Assoc. Prof. Dr.

Alfizah Hanafiah
Dept. of Medical Microbiology & Immunology
Faculty of Medicine,
Universiti Kebangsaan Malaysia Medical Centre,
Cheras, Kuala Lumpur

Diploma Medical Microbiology Course 2017

Institute for Medical Research, Kuala Lumpur

Date: 30th March 2017

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Vibrio spp.
Aeromonas spp.

“Push your limits. Challenge yourself to make impossible and know how much more you can achieve.”
 Vibrio spp.
• Vibrio cholerae
the major pathogen in this genus
causes cholera
• Vibrio parahemolyticus
causes diarrhoea associated with eating raw or
improperly cooked seafood
• Vibrio vulnificus
causes cellulitis and sepsis
• Vibrio alginolyticus
 causes otitis externa, wound infection
 Vibrio spp.
Characteristics
• Gram negative rods, curved, comma-shaped
• V. cholerae:
• Different serogroups (based on O cell wall antigen):
• V. cholerae O1
cause epidemic and pandemic disease
2 biotypes: El Tor and Classical
3 serotypes: Ogawa, Inaba and Hikojima
• V. cholerae O139 (synonym Bengal)
• V. cholerae non-O1 – cause sporadic, mild gastroenteritis or
nonpathogens

• V. parahemolyticus & V. vulnificus

• Marine organisms, live primarily in the ocean (esp. warm saltwater)
V. cholerae: Epidemiology
• Transmitted by fecal contamination of water and food (primarily from
human sources)
• Most frequent in communities with poor sewage and water treatment
• Human carriers – frequently asymptomatic
• Animal reservoir – marine selfish such as shrimp and oysters
• V. cholerae O1 El Tor:
A major epidemic cholera (1960s and 1970s): began in Southeast Asia
and spread over 3 continents to Africa, Europe and Asia
A pandemic cholera (1991) – began in Peru and spread to many
countries in Central and South America
• V. cholerae O139:
Cholera epidemic began in Bengal, India in 1992 and has now spread to
Southeast Asia and the Far East
Has been reported from China, Saudi Arabia and South Asia
V. cholerae: Pathogenesis

• Pathogenesis is depend on:

 colonization of the small intestine
 secretion of enterotoxin (exotoxin)
• For colonization to occur – a high inoculum (at least
108) cells must be ingested
• because the organisms is sensitive to stomach acid
• Bacteria secrete enzyme mucinase (dissolves the
protective glycoprotein coating over the intestinal
cells) – adhere to the cells of the guts
• Bacteria multiplies and secrete exotoxin (cholera
toxin)
The action of cholera toxin in intestinal epithelial cells
V. cholerae: Clinical findings

• Hallmark of cholera – watery diarrhoea in large volumes.

• No red blood cells or white blood cells in the stool (term as rice-water
stool).
• No abdominal pain.
• Severe fluid and electrolyte losses result in:
• dehydration
• metabolic acidosis (decreased pH of body fluids) – due to loss of bicarbonate ions,
hypokalemia, and hypovolemic shock caused by reduced blood volume in the body
• lead to muscle cramping, irregularities in heartbeat, kidney failure, coma and death.
• Mortality is 40-60% in untreated patients infected by strain O1.
• Death can occur less than 48 h after infection.
• In non-fatal cases, cholera ends spontaneously after a few days
(pathogens and toxins are flushed out by the severe diarrhoea)
V. cholerae: Laboratory Diagnosis

• Specimen: feces
• Alkaline peptone water: a transport and enrichment medium
• Morphology: Gram negative motile, curved rods
• Culture:
• an aerobe and facultative anaerobe
• grow over a wide temperature range of 16-40 C (optimum 37 C)
• grow best at alkaline pH (pH 8.2)
• TCBS agar: sucrose-fermenting yellow colonies (2-3 mm in diameter)
• Blood agar: produce beta-hemolytic colonies
• Oxidase positive
• Do not ferment L-arabinose (differentiating V. cholerae from V.
fluvalis – both produce yellow colonies on TCBS)
• Serotyping (separate antisera): VC Inaba, VC Ogawa, VC O139
 V. cholerae: Treatment & Prevention
Treatment
• Prompt, adequate replacement of water and electrolytes (orally or
intravenously)
• Antibiotic (tetracyline or doxycycline) not necessary
• but they do shorten the duration of symptoms and reduce the time of
organism excretion
• recommended for severely ill patients and hospitalized patients

Prevention
• Public health measures - ensure a clean water and food supply
• The vaccine composed of killed organisms – limited usefulness
• Only 50% effective, protection lasting for only 3 to 6 months
• Does not interrupt transmission
• Not recommended for routine use in travelers
• Antibiotic prophylaxis not effective
Vibrio parahemolyticus

• A halophilic (salt loving) vibrio

• Transmitted by ingestion of contaminated raw or undercooked seafood
• Clinical findings:
 From mild to quite severe watery diarrhoea, nausea, vomiting, abdominal
cramps and fever.
• Pathogenesis: unclear
• The illness is self-limited, lasting about 3 days
• Laboratory diagnosis:
• Different from V. cholerae on the basis of growth in NaCl (VP grow in 8%
NaCl, VC does not)
• Culture on TCBS produce non-sucrose fermenting (green-blue) colonies
• Treatment: antibiotic and rehydration
• Prevention: proper refrigeration and cooking of seafood
Vibrio vulnificus

• Marine organism, found in warm salt waters such as the Caribbean Sea
• Able to infect by penetrating directly into a deep wound, a cut or even a
tiny scratch
• Causes:
o severe skin and soft tissue infections (cellulitis) especially in shellfish
handlers who often sustain skin wounds
o fatal septicemia in immunocompromised people who have eaten
contaminated raw shellfish
o severe infections in patients with chronic liver disease (e.g. cirrhosis)
• Wound infections characterized by swelling and reddening at the site of
infection, accompanied by fever and chills
• Culture on TCBS: non-sucrose fermenting colonies
• Treatment: antibiotic (doxycycline)
 Aeromonas spp.
• Can be found in water and soil
• Most are non-pathogenic or of low pathogenicity
• Morphology: Gram negative motile rods
• Culture: produce small -hemolytic colonies on blood
agar
• Oxidase positive
• Grow on TCBS producing yellow colonies
• Motility in distilled water: used to differentiate
Aeromonas from V. cholerae
 Aeromonas hydrophila
• PATHOGENICITY:
o associated with gastroenteritis (acute diarrhoea resembling
cholera), wound infections (cellulitis), septicemia, ocular and
respiratory tract infections, pneumonia and urinary tract
infections
o frequent pathogens for cold-blooded marine and freshwater
amphibians and reptiles (red leg disease in frogs); also in birds
• EPIDEMIOLOGY:
o Worldwide; especially near freshwater sources; incidence of
serious human disease is increasing and many isolates are
probably misdiagnosed as coliforms
• HOST RANGE: Humans, amphibians, fish, reptiles, birds
 Aeromonas hydrophila

• MODE OF TRANSMISSION:
o Fecal-oral transmission; contact with contaminated water,
food, soil, feces; ingestion of contaminated fish or reptiles
• RESERVOIR: Salt and freshwater, soil, sewage
• DRUG SUSCEPTIBILITY:
o Susceptible to expanded- and broad-spectrum
cephalosporins, aminoglycosides, carbapenems,
chloramphenicol, tetracycline, trimethoprim-
sulfamethoxazole and the quinolones
• DRUG RESISTANCE:
o Resistant to penicillin, ampicillin, carbenicillin and ticarcillin