CHOLERA, DIARRHEA AND DYSENTERY UPDATE:
Cholera with severe renal failure in an Italian tourist returning from
An Italian man in his late 40s with cholera was hospitalized in
The day after his return, he was admitted to hospital with watery diarrhea, dehydration, loss of 10 kg (22 pounds) of body weight, low blood pressure and severe renal failure. He underwent continuous intravenous hydration and correction of metabolic acidosis and low blood potassium level. He also had a hemodialysis session and started empirical antibiotic therapy with ciprofloxacin (200 mg twice daily for 7 days).
The patient's condition progressively improved, the laboratory test abnormalities returned to normal values and he was discharged 10 days after admission. The patient's travel companion had consumed the same meals during their stay in
_Vibrio cholerae_ was isolated from the patient's stool samples taken on the 1st day of hospitalization. The serogroup and serotype were confirmed by slide agglutination in polyvalent O1 and mono-specific Inaba and Ogawa antisera (Oxoid Ltd,
O1 serotype Ogawa. Double mismatch amplification mutation assay
(DMAMA) polymerase chain reaction (PCR) was performed in order to discriminate between the classical, El Tor, and Haitian type of ctxB allele (encoding cholera toxin B subunit) .
Antimicrobial drug susceptibility testing of the isolated _V.cholerae_ strain was performed by the disk diffusion method, according to the Clinical and Laboratory Standards Institute (CLSI) , and by Etest (Oxoid Ltd, United Kingdom), for phenotypic characterization of the isolate.
The strain was positive for the Haitian type of ctxB allele: it displayed resistance to sulfonamide, streptomycin, trimethoprim/sulfamethoxazole, nalidixic acid and ceftazidime, and susceptibility to cefotaxime, tetracycline, ampicillin, chloramphenicol and gentamicin. The strain showed also reduced susceptibility to ciprofloxacin (minimum inhibitory concentration: 0.25-0.5 mg/L). Genotyping was performed by pulsed-field gel electrophoresis (PFGE) analysis using the restriction enzymes NotI and SfiI according to the PulseNet United States protocol. The PFGE patterns were defined as KZGS12.0097(SfiI) and KZGN11.0124 (NotI), corresponding to those currently observed in most _V. cholerae_ strains from
Cholera is an acute, secretory diarrhea caused by ingestion of food or water contaminated with the bacterium, _V cholerae_. The clinical presentation of infection may range from mild illness to massive watery diarrhea, shortly progressing to severe volume and electrolyte depletion, severe hypotension and renal failure, with death occurring within hours.
In 2012, the World Health Organization (WHO) recorded 245 393 cholera cases and 3034 deaths globally, with a case fatality rate of 1.2 percent, representing a 58 percent decrease in number of cases compared with the previous year. However, the actual number of cases is known to be much higher than those reported. In 2012,
Cases of imported cholera in
Cholera can be a life-threatening disease. Early recognition, based on travel history and clinical features, is the cornerstone of successful patient management. Renal dysfunction can be present in the course of the disease, as occurred in our patient, can be a potential complication of the infection itself or secondary to volume depletion. Taken together, the phenotypic and genetic characterization of _V. cholerae_ O1 isolated from our patient shows its relationship with Haitian epidemic strains.
On 9 Aug 2013, another 4 cases of cholera in persons returning from travel to
In January 2013, the risk of cholera in travellers visiting
Physicians should consider the diagnosis of cholera in patients returning from
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