Spotlight on the epidemiology and antimicrobial susceptibility profiles of <i>Vibrio</i> species in the MENA region, 2000–2023
Creators: name: Rafei, Rayane
name: Osman, Marwan
name: Kassem, Issmat I
name: Dabboussi, Fouad
name: Weill, François-Xavier
name: Hamze, Monzer
Publisher: name: Taylor & Francis
Year: 2024
Subjects: subject: Space Science
subject: Medicine
subject: Microbiology
subject: FOS: Biological sciences
subject: Biotechnology
subject: Environmental Sciences not elsewhere classified
subject: Ecology
subject: Biological Sciences not elsewhere classified
subject: Infectious Diseases
subject: FOS: Health sciences

description: Recent cholera outbreaks in many countries in the Middle East and North Africa (MENA) region have raised public health concerns and focused attention on the genus <i>Vibrio</i>. However, the epidemiology of <i>Vibrio</i> species in humans, water, and seafood is often anecdotal in this region. In this review, we screened the literature and provided a comprehensive assessment of the distribution and antibiotic resistance properties of <i>Vibrio</i> species in different clinical and environmental samples in the region. This review will contribute to understanding closely the real burden of <i>Vibrio</i> species and the spread of antibiotic-resistant strains in the MENA region. The overall objective is to engage epidemiologists, sanitarians and public health stakeholders to address this problem under the One-health ethos. The <i>Vibrio</i> genus contains many bacterial species normally found in freshwater, estuaries and marine environments. Some of these species can be transmitted by water and food and can make people severely ill. For instance, some groups of the bacterium <i>Vibrio cholerae</i> (serogroups O1 and O139) can cause serious watery diarrhea called cholera. Other pathogenic <i>Vibrio</i> bacteria can cause other types of infections such as gastroenteritis and wound infections. Some of these bacteria are becoming increasingly resistant to antibiotics, which will threaten and complicate therapy. This review discusses the occurrence and antibiotic resistance of different important <i>Vibrio</i> species in the Middle East and North Africa (MENA) region. <i>Vibrio</i> spp. are Gram-negative, curved rod-shaped bacteria and are part of the normal freshwater, estuarine and marine environment flora. <i>Vibrio cholerae</i>, <i>V. parahaemolyticus</i>, <i>V. vulnificus</i> and <i>V. alginolyticus</i> are among the most common pathogenic species. <i>Vibrio</i> spp. cause two major groups of human diseases: cholera and non-cholera infections. Cholera disease is a mild to potentially fatal acute secretory diarrhea caused only by toxigenic serogroups O1 and O139 of <i>V. cholerae</i> after the ingestion of contaminated water or food. Non-cholera infections or vibriosis are caused by non-O1/non-O139 <i>V. cholerae</i> or NOVC serogroups, non-toxigenic serogroups O1 and O139 of <i>V. cholerae</i> and non-<i>V. cholerae</i> species such as <i>V. parahaemolyticus</i>. The clinical presentation of vibriosis is diverse and could be diarrhea, wound infections, septicemia and other extra-intestinal infections following the ingestion of raw, undercooked, or mishandled seafood, or exposure of open wounds to contaminated water. <i>Vibrio</i> infection is managed differently according to the pathogen, route of infections and symptoms. Cholera thrives in some MENA countries in epidemic and endemic patterns and many recent outbreaks have been described in some countries after decades of cholera-free status (such as Lebanon). Isolates with an extended spectrum of antibiotic resistance have been described, with multi-drug resistant (MDR) plasmids reported in Yemen and Lebanon. Clinical cases of non-toxigenic <i>V. cholerae</i> O1 and NOVC were described and the infection sources of NOVC were usually attributed to seafood and swimming. NOVC clinical isolates were more susceptible to antibiotics, with sporadic resistance patterns compared with <i>V. cholerae</i> serogroups O1 and O139. Similar to NOVC, many reports described the widespread occurrence of <i>V. parahaemolyticus, V. vulnificus</i> and <i>V. alginolyticus</i> in aquatic environments and seafood. The clinical data on non-cholera species in terms of morbidity and mortality are scarce, with only a few reports documenting clinical cases and outbreaks of <i>V. parahaemolyticus</i>. Despite the notable heterogeneity of results between articles, disturbing antibiotic resistance levels of <i>Vibrio</i> spp. were documented and MDR strains were also described in the MENA countries. Species-based differences in antibiotic susceptibility profiles were noted, but more studies are needed to validate these observations. In the majority of MENA studies, ciprofloxacin appears to retain its effectiveness, but reports with notable resistance rates have been emerging. Although the real burden of <i>Vibrio</i> species is underestimated due to weak or incomplete surveillance, sporadic reports from the MENA region highlighted a consequential impact at the clinical level and a concerning level of antibiotic resistance. There is a paramount need for systematic surveillance of the occurrence of <i>Vibrio</i> spp. in clinical samples and continuous surveys of MDR <i>Vibrio</i> spp. in aquatic environments and food. The adoption of a one-health approach, including a vigilant use of antibiotics in all ecosystems, is required to tackle the emergence and dissemination of resistance.