背景:气单胞菌物种已被证明在霍乱弧菌的微生物学测试中产生假阳性结果。它们与弧菌物种具有许多生化特性,在基因型信息提供新的见解之前,它们被共同分类为弧菌科。气单胞菌越来越多地与胃肠道感染相关,尽管该属物种之间和内部的致病性和毒力差异很大。我们报告了两例临床上有轻度霍乱样症状的病例,在该国其他地区(坦桑尼亚)爆发霍乱的时候。这是本地区首次报道的气单胞菌模仿霍乱的病例。
方法:两名患者在乞力马扎罗山基督教医学中心指定的新出现传染病隔离病房入院,并在临时诊断为胃肠炎的情况下提供定期粪便分析和培养的知情同意。第一位患者是一名23岁的非洲黑人妇女,有2天的水样腹泻和呕吐病史,体温为39.7°C。第二名患者是一名47岁的非洲黑人妇女,有2天的腹泻和呕吐病史,体温为37.7°C,她的血液动力学稳定.两名患者均隔离在特定区域进行感染控制,并接受液体和口服补液治疗。环丙沙星,甲硝唑,和扑热息痛.粪便文化已经完成。分离的菌落被报告为霍乱弧菌,并转移到乞力马扎罗临床研究所的研究实验室,使用全基因组测序进行确认。微生物测试确定从粪便中分离出的菌落是霍乱弧菌,并有理由得出“推定霍乱”的结论。“全基因组测序,然而,确定了毒气单胞菌而不是霍乱弧菌的存在。
结论:在霍乱流行地区,气单胞菌与霍乱弧菌的共存表明,部分疑似霍乱病例可能是气单胞菌感染。然而,几乎没有关于撒哈拉以南非洲腹泻和痢疾病例中的气单胞菌感染的流行病学数据,目前尚无法确定误诊的程度.全基因组测序显示容易排除霍乱弧菌作为病原体,并确定气单胞菌物种的存在。
BACKGROUND: Aeromonas species have been documented to yield false positive results in microbiological tests for Vibrio cholerae. They share many biochemical properties with Vibrio species, with which they were jointly classified in the family Vibrionaceae until genotypic information provided new insights. Aeromonas species are increasingly associated with gastrointestinal infections, albeit with great apparent variation in pathogenicity and virulence both between and within species of the genus. We report two cases with clinically mild cholera-like symptoms, at a time when a cholera outbreak was unfolding in other regions of the country (Tanzania). These are the first cases to be reported with Aeromonas mimicking cholera in our area.
METHODS: Two patients were admitted at the isolation unit designated by the Kilimanjaro Christian Medical Centre for emerging infectious diseases and provided informed consent about regular stool analysis and culture under the provisional diagnosis of gastroenteritis. The first patient was a 23-year-old black African woman with a 2-day history of watery diarrhea and vomiting associated with a temperature of 39.7 °C. The second patient was a 47-year-old black African woman with a 2-day history of diarrhea and vomiting with a temperature of 37.7 °C, and she was hemodynamically stable. Both patients were isolated in a specific area for infection control and treated with fluids and orally administered rehydration solution, ciprofloxacin, metronidazole, and paracetamol. Stool culture was done. The isolated colonies were reported as V. cholerae and transferred to the research laboratory of Kilimanjaro Clinical Research Institute for confirmation using whole genome sequencing. Microbiological testing determined colonies isolated from stool to be V. cholerae, and warranted the conclusion \"presumptive cholera.\" Whole genome sequencing, however, established the presence of Aeromonas caviae rather than V. cholerae.
CONCLUSIONS: The co-existence of Aeromonas species with V. cholerae in cholera-endemic regions suggests the possibility that a proportion of suspected cholera cases may be Aeromonas infections. However, with close to no epidemiological data available on Aeromonas infection in cases of diarrhea and dysentery in Sub-Saharan Africa, it is not currently possible to establish the extent of misdiagnosis to any degree of certainty. Whole genome sequencing was shown to readily exclude V. cholerae as the etiological agent and establish the presence of Aeromonas species.