Diversidad molecular de variantes patogénicas de Vibrio parahaemolyticus en el Perú / Molecular diversity in pathogenic variants of vibrio parahaemolyticus in Peru

RESUMEN Con el objetivo de determinar la diversidad de variantes patogénicas de Vibrio parahaemolyticus en el Perú durante el periodo 1995-2017, se analizaron 102 genomas peruanos (97 clínicos y 5 ambientales) empleando el esquema de tipificación multilocus y BLASTn para la búsqueda de genes de virulencia. Se identificaron 15 tipos de secuencia diferentes, encontrándose que el genotipo ST3, perteneciente al clon pandémico, fue el más abundante, con 52% (n=53); seguido por el ST120, con 23,5% (n=24); y el complejo clonal CC345, con 11,8% (n=12). Un total de 89 cepas analizadas presentaron genes que codifican la isla de patogenicidad VpaI-7 (87,3%), mientras que 96 presentaron el gen tdh (94,1%), y 6, el trh (5,9%). Durante el periodo evaluado, se resalta la predominancia del ST3, causante de un importante brote en el pasado del Perú, además de otros genotipos patógenos que representan un riesgo latente en salud pública asociado al consumo de alimentos marinos.

ABSTRACT During the period from 1995 to 2017, in order to determine the diversity of Vibrio parahaemolyticus pathogenic variants in Peru, 102 Peruvian genomes (97 from a hospital setting and 5 from an out-of-hospital setting) were analyzed using the multilocus typification scheme and BLASTn in the search for virulence genes. Fifteen different sequence types were identified. It was found that the ST3 genotype, which is found in the pandemic clone, was the most abundant, with 52% (n=53); followed by ST120, with 23.5% (n=24); and the CC345 clonal complex, with 11.8% (n=12). A total of 89 analyzed strains presented genes encoding the pathogenicity island VpaI-7 (87.3%), while 96 presented the tdh gene (94.1%), and 6 the trh gene (5.9%). The ST3 genotype was the predominant one during the evaluated period, this genotype was the cause of a major outbreak in Peru's past history. Other pathogenic genotypes found represent a latent public health risk associated with seafood consumption.

First isolation of Vibrio vulnificus causing sepsis in Santa Catarina, Brazil / Primeiro isolamento de Vibrio vulnificus causando sepse em Santa Catarina, Brasil

Vibrio vulnificus is a bacterium present in natural marine environments that causes infections in immunocompromised people. Sepsis in humans caused by this microorganism is usually accompanied by bullous skin lesions. In the present study we report a case of infection caused by this bacterium affecting a diabetic man, 74 years old, who fell overboard and hurt his leg. The identification of the V. vulnificus was made in the blood culture sample. This is the first report of isolation of V. vulnificus in Santa Catarina, Brazil, showing the dissemination of this bacterium in warm seawater over the world (AU)

Vibrio vulnificus é uma bactéria que se desenvolve em ambientes marinhos naturais e causa infecção em pessoas imunocomprometidas. Sepse em humanos causada por esse microrganismo é geralmente acompanhada por lesões bolhosas da pele. Relatamos um caso de infecção causada por esta bactéria que afetou um homem diabético, de 74 anos, que caiu ao mar e machucou a perna. A identificação do V. vulnificus foi feita na amostra de hemocultura. Este é o primeiro relato de isolamento de V. vulnificus em Santa Catarina, Brasil, elucidando a disseminação das bactérias de ambiente marítimo de água quente pelo mundo (AU)

Gastroenteritis aguda causada por Vibrio cholerae no-O1, no-O139 que porta una región homologa a la isla de patogenicidad VpaI-7 / Acute gastroenteritis caused by a Vibrio cholerae non-O1, non-O139 strain harboring a genetic region homologous to the VpaI-7 pathogenicity island

Pathogenic Vibrio cholerae isolates, the etiologic agents of cholera, generally express one of two O antigens (O1 or O139). Most environmental isolates are nonpathogenic and are referred to as "non-O1, non-O139". However some V. cholerae non-O1, non-O139 strains are clearly pathogenic and have caused outbreaks or sporadic cases of gastroenteritis and extraintestinal infections in humans. We report a case of acute gastroenteritis by a V. cholerae non-O1, non-O139 harboring a genetic region homologous to a segment of the VpaI-7 V. parahaemolyticus pathogenicity island.

Cepas patogénicas de Vibrio cholerae, el agente causal del cólera, expresan generalmente uno de dos antígenos O (denominados O1 u O139). La mayoría de las cepas ambientales son no patogénicas y corresponden al tipo denominado "no-O1, no-O139". Sin embargo, algunas cepas de este tipo son claramente patogénas y han causado brotes de gastroenteritis e infecciones extra-intestinales en humanos. Se reporta un caso clínico de gastroenteritis aguda causado por una cepa de V. cholerae no-O1, no-O139 que contiene en su genoma una región homóloga a un segmento de la isla de patogenicidad VpaI-7 descrita previamente en V. parahaemolyticus.

Bacteriemia por Vibrio cholerae no-O1, no-O139 en un paciente en hemodiálisis crónica / Non-O1, non-O139 Vibrio cholerae bacteremia in a chronic hemodialysis patient

Vibrio cholerae no-O1, no-O139 es un agente poco frecuente como causal de bacteriemias y no hay informes que documenten su presencia en pacientes en hemodiálisis crónica. Se describe el caso de una paciente en hemodiálisis crónica que presentó un cuadro de sepsis, por lo cual inició un tratamiento con vancomicina y ceftacidima. Al cabo de seis horas y media de incubación en el sistema BACT/ALERT de hemocultivo, se evidenció la presencia de bacilos curvos gram negativos, posteriormente identificados como Vibrio cholerae mediante pruebas bioquímicas convencionales y el uso de los kits API 20 NE y VITEK 2. La evaluación del serogrupo y de la presencia de factores de patogenicidad, realizada en el laboratorio de referencia, determinó que el microorganismo hallado pertenecía al serogrupo no-O1, no-O139. No se detectó la toxina de cólera, tampoco el factor de colonización ni la toxina termoestable. El aislamiento presentó sensibilidad frente a ampicilina, trimetoprima-sulfametoxazol, ciprofloxacina, tetraciclina, ceftacidima y cefotaxima por el método de difusión con discos y por VITEK 2. La paciente cumplió 14 días de tratamiento con ceftacidima endovenosa, con evolución favorable.

Non-O1, and non-O139 Vibrio cholerae is an infrequent cause of bacteremia. There are no reports of such bacteremia in chronic hemodialysis patients. This work describes the case of a chronic hemodialysis patient that had an episode of septicemia associated with dialysis. Blood cultures were obtained and treatment was begun with vancomycin and ceftazidime. After 6.5 hours of incubation in the Bact/Alert system there is evidence of gram-negative curved bacilli that were identified as Vibrio cholerae by conventional biochemical tests, API 20 NE and the VITEK 2 system. This microorganism was sent to the reference laboratory for evaluation of serogroup and virulence factors and was identified as belonging to the non-O1 and non-O139 serogroup. The cholera toxin, colonization factor and heat-stable toxin were not detected. The isolate was susceptible to ampicillin, trimethoprim-sulfamethoxazole, ciprofloxacin, tetracycline, ceftazidime and cefotaxime by the disk diffusion method and the VITEK 2 system. The patient received intravenous ceftazidime for a 14 day- period and had a favorable outcome.

Isolation and experimental infection with Vibrio alginolyticus in the sea horse, Hippocampus reidi Ginsburg, 1933 (Osteichthyes: Syngnathidae) in Brazil / Isolamento e infecção experimental de Vibrio alginolyticus em cavalo-marinho, Hippocampus reidi Ginsburg, 1933 (Osteichthyes: Syngnathidae) no Brasil

The aim of this study was to evaluate the pathogenicity of Vibrio alginolyticus isolated from an outbreak of sea horse Hippocampus reidi reared in the State of Santa Catarina, Brazil, by experimental infection. Sea horses with necrosis on the mouth epithelium were collected from aquaria at the Aquaculture Department, UFSC and the bacterium isolated from the mouth, liver, heart and blood in tiosulphate citrate bilesalt sucrose agar broth. The strains were identified by API 20E kit with 99.1 percent probability as Vibrio alginolyticus. Twelve adult sea horses (9.63 ± 2.42 g and 15.12 ± 0.87 cm) were distributed in six aquaria of 10 L capacity with aerated sea water. Fish from three aquaria were submitted to an immersion bath in a solution containing 1.0 × 10(7) CFU of V. alginolyticus/mL for 15 minutes. Fish from the other three aquaria received the same procedure without bacteria. Twenty four hours after this challenge, 100 percent mortality was observed in the animals infected with V. alginolyticus. No mortality was observed in non-infected fish. Hyperplasia, displacement and fusion of secondary lamellae of the gills; leukocyte infiltration and necrotic foci in the kidney; hyperplasia, sinusoidal deformation and necrotic foci in the liver were observed in histopathological analysis. The V. alginolyticus isolated in this study was pathogenic to H. reidi and constitutes an important sanitary problem to its culture.

Foi avaliado por meio de infecção experimental a patogenicidade de Vibrio alginolyticus isolado de um surto de enfermidade em cavalo-marinho Hippocampus reidi cultivado no Estado de Santa Catarina, Brasil. Os peixes com necroses no epitélio bucal foram coletados em aquários do Departamento de Aquicultura, UFSC e as bactérias isoladas da boca, fígado, coração e sangue em meio Agar tiossulfato citrato bile sacarose. Os isolados foram identificados pelo kit API 20E como Vibrio alginolyticus com 99,1 por cento de probabilidade. Doze peixes adultos (9,63 ± 2,42 g e 15,12 ± 0,87 cm) foram distribuídos em seis aquários de 10 L com água marinha e aeração. Peixes de três aquários foram submetidos a um banho de imersão por 15 minutos em uma solução contendo 1,0 × 10(7) UFC de V. alginolyticus/mL. Nos outros três aquários realizou-se o mesmo procedimento sem a bactéria. Vinte e quatro horas após o desafio, 100 por cento de mortalidade foi observada nos animais infectados com V. alginolyticus. Não houve mortalidade nos peixes não infectados. Nas análises histopatológicas, foi observado hiperplasia, deslocamento do epitélio e fusão das lamelas secundárias das brânquias; infiltração de leucócitos e necrose no rim; hiperplasia, deformação sinusoidal e necrose no fígado nos animais desafiados com V. alginolyticus. O V. alginolyticus isolado neste estudo foi patogênico para H. reidi, constituindo-se de um importante problema para seu cultivo.

Inhibition of shrimp pathogenic vibrios by extracellular compounds from a proteolytic bacterium Pseudomonas sp. W3 / Inhibición de vibrios patógenos del camarón por compuestos extracelulares de una bacterias proteolítica Pseudomonas sp.W3

Pseudomonas sp. W3, a bacterium known to produce an extracellular alkaline protease, secreted secondary metabolites that inhibited pathogenic bacteria responsible for shrimp luminous vibriosis disease. Antivibrio compounds in the culture supernatant or culture filtrates (0.45 um and 0.22 um) of the isolate W3 were tested using an agar well diffusion method on a number of pathogenic vibrios. Vibrio harveyi PSU 2015 a pathogenic isolate was the most sensitive strain. The effectiveness of preparations from the isolate W3 against V. harveyi PSU 2015, and V. cholerae PSSCMI 0062 was in the order of culture supernatant > 0.45 um culture filtrate > 0.22 um culture filtrate. These extracellular antivibrio compounds also lysed both dead and living cells of V. harveyi PSU 2015. Results of the partial characterization tests indicated that there was some particulate antivibrio compound that was destroyed by treatment with enzymes particularly alpha-chymotrypsin, autoclaving at 121ºC for 15 min and was mostly removed by filtration through a 0.22 µm filter. Most of the inhibitory compounds were of small molecular weight able to pass through a 0.22 um filter and were resistant to treatment with various enzymes, pH values between 4-8 and temperatures up to 121ºC for 30 min. The optimum pH for the antivibrio activity in the 0.45 um culture filtrate was between pH 6-7.

Bacteriemia por Vibrio parahaemolyticus: reporte de caso y revisión de la literatura / Vibrio parahaemolyticus bacteremia: case report and literature review

Vibrio parahaemolyticus is a facultative anaerobio gram negative rod responsible of sea food-associated diarr-hoea. Although less common, it also causes wound infections and bacteraemia. We present a case of bacteraemia by this agent and a review of the literature.

Vibrio parahaemolyticus es un bacilo gram negativo, anaerobio facultativo, responsable de brotes de síndrome diarreico agudo por ingestión de mariscos crudos o mal cocidos contaminados. Ocasionalmente. se ha reportado asociado a infección de heridas y sepsis. Se reporta un caso clínico de bacteriemia por este microorganismo y se realiza una revisión de la literatura.

Caracterización de aislamientos de Vibrio cholerae no-O1, no-O139 asociados a cuadros de diarrea / Characterization of Vibrio cholerae non-O1 and non-O139 isolates associated with diarrhea

La infección por Vibrio cholerae, el agente causal del cólera, se trasmite al hombre por ingestión de agua y alimentos contaminados. Aunque son los serogrupos O1 y O139 los que habitualmente se asocian al cólera epidémico, los aislamientos de otros serogrupos también son causales de gastroenteritis e infecciones extra-intestinales. Durante el período 2003-2005, se investigó la presencia de V. cholerae en la materia fecal de niños con diarrea atendidos en el Hospital del Niño Jesús, Tucumán. Se recuperaron 34 aislamientos de V. cholerae no-O1, no-O139. Se determinaron sus perfiles de virulencia por PCR, la sensibilidad a los antimicrobianos y la diversidad genética por electroforesis en campo pulsado. Se obtuvieron ocho perfiles de virulencia, aunque ningún aislamiento fue positivo para la toxina colérica ni para la toxina termoestable. Cuatro aislamientos fueron positivos para el sistema de secreción de tipo tres. El 17,6% de los aislamientos fueron resistentes o de sensibilidad intermedia a ampicilina y el 5,9% fueron resistentes a trimetoprima-sulfametoxazol. Los aislamientos resultaron muy diversos: se hallaron 27 patrones distintos en 29 aislamientos tipificables por electroforesis en campo pulsado. A pesar de su baja incidencia, V. cholerae continúa siendo un agente causal de diarrea en niños, los que se ven afectados por una amplia variedad de cepas circulantes.

Vibrio cholerae, etiologic agent of cholera, is transmitted to humans by ingestion of contaminated food or water. Even though serogroups O1 and O139 are the ones usually associated to epidemic cholera, isolates from other serogroups also cause gastroenteritis and extraintestinal infections. During the period 2003-2005, presence of V. cholerae in stools was investigated in children with diarrhea that seaked assistance at the Niño Jesús Hospital in Tucumán. Thirty four isolates of V. cholerae non-O1, non-O139 were recovered. We characterized the isolates studying its virulence factors by PCR, antimicrobial susceptibility patterns and genetic diversity by pulsed-field gel electrophoresis. Eight virulence patterns were obtained although no isolate was positive for the cholera toxin or the thermostable toxin. Four isolates were positive for the type three secretion system. The 17.6% of the isolates were resistant or intermediate to ampicillin and 5.9% were resistant to trimethoprim-sulfamethoxazole. By SfiI-PFGE, all isolates were genetically very diverse, as 27 different patterns were identified in 29 typeable isolates by pulsed-field gel electrophoresis. Although it has a low incidence, V. cholerae continues to be a causative agent of diarrhea in children, who are affected by a variety of circulating strains of V. cholerae non-O1, non-O139.

Vibrio vulnificus infection in São Paulo, Brazil: case report and literature review

Non cholera Vibrio may cause conjunctivitis, wound infection, gastroenteritis and serious sepsis. Transmission to men is through contact with skin, mucosa or wounds exposed to marine water, and consumption of certain barely cooked or raw seafood, more frequently in the summer. This is one of the first cases of severe infection related to Vibrio vulnificus described in Brazil. The patient was an old man, who ingested seafood in Guarujá, a seashore city near São Paulo, 3 days before hospitalization. He was admitted to the emergency room in an ill state with septic shock. On 2 sets of blood culture a highly virulent microorganism was isolated, Vibrio vulnificus, which leads to sepsis and frequently to death in susceptible patients. The objective of this report was to use this case to discuss clinical aspects, microbiological diagnosis and treatment of the infection caused by this agent, besides the review of epidemiology, associated risk factors and prevention before consuming or getting in contact with seafood, especially in patients with greater susceptibility to this kind of infection.

Septicemia caused by Vibrio cholerae O1 biotype El Tor, in São Paulo, Brazil

We reported a case of septicemia by Vibrio cholerae O1, in São Paulo, Brazil. A 70-year-old male patient, living in an urban area, entered the emergency service having sepsis, dying 12 hours later. Blood culture was positive for Vibrio cholerae O1. This is the first case of bacteremia by Vibrio cholerae O1 reported in South America.

Characterization of vibrio parahaemolyticus isolated from coastal seawater in peninsular Malaysia.

Twenty-one Vibrio parahaemolyticus isolates representing 21 samples of coastal seawater from three beaches in peninsular Malaysia were found to be sensitive to streptomycin, norfloxacin and chloramphenicol. Resistance was observed to penicillin (100%), ampicillin (95.2%), carbenicilin (95.2%), erythromycin (95.2%), bacitracin (71.4%), cephalothin (28.6%), moxalactam (28.6%), kanamycin (19.1%), tetracycline (14.3%), nalidixic acid (9.5%) and gentamicin (9.5%). Plasmids of 2.6 to 35.8 mDa were detected among plasmid-containing isolates. All isolates carried the Vp-toxR gene specific to V. parahaemolyticus and were negative for the tdh gene, but only one isolate was positive for the trh gene. DNA fingerprinting of the isolates using ERIC-PCR and PFGE showed that the isolates belong to two major clonal groups, with several isolates from different locations in the same group, indicating the presence of similar strains in the different locations.

Revisión y recomendaciones para el manejo de diarrea por Vibrio parahaemolyticus / Review and guidelines for treatment of diarrhea caused by Vibrio parahaemolyticus

A contar del año 1998 se han presentado en Chile tres brotes epidémicos por Vibrio parahaemolyticus, el último de ellos durante el verano del 2005, que afectó a más de 10.000 personas. Los afectados presentaron un cuadro clínico caracterizado por diarrea, náuseas, vómitos, dolor abdominal y fiebre; 6 por ciento de los casos tuvo leucocitos fecales positivos y un paciente falleció. La cepa predominante en los tres brotes ha sido la pandémica O3: K6. El diagnóstico de V. parahaemolyticus se realizó con la confirmación microbiológica de las cepas y tipificación o por asociación epidemiológica. Las cepas fueron susceptibles in vitro a tetraciclina, cefalosporinas de tercera generación, quinolonas y cloranfenicol no observándose susceptibilidad a ampicilina. Todos los casos se asociaron al consumo de mariscos crudos o insuficientemente cocidos. Por la repercusión de este brote, el Ministerio de Salud impulsó la formación de una comisión multidisciplinaria para actualizar los aspectos epidemiológicos, clínicos y microbiológicos, y elaborar una guía de recomendaciones en el manejo de esta infección.

Virulence factors of non-O1 non-O139 Vibrio cholerae isolated in Córdoba, Argentina / Factores de virulencia de Vibrio cholerae no-O1 no-O139 aislados en Córdoba, Argentina

V. cholerae non-O1 non-O139 serogroups isolated from clinical and environmental sources in Córdoba, Argentina, were analyzed for the presence and expression of virulence genes. Most of the strains studied contained the genes toxR and hlyA, but lacked ctxA, zot, ace, tcpA and stn. The culture supernatants were tested for hemolytic and cytotoxic activity. The enterotoxic potential of the strains was studied in a rabbit ileal loop assay and their genetic profiles were compared by PFGE. The environmental strains varied in their virulence phenotype and showed no-clonal relationships. The clinical strains were highly enterotoxic, hemolytic, proteolytic and showed indistinguishable PFGE profiles, although they differed in their cytotoxic activity. This is the first description, using cell culture and “in vivo” studies, of the virulence properties of non-O1 non-O139 V. cholerae from Argentina.

En este trabajo se analizó la presencia y expresión de genes de virulencia en V. cholerae no-O1 no-O139 de origen clínico y ambiental, aislados en Córdoba, Argentina. La mayoría de las cepas estudiadas contiene los genes toxR y hlyA, pero no ctxA, zot, ace, tcpA y stn. Se analizó la actividad hemolítica y citotóxica de estas cepas en los sobrenadantes de cultivo, así como su potencial enterotóxico en ensayos de asa ileal ligada de conejo. Además, los aislamientos fueron comparados por sus perfiles genéticos en PFGE. Las cepas del medio ambiente mostraron variación en su fenotipo de virulencia y no mostraron relación clonal. Las cepas clínicas fueron muy enterotóxicas, hemolíticas, proteolíticas y mostraron perfiles indistinguibles de PFGE, aunque mostraron diferencias en su actividad citotóxica. En este trabajo se describen por primera vez, utilizando ensayos de cultivo celular e “in vivo”, propiedades de virulencia de V. cholerae no-O1 no-O139 aislados en Argentina.

Hemolysins and plasmid profiles of Vibrio parahaemolyticus.

Forty clinical isolates of Vibrio parahaemolyticus were studied for the production of the thermostable direct hemolysin (TDH), and the TDH-related hemolysin (TRH) including the respective encoding genes, tdh and trh. The presence of TDH and its encoding genes were found amongst 95% of the strains, whereas the TRH was absent amongst these isolates. Thirty-two isolates were found to be plasmid-free, whereas eight isolates possessed plasmids with sizes ranging from 2.4 > or = 23 kb. Using a DNA probe coding for the homologous region of the tdh and trh, it was found that the tdh genes were present on the chromosomal DNA.

Acute diarrhoea caused by Vibrio mimicus in Calcutta.

Out of 539 acute diarrhoea cases studied, Vibrio mimicus was isolated as a sole pathogen in the faeces of 7 (1.3%) cases. The chief clinical presentations of the seven cases were watery diarrhoea and vomiting. Bloody diarrhoea was observed in 2 (28.5%), abdominal pain in 2 (28.57%) and fever in one (14.29) cases. All cases could be effectively treated with ORS except 3 (42.85%) cases who required IV Ringer's lactate. All V. mimicus strains isolated in the study were uniformly susceptible to tetracycline, chloramphenicol, norfloxacin and ciprofloxacin.

Haemolysins of Vibrio parahaemolyticus strains passaged in mice.

Some phenotypically non-haemolytic strains of V. parahaemolyticus were observed to produce haemolysins after two passages in mices. Depending on the strain, both heat stable and heat labile haemolysins were induced. The heat stable haemolysin so induced, was immunologically different from the thermostable direct haemolysin produced by Kanagawa positive strains of V. parahaemolyticus.

Evaluation of coagglutination test for serotyping of enteropathogenic bacteria.

Results of conventional agglutination and coagglutination (COA) tests for serotyping of enteropathogenic Escherichia coli (EPEC), Shigella, Salmonella and Vibrio cholerae were compared. Eighty isolates of different serotypes of EPEC falling in the Wellcome polyvalent (OK) 2, 3 and 4 antisera, showed good (4+) agglutination with COA reagent up to 1:960 dilution. Out of 50 strains of Shigella species tested, 25 of Sh. dysenteriae and 5 of Sh. sonnei gave good reaction up to 1:1920 dilution and 15 of Sh. flexneri up to 1:960 dilution in COA test. Similar reaction (4+) by 5 strains of Sh. boydii was seen up to 1:480 dilution only. All 100 isolates of different Salmonella species viz., S. paratyphi A (5), S. typhimurium (50), S. typhi (15), S. weltevreden (5) and S. senftenberg (25), when serotyped by COA, gave good reaction in 1:480 dilution except S. typhi factor 9 and dH antisera, which gave very weak reaction at 1:480 dilution and good reaction at 1:280 dilution. All seven isolates of V. cholerae gave good reaction in COA test even up to 1:1920 dilution. No cross reaction with any COA reagent was obtained in the 1206 heterologus isolates tested. Thus due to its higher efficiency, lower cost and good specificity, COA may prove to be a better method for serotyping of enteropathogens.