Plesiomonas shigelloides-induced gastroenteritis - Rare cases in Western Europe

Backround: Plesiomonas shigelloides is a common pathogen in tropical region s, whereas it is rarely isolated in temperate climates. It is most often fo und in surface water and fish. During the last 10 years it was found to cau se gastroenteritis 6 times in Ludwigshafen. Not all of these patients repor ted a trip to foreign countries. Case Report: A 54-year-old male patient was hospitalized after a trip to Ma laysia with strong greenish watery diarrhea and chills. On physical examina tion we saw a dehydrated patient in severely reduced general condition. The stool frequency was 30/d. The laboratory examinations only showed elevated parameters of inflammation. Plesiomonas shigelloides was cultivated in the stool cultures. With appropriate substitution of fluid and electrolytes, a nd antidiarrheal therapy the patient resumed a normal diet without any comp lications. Three days later his bowel movements were nomal and his general condition was greatly improved. We withheld antibiotic therapy because of t he non-complicated course of illness. Conclusion: In Germany infections with Plesiomonas shigelloides are rare, a n increase is observed because of increasing tourism to tropical regions. T he course of infection is sometimes asymptomatic, but usually patients deve lop an acute gastroenteritis. Especially immunocompromised patients can sho w serious courses of infection. Plesiomonas shigelloides should be included in the differential diagnosis of acute gastroenteritis after journeys to t ropical regions. Some of our patients, however, denied traveling to tropica l regions. They also denied consuming seafood, which indicates a risk of in fection in Germany. Still an infection with Plesiomonas shigelloides semis to be rare in northern European countries.