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Significance Natural infections with flesh-eating bacteria from exposure to water can have devastating patient outcomes.Aeromonas hydrophila causes necrotizing fasciitis (NF). A patient was infected with 4A. hydrophila strains, 3 clonal (NF2, NF3, and NF4) and 1 (NF1) phylogenetically distinct. By traditional clinical methods, this case was classified as a monomicrobial infection. Metagenomics analysis revealed polymicrobial infection. Clonal strains harbored exotoxin A (ExoA), and NF1 strain possessed a unique effector of the type 6 secretion system (T6SS). The role of T6SS and its effector TseC in direct killing of NF2 in vitro and in vivo and in bacterial phagocytosis/intracellular survival was demonstrated, and the evidence provided that T6SS and ExoA influence dynamics and outcome of mixed infection in NF disease.

T6SS and ExoA of flesh-eating Aeromonas hydrophila in peritonitis and necrotizing fasciitis during mono- and polymicrobial infections