Plesiomonas shigelloides OAN : 3159 NPN : 1672 Session C Epidemiologic features of Diarrheal Disease due to Aeromonas spp. and Plesiomonas shigelloides Infections in Kampong Cham, Cambodia Agus Rachmat1, Malen Luy1, Chenda Yi1, Heng Sopheab2, Chhea Chhorvann2, Men Bunnan3, Jamal Dejli1, Michael Prouty1, and Andrew Vaughn1 1 US Naval Medical Research Unit #2 Det. Phnom Penh; 2 National Institute of Public Health Cambodia; 3 Kampong Cham Provincial Health Department INTRODUCTION Study data indicates that adults have a higher risk of being infected with Aeromonas spp. (OR=1.4, 95%CI: 1.1-1.9) or Plesiomonas shigelloides (OR=1.9, 95%CI: 1.5-2.6). Subjects who worked in retail settings (shop owners or workers) also had a higher risk of being infected with Plesiomonas shigelloides (OR=2.0, 95%CI: 1.2-3.3) whereas the participants who were students, unemployed or worked at home tended to have lower risk (OR=0.7, 95%CI: 0.5-0.8). Abdominal pain and mucus laden stool are the two symptoms significantly associated with the infection of these two pathogens (p< 0.05). Lack of access to clean drinking water (filtered or boiled) or lack of sanitary toilet facilities were identified as increased risk factors for positive stools. 52.3% and 70.2% of Aeromonas spp. positive subjects and 55.6% and 70.3% of Plesiomonas shigelloides positive subjects did not have access to clean water or toilet facilities, respectively. Diarrheal diseases is the second leading cause of morbidity and mortality in developing countries, including Cambodia. Bacterial diarrhea is one of major infectious diseases in Cambodia, where families are at high risk for the disease as a result of living in poor sanitary conditions and not having access to clean water. Aeromonas spp. and Plesiomonas shigelloides commonly isolated from stools of patients with diarrhea and have become increasingly recognize as human enteropathogens. METHODS A prospective cohort study with ongoing recruitment. ~5,000 subjects were recruited from two different populations, one from rural locations (Chong Angkrang and La Ork village) and the other near a peri-urban areas (Trapeang Chhuk and Roveang village) . Study participants were interviewed weekly for recent symptoms (less than 10 days) of diarrhea (3 or more loose stool within 24 hours or 2 loose stool associated with gastrointestinal complaint within 24 hours). Those with diarrhea were asked to submit fresh stools. Study subjects with diarrhea were interviewed during the subsequent 60 days to determine disease outcome including hospitalization, death, or resolution. Table. Baseline Characteristics, Aug 2012 - Mar 2015 (N = 2,603) Parameter Aeromonas sp. OR (95%CI) Sig. Plesiomonas shigelloides Total isolated, n 258 266 Male sex, n (%) 82 (31.8) 0.8 (0.6-1.0) 0.058 83 (31.2) 0.7 (0.6-1.0) 0.033 Adult (age≥18yrs),n (%) 167 (64.7) 1.4 (1.1-1.9) 0.009 188 (70.7) 1.9 (1.5-2.6) < 0.001 Age, mean (SD), years 31.8 (21.1) 34.7 (20.1) Occupation, n % Farmer 114 (44.2) 1.1 (0.9-1.5) 0.436 126 (47.4) 1.3 (1.0-1.7) 0.057 Government employee 3 (1.2) 0.6 (0.1-2.0) 0.475 9 (3.4) 2.0 (0.9-4.4) Business worker 13 (5.0) 1.1 (0.6-2.1) 0.681 21 (7.9) 2.0 (1.2-3.3) 0.005 Non-government employee 0.8 (0.2-2.7) 1.000 4 (1.5) 1.1 (0.3-3.2) 0.787 Unemployed 124 (48.1) 0.9 (0.7-1.1) 0.305 110 (41.4) 0.7 (0.5-0.8) 0.001 Other 10 (3.9) 1.4 (0.7-2.8) 0.336 7 (2.6) 0.9 (0.4-2.0) 0.768 Diarrhea in the last 10 days, n (%) 258 (100.0) 266 (100.0) Symptom, n (%) Abdominal pain 237 (91.9) 2.0 (1.3-3.3) 0.002 242 (91.0) 1.8 (1.1-2.8) 0.008 Fever/Chills 14 (5.4) 0.6 (0.3-1.0) 0.046 11 (4.1) 0.4 (0.2-0.8) Abdominal distention 127 (49.2) 0.9 (0.7-1.2) 0.400 127 (47.7) 0.8 (0.6-1.1) 0.172 Vomit 0.5 (0.3-1.0) 0.025 Bloody stool 12 (4.7) 0.9 (0.5-1.7) 0.746 16 (6.0) 1.2 (0.7-2.2) 0.459 Mucus stool 87 (33.7) 1.3 (1.1-1.8) 0.038 99 (37.2) 1.6 (1.2-2.1) Source of drinking and cooking water, n (%) Open well 170 (65.9) 1.0 (0.8-1.4) 0.722 175 (65.8) 1.1 (0.8-1.4) 0.745 Protected/pumping well 94 (36.4) 0.824 93 (35.0) 1.0 (0.7-1.3) 0.762 Rain water 29 (11.2) 0.9 (0.6-1.3) 0.450 25 (9.4) 0.7 (0.4-1.1) 0.100 Tap 1 (0.4) - 0.567 0 (0.0) Tanker truck 2 (0.8) 0.222 0.611 Drinking water storage, n (%) Kettle 21 (8.1) 1.0 (0.6-1.6) 0.941 18 (6.8) 0.8 (0.5-1.3) 0.351 Jar 0.519 Large water clay 203 (78.7) 0.812 200 (75.2) 0.225 Plastic bottle 126 (48.8) 1.0 (0.7-1.2) 0.718 146 (54.9) 1.3 (1.0-1.6) 0.086 18 (7.0) 0.8 (0.5-1.4) 0.381 12 (4.5) 0.5 (0.3-0.9) 0.016 Do with water before drink, n (%) Nothing 135 (52.3) 148 (55.6) Boil 78 (30.2) 87 (32.7) Add chemicals Filter 44 (17.1) 29 (10.9) Sanitation, n (%) Modern flush toilet Toilet with septic tank 76 (29.5) 78 (29.3) Traditional pit No facility 181 (70.2) 187 (70.3) RESULTS Study subjects were comprised of 2,921 adults and 1,749 children (aged < 18 years old). There were 258 Aeromonas spp. and 266 Plesiomonas shigelloides isolates identified from 2,603 specimens collected and tested between August 2012 and March 2015. The highest rate for Aeromononas spp. positive stools was found in Trapeang Chhuk village (215/1776 stools) whereas the highest rate of Plesiomonas shigelloides was found in Chong Angkrang (34/273 stools). CONCLUSION Aeromonas spp. and Plesiomonas shigelloides are common potential pathogens isolated from Cambodian subjects diagnosed with acute diarrhea. The prevalence of these pathogens appears to be correlated with inadequate access to potable water and sanitary toilet facilities. Disclaimer : This work was prepared as part of the author’s official duties. Title 17 U.S.C. 105 provides that “Copyright protection under this title is not available for any work of the US Government”. Title 17 U.S.C defines a US Government work as a work prepared by a military service member or employee of the US Government as part of that person’s official duties. This work was supported by the US Armed Forces Health Surveillance Center-Global Emerging Infectious Surveillance Operation. This study was approved by Institutional Review Boards at the US Naval Medical Research Center, Silver Spring, MD and the Cambodian National Ethics Committee for Human Research. Each participant provided written informed consent.