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Epidemiologic Notes and Reports
Aquarium-Associated Plesiomonas shigelloides Infection -- Missouri
In July 1988, a community hospital in southeastern Missouri
reported
isolating Plesiomonas shigelloides from the stool of a 14-month-old
girl with watery diarrhea (no blood or mucus) and fever. Her
highest
recorded rectal temperature was 102 F (38.9 C). Her stool was
negative
for Campylobacter, Salmonella, Shigella, Yersinia, Aeromonas, and
rotavirus. The child was treated with
trimethoprim/sulfamethoxazole,
and her illness resolved after 5 days.
The child had consumed no shellfish and had never traveled more
than
80 miles from her home. She had consumed water only from the
municipal
system and recently had waded in two area lakes. She attended a
day-care center, but no other children in her age group were
reported
ill. The child did not have an aquarium or other close association
with
animals. However, 1 evening each week, the child stayed in the home
of
a babysitter who kept piranhas in an aquarium. When the aquarium
was
cleaned, the water was poured into the bathtub. The child routinely
was
bathed in the bathtub before going home. The babysitter reported
that
the child could have been bathed immediately after the aquarium
water
had been poured into the bathtub.
P. shigelloides was isolated from samples of aquarium water
submitted
to the State Public Health Laboratory. However, plasmid studies
were
not performed, and it was not determined whether the bacterial
strain
isolated from the child's stool was identical to that isolated from
the
babysitter's aquarium.
To estimate the prevalence of P. shigelloides in tropical fish
tanks,
investigators from the Missouri Department of Health (MDH) surveyed
aquarium water samples from several sites in Missouri (Table 1).
Samples were taken from 18 aquariums, including at least two tanks
from
each of Missouri's six regional health districts. P. shigelloides
was
isolated from four (22%) of the 18 tanks. The four tanks were
located
in three different pet shops: two in central Missouri and one in
eastern Missouri. Employees of the three pet shops reported no
health
problems in the fish in the culture-positive tanks.
MDH advised managers of all surveyed pet shops to have employees
wash
hands after contact with aquarium water or fish. No special
precautions
were recommended to managers of shops from which P. shigelloides
was
isolated. In addition, the baby sitter was advised to clean the tub
thoroughly using chlorine bleach after discarding the aquarium
water
and before using the tub for bathing.
Reported by: PS Tippen, A Meyer, EC Blank, DrPH, State Public
Health
Laboratory, HD Donnell, Jr, MD, State Epidemiologist, Missouri Dept
of
Health. Div of Field Svcs, Epidemiology Program Office, CDC.
Editorial Note: P. shigelloides, a gram-negative bacterial rod, is
an
opportunistic pathogen in the immunocompromised host and has been
suspected to cause diarrheal illness in normal hosts (1,2).
However,
the organism failed to produce illness in volunteer feeding
studies,
and its role as an enteric pathogen remains unproven (1). Persons
with
P. shigelloides infection typically describe a self-limited
diarrhea,
sometimes with blood and mucus in the stool; appropriate antibiotic
therapy appears to shorten the duration of illness (3,4). P.
shigelloides can also cause cellulitis and septicemia.
This organism has been isolated from surface water, the gut of
freshwater fish, and many animals (including dogs and cats) and is
particularly common in tropical and subtropical habitats (5). In
humans, most isolates have been from stools of patients with
diarrhea
who live in tropical and subtropical regions of Asia, Africa, and
Australia; isolations from Europe and the United States have been
rare
and usually associated with foreign travel or consumption of raw
oysters (3,6).
Although no other P. shigelloides gastrointestinal infections
associated with aquarium water have been reported, the frequency of
P.
shigelloides in pet shop aquariums reported here suggests this
could be
a source of this rarely recognized infection. Basic precautions,
such
as handwashing after contact with aquarium water and preventing the
contamination of potable or bathing water by aquarium water, should
decrease transmission of potentially pathogenic microorganisms from
aquarium water.
References
Herrington DA, Tzipori S, Robins-Browne RM, Tall BD, Levine MM.
In
vitro and in vivo pathogenicity of Plesiomonas shigelloides. Infect
Immun 1987;55:979-85.
Nolte FS, Poole RM, Murphy GW, Clark C, Panner BJ. Proctitis and
fatal septicemia caused by Plesiomonas shigelloides in a bisexual
man.
J Clin Microbiol 1988;26:388-91.
Holmberg SD, Wachsmuth IK, Hickman-Brenner FW, Blake PA, Farmer
JJ
III. Plesiomonas enteric infections in the United States. Ann
Intern
Med 1986;105:690-4.
Kain KC, Kelly MT. Clinical features, epidemiology, and
treatment of
Plesiomonas shigel loides diarrhea. J Clin Microbiol
1989;27:998-1001.
von Graevenitz A. Aeromonas and Plesiomonas. In: Lennette EH,
Balows
A, Hausler WJ Jr, Shadomy HJ, eds. Manual of clinical microbiology.
4th
ed. Washington, DC: American Society for Microbiology, 1985:278-81.
Reinhardt JF, George WL. Plesiomonas shigelloides-associated
diarrhea. JAMA 1985;253: 3294-5.
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