Vibrio cholerae 01 ogawa (Eltor) Diarrhoea at Sevagram
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《美国医学杂志》
1 Department of Pediatrics, MGIMS, Sevagram, Wardha-442102, India
2 Department of Microbiology, MGIMS, Sevagram, Wardha-442102, India
An outbreak of cholera occurred in and around Sevagram between July and October 2003. This study was conducted to identify the causative strain and to determine the clinical profile, resistance pattern and outcome of cholera in this outbreak. The causative strains and resistance pattern of the culture positive cases of previous five years were also analyzed retrospectively.
All children with acute watery diarrhoea admitted to the Diarrhoea Treatment Unit (DTU) of the Mahatma Gandhi Institute of Medical Sciences, Sevagram during the months of July to October 2003 with a clinical suspicion of cholera (contact with a case, severe dehydration or residing in an area from where cholera was reported) were enrolled for the study. Children with positive stool culture were included for final evaluation. Treatment details and complications during the hospital stay were noted.
There were nineteen culture positive cases of cholera in the year 2003. In all the cases Vibrio cholerae 01 ogawa (Eltor) strain was the causative organism. Two (10.5%) children were below 1 year (3 months and 11 months), 10 (52.6%) children were in 1-5 year age group and 7 (36.9%) above five years of age. There were 11(57.9%) females and 8(42.1%) males. Eight (42.1%) had severe malnutrition (IAP grade III/IV). Seven (36.9%) children had febrile onset. Vomiting was associated in all the cases. At the time of admission 15 (79.0%) children had severe dehydration and 4 (21.0%) had some dehydration. Three (15.8%) children had hyponatremia and 10 (52.5%) had hypokalemia. One patient had paralytic ileus with serum potassium level of 1.8 meq/L at admission. There was no mortality.
All children were treated with intravenous fluids for initial correction of dehydration and maintenance. Apart from severe dehydration, indications for intravenous fluids included persistent vomiting, paralytic ileus and high purge rate. The average duration of hospital stay was 5.2 days. The causative organism in the present sample was Vibrio cholerae 01 ogawa (Eltor) strain which is reported to be the predominant cause of cholera in India.[1] Serotyping of the strains was done using high titer sera poly 01 ogawa and inaba obtained from CRI Kasauli and 0139 from NICDE Kolkata. Antibiotic susceptibility testing was performed by modified stokes method on Muller Hinton agar using commercial antibiotic disks from Hi Media Mumbai. The antibiotics used were Chloramphenicol (30μgm), tetracycline (30 μgm), ampicillin (10 μgm), gentamicin (10μgm), norfloxacin (10 μgm), trimethoprim (1.25 μgm), ciprofloxacin (10 μgm), cotrimoxazole (25μgm), nalidixic acid (30μgm), and amikacin (10 μgm).
To the authors' surprise, there is an expanding pattern of multidrug resistant Vibrio cholerae 01 ogawa (Eltor) in this region, as was evident by the culture and sensitivity reports. Analysis of the last five year data revealed twenty one culture positive cases in the year 1998, fourteen cases in 2000 and nineteen cases in the year 2003. However, between these years the numbers of cases were quite less. The analysis also revealed increase in the resistance to fluroquinolones from zero in 1998 to 42.1 % in the year 2003. Resistance to all the first line drugs (furazolidone, nalidixic acid, ampicillin) was 90-100%, and to tetracycline was 42.2% in the year 2003. Among the nineteen isolates in the year 2003 only one (5.25%) was resistant to amikacin.
Considerable increase in fluroquinolone resistance among V.cholerae strains belonging to 01 serogroups has been reported from India.[2] Possibly, ciprofloxacin resistance might have emerged in direct response to the selective pressure exerted by nalidixic acid coupled with disproportionate use of fluroquinolones in the clinical settings. It is also important to note that tetracycline resistant V.cholerae 01 strains have been responsible for major epidemics of cholera in Latin America, Tanzania, Bangladesh and Zaire.[3]
Expanding multiple antibiotic resistance among clinical strains of vibrio cholerae 01 ogawa (Eltor) in children is a matter of concern and attention must be paid to this trend. Fortunately all our children showed good response to amikacin.
References
1. Singh J, Bora D, Sachdeva V, Sharma RS, Varghese T. Vibrio cholerae 01 and 0139 in less than five-year-old children hospitalized for watery diarrhea in Delhi. J Diarrheal Dis Res 1997; 15 : 3-6.
2. Garg P, Sinha S, Chakraborty R, Bhattacharya SK, Nair GB, Ramamurthy T. Emergence of Fluoroquinolone-Resistant Strains of Vibrio cholerae 01 Biotype El Tor among hospitalized patients with Cholera in Calcutta, India. Antimicrobial Agents and Chemotherapy 2001(May); 45(5): 1605-1606.
3. Garg P, Chakraborty S, Basu I et al. Expanding multiple antibiotic resistance among clinical strains of Vibrio cholerae isolated from 1992-7 in Calcutta, India. Epidemiol Infect 2002; 124 : 393-399.(Batra Prerna, Saha Abhije)
2 Department of Microbiology, MGIMS, Sevagram, Wardha-442102, India
An outbreak of cholera occurred in and around Sevagram between July and October 2003. This study was conducted to identify the causative strain and to determine the clinical profile, resistance pattern and outcome of cholera in this outbreak. The causative strains and resistance pattern of the culture positive cases of previous five years were also analyzed retrospectively.
All children with acute watery diarrhoea admitted to the Diarrhoea Treatment Unit (DTU) of the Mahatma Gandhi Institute of Medical Sciences, Sevagram during the months of July to October 2003 with a clinical suspicion of cholera (contact with a case, severe dehydration or residing in an area from where cholera was reported) were enrolled for the study. Children with positive stool culture were included for final evaluation. Treatment details and complications during the hospital stay were noted.
There were nineteen culture positive cases of cholera in the year 2003. In all the cases Vibrio cholerae 01 ogawa (Eltor) strain was the causative organism. Two (10.5%) children were below 1 year (3 months and 11 months), 10 (52.6%) children were in 1-5 year age group and 7 (36.9%) above five years of age. There were 11(57.9%) females and 8(42.1%) males. Eight (42.1%) had severe malnutrition (IAP grade III/IV). Seven (36.9%) children had febrile onset. Vomiting was associated in all the cases. At the time of admission 15 (79.0%) children had severe dehydration and 4 (21.0%) had some dehydration. Three (15.8%) children had hyponatremia and 10 (52.5%) had hypokalemia. One patient had paralytic ileus with serum potassium level of 1.8 meq/L at admission. There was no mortality.
All children were treated with intravenous fluids for initial correction of dehydration and maintenance. Apart from severe dehydration, indications for intravenous fluids included persistent vomiting, paralytic ileus and high purge rate. The average duration of hospital stay was 5.2 days. The causative organism in the present sample was Vibrio cholerae 01 ogawa (Eltor) strain which is reported to be the predominant cause of cholera in India.[1] Serotyping of the strains was done using high titer sera poly 01 ogawa and inaba obtained from CRI Kasauli and 0139 from NICDE Kolkata. Antibiotic susceptibility testing was performed by modified stokes method on Muller Hinton agar using commercial antibiotic disks from Hi Media Mumbai. The antibiotics used were Chloramphenicol (30μgm), tetracycline (30 μgm), ampicillin (10 μgm), gentamicin (10μgm), norfloxacin (10 μgm), trimethoprim (1.25 μgm), ciprofloxacin (10 μgm), cotrimoxazole (25μgm), nalidixic acid (30μgm), and amikacin (10 μgm).
To the authors' surprise, there is an expanding pattern of multidrug resistant Vibrio cholerae 01 ogawa (Eltor) in this region, as was evident by the culture and sensitivity reports. Analysis of the last five year data revealed twenty one culture positive cases in the year 1998, fourteen cases in 2000 and nineteen cases in the year 2003. However, between these years the numbers of cases were quite less. The analysis also revealed increase in the resistance to fluroquinolones from zero in 1998 to 42.1 % in the year 2003. Resistance to all the first line drugs (furazolidone, nalidixic acid, ampicillin) was 90-100%, and to tetracycline was 42.2% in the year 2003. Among the nineteen isolates in the year 2003 only one (5.25%) was resistant to amikacin.
Considerable increase in fluroquinolone resistance among V.cholerae strains belonging to 01 serogroups has been reported from India.[2] Possibly, ciprofloxacin resistance might have emerged in direct response to the selective pressure exerted by nalidixic acid coupled with disproportionate use of fluroquinolones in the clinical settings. It is also important to note that tetracycline resistant V.cholerae 01 strains have been responsible for major epidemics of cholera in Latin America, Tanzania, Bangladesh and Zaire.[3]
Expanding multiple antibiotic resistance among clinical strains of vibrio cholerae 01 ogawa (Eltor) in children is a matter of concern and attention must be paid to this trend. Fortunately all our children showed good response to amikacin.
References
1. Singh J, Bora D, Sachdeva V, Sharma RS, Varghese T. Vibrio cholerae 01 and 0139 in less than five-year-old children hospitalized for watery diarrhea in Delhi. J Diarrheal Dis Res 1997; 15 : 3-6.
2. Garg P, Sinha S, Chakraborty R, Bhattacharya SK, Nair GB, Ramamurthy T. Emergence of Fluoroquinolone-Resistant Strains of Vibrio cholerae 01 Biotype El Tor among hospitalized patients with Cholera in Calcutta, India. Antimicrobial Agents and Chemotherapy 2001(May); 45(5): 1605-1606.
3. Garg P, Chakraborty S, Basu I et al. Expanding multiple antibiotic resistance among clinical strains of Vibrio cholerae isolated from 1992-7 in Calcutta, India. Epidemiol Infect 2002; 124 : 393-399.(Batra Prerna, Saha Abhije)