The results suggest that mussels are a reservoir of multidrug and heavy-metal-resistant Aeromonas spp.

Identification, antibiotic resistance, and virulence profiling of Aeromonas and Pseudomonas species from wastewater and surface water

Aquatic environments are hotspots for the spread of antibiotic-resistant bacteria and genes due to pollution caused mainly by anthropogenic activities. The aim of this study was to evaluate the impact of wastewater effluents, informal settlements, hospital, and veterinary clinic discharges on the occurrence, antibiotic resistance profile and virulence signatures of Aeromonas spp. and Pseudomonas spp. isolated from surface water and wastewater. High counts of Aeromonas spp. (2.5 (± 0.8) - 3.3 (± 0.4) log₁₀ CFU mL^-1) and Pseudomonas spp. (0.6 (± 1.0) - 1.8 (± 1.0) log₁₀ CFU mL^-1) were obtained. Polymerase chain reaction (PCR) and MALDI-TOF characterization identified four species of Aeromonas and five of Pseudomonas. The isolates displayed resistance to 3 or more antibiotics (71% of Aeromonas and 94% of Pseudomonas). Aeromonas spp. showed significant association with the antibiotic meropenem (χ² = 3.993, P < 0.05). The virulence gene aer in Aeromonas was found to be positively associated with the antibiotic resistance gene blaOXA (χ² = 6.657, P < 0.05) and the antibiotic ceftazidime (χ² = 7.537, P < 0.05). Aeromonas recovered from both wastewater and surface water displayed high resistance to ampicillin and had higher multiple antibiotic resistance (MAR) indices close to the hospital. Pseudomonas isolates on the other hand exhibited low resistance to carbapenems but very high resistance to the third-generation cephalosporins and cefixime. The results showed that some of the Pseudomonas spp. and Aeromonas spp. isolates were extended-spectrum β-lactamase producing bacteria. In conclusion, the strong association between virulence genes and antibiotic resistance in the isolates shows the potential health risk to communities through direct and indirect exposure to the water.

Bacteriological, Clinical and Virulence Aspects of Aeromonas-associated Diseases in Humans

Aeromonads have been isolated from varied environmental sources such as polluted and drinking water, as well as from tissues and body fluids of cold and warm-blooded animals. A phenotypically and genotypically heterogenous bacteria, aeromonads can be successfully identified by ribotyping and/or by analysing gyrB gene sequence, apart from classical biochemical characterization. Aeromonads are known to cause scepticemia in aquatic organisms, gastroenteritis and extraintestinal diseases such as scepticemia, skin, eye, wound and respiratory tract infections in humans. Several virulence and antibiotic resistance genes have been identified and isolated from this group, which if present in their mobile genetic elements, may be horizontally transferred to other naive environmental bacteria posing threat to the society. The extensive and indiscriminate use of antibiotics has given rise to many resistant varieties of bacteria. Multidrug resistance genes, such as NDM1, have been identified in this group of bacteria which is of serious health concern. Therefore, it is important to understand how antibiotic resistance develops and spreads in order to undertake preventive measures. It is also necessary to search and map putative virulence genes of Aeromonas for fighting the diseases caused by them. This review encompasses current knowledge of bacteriological, environmental, clinical and virulence aspects of the Aeromonas group and related diseases in humans and other animals of human concern.

Multidrug-resistant Aeromonas hydrophila causing fatal bilateral necrotizing fasciitis in an immunocompromised patient: a case report

BACKGROUND

Aeromonas hydrophila is a water-dwelling, gram-negative rod-shaped bacterium, associated with diarrheal illness and, less commonly, necrotizing skin and soft tissue infections, especially among immunocompromised patients. Necrotizing fasciitis is associated with a high mortality rate, especially when caused by Aeromonas spp. Our patient was infected with an extremely aggressive form of multidrug-resistant Aeromonas spp. that produced both an extended-spectrum β-lactamase and an AmpC enzyme. Aeromonads are being recognized as important emerging pathogens because of their inherent antibiotic resistance profiles compounded by other virulence factors. These difficult-to-treat organisms can have significant implications in both clinical and public health settings.

CASE PRESENTATION

A 37-year-old Caucasian male with immunosuppression due to aplastic anemia being treated with cyclosporine, presented to hospital with relapsed disease. While in hospital, he subsequently developed overwhelming sepsis secondary to bilateral lower extremity necrotizing fasciitis. The necrotizing fasciitis was caused by a multidrug-resistant strain of A. hydrophila. Despite broad-spectrum antibiotics and aggressive surgical debridement, he succumbed to this severe invasive infection.

CONCLUSIONS

Necrotizing fasciitis caused by Aeromonas spp. is a rare infection that may have a poor clinical outcome, particularly if the diagnosis is delayed and/or the organism is highly virulent and multidrug resistant. Enhanced education of clinicians and microbiologists is required to prevent unnecessary complications and improve survival.

Emerging Aeromonas species infections and their significance in public health

Aeromonas species are ubiquitous bacteria in terrestrial and aquatic milieus. They are becoming renowned as enteric pathogens of serious public health concern as they acquire a number of virulence determinants that are linked with human diseases, such as gastroenteritis, soft-tissue, muscle infections, septicemia, and skin diseases. Proper sanitary procedures are essential in the prevention of the spread of Aeromonas infections. Oral fluid electrolyte substitution is employed in the prevention of dehydration, and broad-spectrum antibiotics are used in severe Aeromonas outbreaks. This review presents an overview of emerging Aeromonas infections and proposes the need for actions necessary for establishing adequate prevention measures against the infections.

Antimicrobial susceptibilities of Aeromonas strains isolated from clinical and environmental sources to 26 antimicrobial agents

We determined the susceptibilities of 144 clinical and 49 environmental Aeromonas strains representing 10 different species to 26 antimicrobial agents by the agar dilution method. No single species had a predominantly nonsusceptible phenotype. A multidrug nonsusceptible pattern was observed in three (2.1%) clinical strains and two (4.0%) strains recovered from diseased fish. Common clinical strains were more resistant than the corresponding environmental isolates, suggesting that resistance mechanisms may be acquired by environmental strains from clinical strains.

The genus Aeromonas: taxonomy, pathogenicity, and infection

Over the past decade, the genus Aeromonas has undergone a number of significant changes of practical importance to clinical microbiologists and scientists alike. In parallel with the molecular revolution in microbiology, several new species have been identified on a phylogenetic basis, and the genome of the type species, A. hydrophila ATCC 7966, has been sequenced. In addition to established disease associations, Aeromonas has been shown to be a significant cause of infections associated with natural disasters (hurricanes, tsunamis, and earthquakes) and has been linked to emerging or new illnesses, including near-drowning events, prostatitis, and hemolytic-uremic syndrome. Despite these achievements, issues still remain regarding the role that Aeromonas plays in bacterial gastroenteritis, the extent to which species identification should be attempted in the clinical laboratory, and laboratory reporting of test results from contaminated body sites containing aeromonads. This article provides an extensive review of these topics, in addition to others, such as taxonomic issues, microbial pathogenicity, and antimicrobial resistance markers.

Risk factors for the outcome of cirrhotic patients with soft tissue infections

GOAL

The aims of this study were to identify risk factors that influence outcomes of cirrhotic patients with soft tissue infections and to describe specific management for such patients.

BACKGROUND

Soft tissue infections account for 11% of infections overall in cirrhotic patients and the severe form of necrotizing infection carries a high mortality rate. It is essential that clinicians make an early diagnosis and start appropriate treatment to improve outcomes of cirrhotic patients with soft tissue infections.

METHODS

Cirrhotic patients who had been admitted to our hospital with the diagnosis of soft tissue infection from June 1, 2003 to June 1, 2005 were included in this retrospective study. Clinical manifestations, laboratory data, and microbiologic results were recorded and compared between survivor and nonsurvivor groups.

RESULTS

There was a total of 118 episodes of admission for soft tissue infection with 26 episodes resulting in mortality and 92 in survival. The following clinical parameters showed significant differences between the 2 groups: Child-Pugh grade C, pain, altered consciousness, emergence of hemorrhagic bullae, and local injury. The following laboratory data showed significant differences between the 2 groups: appearance of band form, serum creatinine, serum albumin below 2.5 g/dL, serum bilirubin above 3 mg/dL, and prothrombin time prolongation greater than 5 seconds. Gram-negative bacterial infection was predominant in the nonsurvivor group and was statistically significant. Multivariate analysis showed that the emergence of hemorrhagic bullae and Child-Pugh grade C were independent predictive factors for outcome.

CONCLUSIONS

When treating soft tissue infection in cirrhotic patients, especially in those with Child-Pugh C liver function or emergence of hemorrhagic bullae, it is essential to start surgical evaluation and specific broad-spectrum antibiotics early to reduce the high mortality associated with this disease.

Biofilms and their relevance to veterinary medicine

Bacteria are renowned for their ability to tolerate and adapt to a wide range of adverse environmental conditions. The primary mechanism that facilitates these adaptations is thought to be the capacity to form and maintain biofilms. Within a biofilm, bacteria become attached to a surface where they exist in complex communities which are able to interact with each other through intracellular communication and thus rapidly adapt to changing environments. The organisms within biofilms are notorious for their resistance towards the host immune response and antibacterial agents compared to their free-living planktonic counterparts. Consequently, biofilms are of significant importance to both clinical and veterinary science. However, although bacterial infections are widely reported in animals their association with biofilms is rarely discussed. The aim of this review is to look at the characteristics of biofilm infections in humans and to relate this knowledge to veterinary science in order to assess their relevance in this area.

Fatal case of myonecrosis and septicaemia caused by Aeromonas hydrophila in Finland

A 48-y-old female developed cellulitis, myonecrosis and sepsis after a prick wound in her hand while boning freshwater fish. Cultures revealed Aeromonas hydrophila, a Gram-negative bacillus. Despite prompt care the patient died 4 d after the incident. Our case shows that the occurrence of severe Aeromonas infections is not limited to tropical and subtropical areas of the world.