A bacterial agglutination assay, a toxin-neutralizing assay, and an enzyme-linked immunosorbent assay (ELISA) were used to compare antibodies against intestinal Aeromonas strains in serum samples from healthy carriers (n = 6), from patients with acute (n = 15) or chronic (n = 8) gastroenteritis, from patients with gastroenteritis caused by other enteropathogenic bacteria (n = 3), and from healthy blood donors (n = 50). Evaluation of the bacterial agglutination assay showed that it was not very useful. The sensitivity of the ELISA in patients with acute or chronic aeromonas-associated diarrhea was 30% (7 of 23 patients were positive), whereas the specificity was 74% (13 of 50 healthy donors were positive). Positive results in the ELISA correlated with immunoglobulin M and immunoglobulin G responses to lipopolysaccharides of homologous Aeromonas strains, as determined by gel immunoradioassay and Western immunoblot analysis. The sera showed cross-reactions with heterologous Aeromonas strains and with Escherichia coli strains. The toxin-neutralizing assay was positive in 5 of 11 patients who had developed acute severe diarrhea associated with cytotoxin-producing Aeromonas strains (46% sensitivity), whereas only 3 of 50 healthy donors had low serum titers of cytotoxin-neutralizing antibodies (94% specificity). All five patients were over 60 years of age. Cytotoxin-neutralizing activity was not observed in the sera of other groups of patients with aeromonads in their feces. We concluded that the three different serologic assays were not consonant with one another and that only the toxin-neutralizing assay distinguished patients with acute diarrhea from other groups of patients.