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Vibrio fluvialis and Vibrio mimicus associated with terminal ileitis
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9. Steere, A. C., T. F. Broderick, and S. E. Malawista. 1978. Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector. Am. J. Epidemiol. 108: 312-321. 10. Steere, A. C. et al. 1979. Chronic Lyme arthritis: clinical and immunogenetic differentiation from rheumatoid
arthritis. Ann. Intern. Med. 90: 286-291. 11. Steere, A. C. et al. 1983• The spirochetal etiology of Lyme disease. N. Engl. J. Med. 308:733-740. 12. Steere, A. C. et al. 1977. Erythema chronicum migrans and Lyme arthritis: the enlarging clinical spectrum. Ann. Intern. Med. 86:685-698.
13. Steere, A. C. et al. 1980. Antibiotic therapy in Lyme disease. Ann. Intern. Med. 93:1-8. 14. Steere, A. C. et al. 1977. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum. 20:7-17.
lobacter agar (Butzler formulation), and thiosulfate citrate bile salts (TCBS) agar plates, and GN broth and phosphate buffered saline for Yersinia cold enrichment. No Sabnonella, Shigella, Campylobacter, or Yersinia was isolated. Two types of Vibrio-like colonies grew on TCBS agar. One type produced yellow colonies (sucrose fermenter), the other type blue-green colonies. Both colony types were inoculated into the API 20E system (Analytab Products Inc., Plainview, New York) and incubated overnight at 37°C. The API 20E profile number for the sucrose-fermenting organism was 1046126, and the identification was Vibrio fluvialis confirmed by the State of Maryland Department of Health Laboratory. The profile number for the sucrose-negative organism was 5046104, and the identification was V. mimicus--confirmed by the Centers for Disease Control. Disk diffusion susceptibility tests were performed (Table 1). Five Vibrio species are associated
with diarrhea. All, except Vibrio hollisae, grow well on TCBS agar (2). Vibrio cholerae and V. fluvialis are sucrose fermenters and produce yellow colonies. Vibrio parahaemolyticus and V. minlictts do not ferment sucrose and thus produce blue-green colonies on TCBS agar. Vibriofluvialis is halophilic and ferments arabinose, whereas V. cholerae does not require salt or ferment arabinose. Two of the sucrose-negative species, V. parahaemolytictts and V. hollisae, are halophilic; Vibrio parahaemolyticus produces ornithine and lysine decarboxylases (3). Vibrio mimicus is similar to V. cholerae but is Voges-Proskauer-negative and polymyxin susceptible (1). Both V. fluvialis and V. mhnicus have been isolated from water, shellfish, and diarrheal stools• Infection is often associated with eating raw or poorly cooked seafood (1, 2, 3). When questioned, the patient remembered eating large amounts of seafood two days before his illness• His disease was unusual because terminal ileitis was documented and two different Vibrio spp. were isolated from his feces.
Case Report
Vibrio fluvialis and Vibrio mimicus Associated with Terminal Ileitis Donna Watsky, M.T. (A.S.C.P.), S.M. Microbiology Supervisor Anne Arundel General Hospital Franklin and Cathedral Streets Annapolis, Maryland 21401 A 30-yr-old male was admitted to Anne Arundel General Hospital with a diagnosis of appendicitis. He suffered severe diffuse abdominal pain localized to the right lower quadrant and had an elevated white blood cell count. He subsequently developed nausea, vomiting, and nonbloody, watery diarrhea. The day following admission, an exploratory laparotomy and appendectomy were performed. A normal appendix was removed; bilestained fluid was found in the abdomen and inflammatory changes were seen in two feet of the terminal ileum. The day after surgery he continued to have abdominal cramping, which was relieved the next day by the onset of diarrhea. A gastroenterologist then saw the patient and suspected bacterial enteritis. Stool cultures were collected, and the patient was started on treatment with tetracycline. He improved and was discharged four days later• A gram-stained smear of the stool revealed small gram-negative rods. The stool specimen was inoculated onto a sheep blood agar plate, Hektoen en'/~-ric (HE) agar, XLD agar, bismuth sulfite agar, MacConkey agar, Campy-
© 1983by ElsevierSciencePublishingCo., Inc.
Table 1 Disk Diffusion Susceptibility
Test Ampicillin Carbenicillin Tobramycin Gentamicin Cephalothin Chloramphenicol Streptomycin Tetracycline Kanamycin
V. fluvialis V. mimicus I I S S R S S S S
S S S S S S S S S
References 1. Davis, B. R. el ai. 1981. Characterization of biochemically atypical Vibrio cholerae strains and designation of a new pathogenic species, Vibrio mimicus. J. Clin. Microbiol. 14:631-639. 2. Tacket, C. O. et al. 1982. Diarrhea associated with Vibrio fluvialis in the United States. J. Clin. Microbiol. 16:991-992. 3. yon Graevenitz, A. 1983• Clinical microbiology of Vibrio species• Clin. Microbiol. Newsl. 5:41-43.
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9. Steere, A. C., T. F. Broderick, and S. E. Malawista. 1978. Erythema chronicum migrans and Lyme arthritis: epidemiologic evidence for a tick vector. Am. J. Epidemiol. 108: 312-321. 10. Steere, A. C. et al. 1979. Chronic Lyme arthritis: clinical and immunogenetic differentiation from rheumatoid
arthritis. Ann. Intern. Med. 90: 286-291. 11. Steere, A. C. et al. 1983• The spirochetal etiology of Lyme disease. N. Engl. J. Med. 308:733-740. 12. Steere, A. C. et al. 1977. Erythema chronicum migrans and Lyme arthritis: the enlarging clinical spectrum. Ann. Intern. Med. 86:685-698.
13. Steere, A. C. et al. 1980. Antibiotic therapy in Lyme disease. Ann. Intern. Med. 93:1-8. 14. Steere, A. C. et al. 1977. Lyme arthritis: an epidemic of oligoarticular arthritis in children and adults in three Connecticut communities. Arthritis Rheum. 20:7-17.
lobacter agar (Butzler formulation), and thiosulfate citrate bile salts (TCBS) agar plates, and GN broth and phosphate buffered saline for Yersinia cold enrichment. No Sabnonella, Shigella, Campylobacter, or Yersinia was isolated. Two types of Vibrio-like colonies grew on TCBS agar. One type produced yellow colonies (sucrose fermenter), the other type blue-green colonies. Both colony types were inoculated into the API 20E system (Analytab Products Inc., Plainview, New York) and incubated overnight at 37°C. The API 20E profile number for the sucrose-fermenting organism was 1046126, and the identification was Vibrio fluvialis confirmed by the State of Maryland Department of Health Laboratory. The profile number for the sucrose-negative organism was 5046104, and the identification was V. mimicus--confirmed by the Centers for Disease Control. Disk diffusion susceptibility tests were performed (Table 1). Five Vibrio species are associated
with diarrhea. All, except Vibrio hollisae, grow well on TCBS agar (2). Vibrio cholerae and V. fluvialis are sucrose fermenters and produce yellow colonies. Vibrio parahaemolyticus and V. minlictts do not ferment sucrose and thus produce blue-green colonies on TCBS agar. Vibriofluvialis is halophilic and ferments arabinose, whereas V. cholerae does not require salt or ferment arabinose. Two of the sucrose-negative species, V. parahaemolytictts and V. hollisae, are halophilic; Vibrio parahaemolyticus produces ornithine and lysine decarboxylases (3). Vibrio mimicus is similar to V. cholerae but is Voges-Proskauer-negative and polymyxin susceptible (1). Both V. fluvialis and V. mhnicus have been isolated from water, shellfish, and diarrheal stools• Infection is often associated with eating raw or poorly cooked seafood (1, 2, 3). When questioned, the patient remembered eating large amounts of seafood two days before his illness• His disease was unusual because terminal ileitis was documented and two different Vibrio spp. were isolated from his feces.
Case Report
Vibrio fluvialis and Vibrio mimicus Associated with Terminal Ileitis Donna Watsky, M.T. (A.S.C.P.), S.M. Microbiology Supervisor Anne Arundel General Hospital Franklin and Cathedral Streets Annapolis, Maryland 21401 A 30-yr-old male was admitted to Anne Arundel General Hospital with a diagnosis of appendicitis. He suffered severe diffuse abdominal pain localized to the right lower quadrant and had an elevated white blood cell count. He subsequently developed nausea, vomiting, and nonbloody, watery diarrhea. The day following admission, an exploratory laparotomy and appendectomy were performed. A normal appendix was removed; bilestained fluid was found in the abdomen and inflammatory changes were seen in two feet of the terminal ileum. The day after surgery he continued to have abdominal cramping, which was relieved the next day by the onset of diarrhea. A gastroenterologist then saw the patient and suspected bacterial enteritis. Stool cultures were collected, and the patient was started on treatment with tetracycline. He improved and was discharged four days later• A gram-stained smear of the stool revealed small gram-negative rods. The stool specimen was inoculated onto a sheep blood agar plate, Hektoen en'/~-ric (HE) agar, XLD agar, bismuth sulfite agar, MacConkey agar, Campy-
© 1983by ElsevierSciencePublishingCo., Inc.
Table 1 Disk Diffusion Susceptibility
Test Ampicillin Carbenicillin Tobramycin Gentamicin Cephalothin Chloramphenicol Streptomycin Tetracycline Kanamycin
V. fluvialis V. mimicus I I S S R S S S S
S S S S S S S S S
References 1. Davis, B. R. el ai. 1981. Characterization of biochemically atypical Vibrio cholerae strains and designation of a new pathogenic species, Vibrio mimicus. J. Clin. Microbiol. 14:631-639. 2. Tacket, C. O. et al. 1982. Diarrhea associated with Vibrio fluvialis in the United States. J. Clin. Microbiol. 16:991-992. 3. yon Graevenitz, A. 1983• Clinical microbiology of Vibrio species• Clin. Microbiol. Newsl. 5:41-43.
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