- Email: [email protected]
Observations on Aeromonas species isolated from human faeces
Letters to the Editor
267
with only two previously reported cases to our knowledge.8' 4 One of these involved the skull and epidural space in a man who had mandibular osteomyelitis 22 years p r e v i o u s l y ? Another patient had actinomycotic osteomyelitis of the skull with intracranial granuloma. 4 Smego 5 reviewed 70 cases of C N S actinomycosis but found none secondary to osteomyelitis of the skull. T h i s report leads us to make the observation that although actinomycosis usually presents as a chronic suppurative disease, it may rarely do so as a m u c h more acute illness. It also emphasises the point that a p r i m a r y focus of infection may not always be apparent in actinomycosis. Such atypical features of a case should not dissuade one f r o m including actinomycosis in the differential diagnosis of clinical infections. (We thank Mr R. D. E. Battersby for permission to report this case.)
Department of Bacteriology and Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield SIO 2JF, U.K.
Linda A. Jewes R. J. C. Laing
Address correspondence to: Dr Linda Jewes, Public Health Laboratory, Northern General Hospital, Herries Road, Sheffield $5 7AU, U.K. References
I. Burden P. Actinomycosis. ff Infect 1989; x9: 95-99. 2. Birley H D L , Teare EL, Utting JA. Actinomycotic osteomyelitis of the thoracic spine in a penicillin-sensitive patient. J Infect I989; I9: 193-194. 3. Kirsch WM, Skcess JC. Actinomycotic osteomyelitis of the skull and epidural space. J Neurol 197o; 33: 347-351. 4- Khosler UK, Banerjee AK, Chopra JS. Intracranial actinomycoma with osteomyelitis simulating meningioma. J Neurosurg 1984; 6o: 204-207. 5. Smego RA. Actinomycosis of the central nervous system. Rev Infect Dis 1987; 9: 855-865.
Observations on Aeromonas species isolated from human faeces
Accepted for publication 6 January 199o Sir, Recent reports 1,2 suggest that it is rare to find multiple species or biotypes of Aeromonas in h u m a n faeces. I f true, this would contrast with the multiple biotypes and species found in environmental samples and animal faeces, s-~ Further, it has been suggested that h u m a n beings acquire enteric aeromonads from the environment. 6 We wish to report some observations we have made on the isolation of aeromonads from h u m a n faeces. D u r i n g the period N o v e m b e r 1986 to September 1988, all faecal samples submitted to this laboratory f r o m patients with diarrhoea were screened for the presence of aeromonads by direct culture on Bile Salt Irgasan Brilliant G r e e n Agar (Difco Laboratories Ltd., U.K.). Morphologically distinct non-xylose fermenting colonies were subcultured for further investigation. After adjustment for multiple submissions from some patients and the exclusion of k n o w n repeated samples, aeromonads were isolated f r o m 91 (2"4 %) of 3766 faecal specimens. O f these 91 samples, 23 (25 %) also contained a well recognised enteropathogen. (Eleven contained Campylobacter spp., nine Salmonellae, one Shigella sonnei, one Clostridium difficile and one contained b o t h Campylobacter spp. and Giardia lamblia).
268
Letters to the Editor
T h e 9I positive samples yielded r I2 strains of Aeromonas, I9 (20"9 %) having m o r e than one species or biotype. O f the 29 (32 %) samples from which A. caviae was the only aeromonad species isolated, five (four with two and one with three) contained multiple biotypes. A. sobria was the only aeromonad species isolated f r o m 30 (33 %) samples, seven (six with two and one with three) of which contained multiple biotypes. N o n e of the 25 (27 %) samples, from which A. hydrophila was the sole species isolated, contained multiple biotypes. A further seven (8 ~o) contained more than one species. It would appear that the presence of multiple species and biotypes of Aeromonas in h u m a n faeces is not as rare as has been suggested.
Public Health Laboratory, University Hospital of Wales, Cardiff CF4 4 X W , U.K.
S . J . Gray H. Griffiths References
i. Janda JM, Dixon M, Raucher B, Clark RB, Bottone EJ. Value of blood agar for primary plating and clinical implications of simultaneous isolation of Aeromonas hydrophila and Aeromonas caviae from a patient with gastroenteritis. J Clin Microbiol r984; 2o : 122 I-1222. 2. Kuijper EJ, van Alphen L, Leenders E, Zanen HC. Typing of.4eromonas strains by DNA restriction endonuclease analysis and polyacrylamide gel electrophoresis of cell envelopes. J Clin Microbiol I989; 27: rzSo--r285. 3- Gray SJ. Aeromonas hydrophila in livestock: incidence, biochemical characteristics and antibiotic susceptibility. J Hyg I984; 92:365-375 • 4- Picard B, Goullet P. Epidemiological complexity of hospital aeromonas infections revealed by electrophoretic typing of esterases. Epidem Infect r987; 98: 5-I4. 5. Gray, S J, Stickler DJ. Some observations on the faecal carriage of mesophilic Aeromonas species in cows and pigs. Epidem Inf I989; IO3: 523-537. 6. Burke V, Robinson J, Gracey M, Peterson D, Partridge K. Isolation of Aeromonas hydrophila from a metropolitan water supply; seasonal correlation with clinical isolates. Appl Environ Microbiol 1984; 48: 36r-366.
267
with only two previously reported cases to our knowledge.8' 4 One of these involved the skull and epidural space in a man who had mandibular osteomyelitis 22 years p r e v i o u s l y ? Another patient had actinomycotic osteomyelitis of the skull with intracranial granuloma. 4 Smego 5 reviewed 70 cases of C N S actinomycosis but found none secondary to osteomyelitis of the skull. T h i s report leads us to make the observation that although actinomycosis usually presents as a chronic suppurative disease, it may rarely do so as a m u c h more acute illness. It also emphasises the point that a p r i m a r y focus of infection may not always be apparent in actinomycosis. Such atypical features of a case should not dissuade one f r o m including actinomycosis in the differential diagnosis of clinical infections. (We thank Mr R. D. E. Battersby for permission to report this case.)
Department of Bacteriology and Neurosurgery, Royal Hallamshire Hospital, Glossop Road, Sheffield SIO 2JF, U.K.
Linda A. Jewes R. J. C. Laing
Address correspondence to: Dr Linda Jewes, Public Health Laboratory, Northern General Hospital, Herries Road, Sheffield $5 7AU, U.K. References
I. Burden P. Actinomycosis. ff Infect 1989; x9: 95-99. 2. Birley H D L , Teare EL, Utting JA. Actinomycotic osteomyelitis of the thoracic spine in a penicillin-sensitive patient. J Infect I989; I9: 193-194. 3. Kirsch WM, Skcess JC. Actinomycotic osteomyelitis of the skull and epidural space. J Neurol 197o; 33: 347-351. 4- Khosler UK, Banerjee AK, Chopra JS. Intracranial actinomycoma with osteomyelitis simulating meningioma. J Neurosurg 1984; 6o: 204-207. 5. Smego RA. Actinomycosis of the central nervous system. Rev Infect Dis 1987; 9: 855-865.
Observations on Aeromonas species isolated from human faeces
Accepted for publication 6 January 199o Sir, Recent reports 1,2 suggest that it is rare to find multiple species or biotypes of Aeromonas in h u m a n faeces. I f true, this would contrast with the multiple biotypes and species found in environmental samples and animal faeces, s-~ Further, it has been suggested that h u m a n beings acquire enteric aeromonads from the environment. 6 We wish to report some observations we have made on the isolation of aeromonads from h u m a n faeces. D u r i n g the period N o v e m b e r 1986 to September 1988, all faecal samples submitted to this laboratory f r o m patients with diarrhoea were screened for the presence of aeromonads by direct culture on Bile Salt Irgasan Brilliant G r e e n Agar (Difco Laboratories Ltd., U.K.). Morphologically distinct non-xylose fermenting colonies were subcultured for further investigation. After adjustment for multiple submissions from some patients and the exclusion of k n o w n repeated samples, aeromonads were isolated f r o m 91 (2"4 %) of 3766 faecal specimens. O f these 91 samples, 23 (25 %) also contained a well recognised enteropathogen. (Eleven contained Campylobacter spp., nine Salmonellae, one Shigella sonnei, one Clostridium difficile and one contained b o t h Campylobacter spp. and Giardia lamblia).
268
Letters to the Editor
T h e 9I positive samples yielded r I2 strains of Aeromonas, I9 (20"9 %) having m o r e than one species or biotype. O f the 29 (32 %) samples from which A. caviae was the only aeromonad species isolated, five (four with two and one with three) contained multiple biotypes. A. sobria was the only aeromonad species isolated f r o m 30 (33 %) samples, seven (six with two and one with three) of which contained multiple biotypes. N o n e of the 25 (27 %) samples, from which A. hydrophila was the sole species isolated, contained multiple biotypes. A further seven (8 ~o) contained more than one species. It would appear that the presence of multiple species and biotypes of Aeromonas in h u m a n faeces is not as rare as has been suggested.
Public Health Laboratory, University Hospital of Wales, Cardiff CF4 4 X W , U.K.
S . J . Gray H. Griffiths References
i. Janda JM, Dixon M, Raucher B, Clark RB, Bottone EJ. Value of blood agar for primary plating and clinical implications of simultaneous isolation of Aeromonas hydrophila and Aeromonas caviae from a patient with gastroenteritis. J Clin Microbiol r984; 2o : 122 I-1222. 2. Kuijper EJ, van Alphen L, Leenders E, Zanen HC. Typing of.4eromonas strains by DNA restriction endonuclease analysis and polyacrylamide gel electrophoresis of cell envelopes. J Clin Microbiol I989; 27: rzSo--r285. 3- Gray SJ. Aeromonas hydrophila in livestock: incidence, biochemical characteristics and antibiotic susceptibility. J Hyg I984; 92:365-375 • 4- Picard B, Goullet P. Epidemiological complexity of hospital aeromonas infections revealed by electrophoretic typing of esterases. Epidem Infect r987; 98: 5-I4. 5. Gray, S J, Stickler DJ. Some observations on the faecal carriage of mesophilic Aeromonas species in cows and pigs. Epidem Inf I989; IO3: 523-537. 6. Burke V, Robinson J, Gracey M, Peterson D, Partridge K. Isolation of Aeromonas hydrophila from a metropolitan water supply; seasonal correlation with clinical isolates. Appl Environ Microbiol 1984; 48: 36r-366.