1/81. A cytotoxin-producing strain of vibrio cholerae non-o1, non-O139 as a cause of cholera and bacteremia after consumption of raw clams. We report a case of a cholera-like gastroenteritis subsequent with bacteremia in a healthy man following consumption of raw clams. Although we failed to recover the organism from the patient's stool culture, his blood culture was positive for a non-cholera toxin-producing yet cytotoxin-producing non-O1 and non-O139 Vibrio cholerae. ( info) |
2/81. Case studies in cholera: lessons in medical history and science. Cholera, a prototypical secretory diarrheal disease, is an ancient scourge that has both wrought great suffering and taught many valuable lessons, from basic sanitation to molecular signal transduction. Victims experience the voluminous loss of bicarbonate-rich isotonic saline at a rate that may lead to hypovolemic shock, metabolic acidosis, and death within afew hours. Intravenous solution therapy as we know it was first developed in an attempt to provide life-saving volume replacement for cholera patients. Breakthroughs in epithelial membrane transport physiology, such as the discovery of sugar and salt cotransport, have paved the way for oral replacement therapy in areas of the world where intravenous replacement is not readily available. In addition, the discovery of the cholera toxin has yielded vital information about toxigenic infectious diseases, providing a framework in which to study fundamental elements of intracellular signal transduction pathways, such as G-proteins. Cholera may even shed light on the evolution and pathophysiology of cystic fibrosis, the most commonly inherited disease among Caucasians. The goal of this paper is to review, using case studies, some of the lessons learned from cholera throughout the ages, acknowledging those pioneers whose seminal work led to our understanding of many basic concepts in medical epidemiology, microbiology, physiology, and therapeutics. ( info) |
3/81. Non-serogroup O:1 Vibrio cholerae bacteremia and cerebritis. We describe a case of non-serogroup O:1 Vibrio cholerae bacteremia and cerebritis in a 41-year-old Thai man with alcoholism who presented with fever and cellulitis of the right ankle. He was successfully treated with parenteral cefotaxime and then was switched to treatment with oral ciprofloxacin. ( info) |
| Vibrio cholerae is an uncommon cause of cellulitis in australia. Most reported cases worldwide have involved marine or brackish water contact. A recognized risk factor for acquiring this infection is chronic liver disease secondary to hepatitis b. We describe a case of extensive facial cellulitis caused by vibrio cholerae non-o1, non-0139, in an 11-year-old indigenous girl from North queensland, australia, who was hepatitis b surface antigen-negative. Treatment consisted of extensive debridement, antibiotics, hyperbaric oxygen and facial reconstructive surgery. Early microbiologic diagnosis and a combined therapeutic approach are important in the management of this condition. ( info) |
5/81. Vibrio cholerae diarrhoea in a three-day-old breastfed neonate. A confirmed case of cholera in a 3-day-old neonate is being reported. Possible source of infection could be by holy water (Chamamrit) given to the baby, which is common ritual in india. Mother's milk has never been reported to transmit cholera, even though mother herself may be suffering from cholera. Contaminated water can transmit the disease as there is no maternally transmitted immunity. ( info) |
| We report three fatal cases of bacteremia (two adults, one neonate) caused by vibrio cholerae o1 (Ogawa), which occurred in the context of a community outbreak of cholera diarrhea in Blantyre, malawi. Only four cases of invasive disease caused by V. cholerae O1 have previously been reported. We describe the clinical features associated with these rare cases and discuss their significance. ( info) |
7/81. Epidemiological investigation of a fatal case of cholera in japan by phenotypic techniques and pulsed-field gel electrophoresis. A fatal case of cholera caused by Vibrio cholerae 01 El Tor serotype Ogawa occurred in Aichi Prefecture, japan in 1995. The patient was identified locally, but the route of the infection was unknown. The causative isolate and 38 other domestic and imported V. cholerae O1 isolates, obtained between 1984 and 1997, were analysed by prophage typing, antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE). This was done to determine whether the isolate from this case differed from others associated with either mild cholera infections or asymptomatic carriage, and to elucidate the route of infection. cholera toxin (CT) from 37 toxigenic isolates was assayed semi-quantitatively. The 39 isolates were divided into 12 temporary types in accordance with the results of the three typing techniques. The isolate from the fatal infection and nine other isolates were classified as temporary type IV. No difference in CT production was found between the isolate from the fatal case and the other 36 toxigenic isolates. Taken together, it is unlikely that a V. cholerae 01 isolate of distinguishable type was responsible for the fatal illness. Temporary type IV isolates were frequently present in both domestic and imported cases from 1994 to 1997 in Aichi, but they did not emerge before 1993. These results suggest that a new clone was introduced after 1993 from overseas and then disseminated into Aichi, and this may have been an important step in triggering the fatal case of cholera. ( info) |
8/81. Splenic abscess with Vibrio cholerae masking pancreatic cancer. A 77-year-old man presented to our hospital with a clinical scenario suspicious for endocarditis with septic emboli to the lungs and splenic abscess. Vibrio cholerae was isolated from purulent material aspirated from the abscess. Medical therapy and percutaneous drainage of the abscess were unsuccessful. The patient underwent splenectomy and distal pancreatectomy revealing a pancreatic tail carcinoma involving the spleen and colon. The patient later expired secondary to metastatic disease. This case represents the first isolation of V. cholerae from a splenic abscess but also illustrates that although newer imaging technologies have made the diagnosis of splenic abscess easier, the true etiology of the abscess may remain elusive. ( info) |
9/81. Vibrio cholerae bacteremia in a neutropenic patient with non-small-cell lung carcinoma. Vibrio cholerae was isolated from the blood cultures of a neutropenic patient treated with chemotherapy for non-small-cell lung cancer. Attempts to isolate Vibrio spp. from a rectal swab and stool were unsuccessful. piperacillin/tazobactam treatment resulted in eradication of the microorganism from the patient's blood. Although Vibrio spp. have occasionally been the source of infection in immunocompromised patients, this report describes the first case of non-0:1 Vibrio cholerae bacteremia in a neutropenic patient with a solid tumour. ( info) |
10/81. The fortuitous diagnosis of cholera in a two-year-old girl. We are reporting the fortuitous diagnosis of a case of cholera and the unusual failure of the commercial bacteriologic media that led to the unexpected isolation of Vibrio cholerae. The case demonstrates the need for communication between the medical staff and laboratory personnel when an uncommon disease, such as cholera, is suspected. This case also alerts the clinician to the possibility of multiple enteric pathogens coinfecting a traveller. ( info) |