1. Plesiomonas shigelloides
OAN : NPN : 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: ) or Plesiomonas shigelloides (OR=1.9, 95%CI: ). 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: ) whereas the participants who were students, unemployed or worked at home tended to have lower risk (OR=0.7, 95%CI: ). 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 % 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 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 ( )
0.058
83 (31.2)
0.7 ( )
0.033
Adult (age≥18yrs),n (%)
167 (64.7)
1.4 ( )
0.009
188 (70.7)
1.9 ( )
< 0.001
Age, mean (SD), years
31.8 (21.1)
34.7 (20.1)
Occupation, n %
Farmer
114 (44.2)
1.1 ( )
0.436
126 (47.4)
1.3 ( )
0.057
Government employee
3 (1.2)
0.6 ( )
0.475
9 (3.4)
2.0 ( )
Business worker
13 (5.0)
1.1 ( )
0.681
21 (7.9)
2.0 ( )
0.005
Non-government employee
0.8 ( )
1.000
4 (1.5)
1.1 ( )
0.787
Unemployed
124 (48.1)
0.9 ( )
0.305
110 (41.4)
0.7 ( )
0.001
Other
10 (3.9)
1.4 ( )
0.336
7 (2.6)
0.9 ( )
0.768
Diarrhea in the last 10 days, n (%)
258 (100.0)
266 (100.0)
Symptom, n (%)
Abdominal pain
237 (91.9)
2.0 ( )
0.002
242 (91.0)
1.8 ( )
0.008
Fever/Chills
14 (5.4)
0.6 ( )
0.046
11 (4.1)
0.4 ( )
Abdominal distention
127 (49.2)
0.9 ( )
0.400
127 (47.7)
0.8 ( )
0.172
Vomit
0.5 ( )
0.025
Bloody stool
12 (4.7)
0.9 ( )
0.746
16 (6.0)
1.2 ( )
0.459
Mucus stool
87 (33.7)
1.3 ( )
0.038
99 (37.2)
1.6 ( )
Source of drinking and cooking water, n (%)
Open well
170 (65.9)
1.0 ( )
0.722
175 (65.8)
1.1 ( )
0.745
Protected/pumping well
94 (36.4)
0.824
93 (35.0)
1.0 ( )
0.762
Rain water
29 (11.2)
0.9 ( )
0.450
25 (9.4)
0.7 ( )
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 ( )
0.941
18 (6.8)
0.8 ( )
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 ( )
0.718
146 (54.9)
1.3 ( )
0.086
18 (7.0)
0.8 ( )
0.381
12 (4.5)
0.5 ( )
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 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.