trimethoprim--sulfamethoxazole-drug-combination and Cholera

Non-O1/non-O139

Topics: Anti-Bacterial Agents; Chloramphenicol; Cholera; Ciprofloxacin; Drug Resistance, Bacterial; Erythromycin; Gentamicins; Humans; Kanamycin; Microbial Sensitivity Tests; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae non-O1

Vibrio cholerae O1/O139 were the predominant circulating serogroups exhibiting multi-drug resistance (MDR) during the cholera outbreak which led to cholera treatment failures.. This meta-analysis aimed to evaluate the weighted pooled resistance (WPR) rates in V. cholerae O1/O139 isolates obtained from environmental samples.. We systematically searched the articles in PubMed, Scopus, and Embase (until January 2020). Subgroup analyses were then employed by publication year, geographic areas, and the quality of studies. Statistical analyses were conducted using STATA software (ver. 14.0).. A total of 20 studies investigating 648 environmental V. cholerae O1/O139 isolates were analysed. The majority of the studies were originated from Asia (n = 9). In addition, a large number of studies (n = 15 i.e. 71.4%) included in the meta-analysis revealed the resistance to cotrimoxazole and ciprofloxacin. The WPR rates were as follows: cotrimoxazole 59%, erythromycin 28%, tetracycline 14%, doxycycline 5%, and ciprofloxacin 0%. There was increased resistance to nalidixic acid, cotrimoxazole, furazolidone, and tetracycline while a decreased resistance to amoxicillin, ciprofloxacin, erythromycin, chloramphenicol, ampicillin, streptomycin, and ceftriaxone was observed during the years 2000-2020. A significant decrease in the doxycycline and ciprofloxacin-resistance rates in V. cholerae O1/O139 isolates was reported over the years 2011-2020 which represents a decrease in 2001-2010 (p < 0.05).. Fluoroquinolones, gentamicin, ceftriaxone, doxycycline, kanamycin, and cefotaxime showed the highest effectiveness and the lowest resistance rate. However, the main interest is the rise of antimicrobial resistance in V. cholerae strains especially in low-income countries or endemic areas, and therefore, continuous surveillance, careful appropriate AST, and limitation on improper antibiotic usage are crucial.

Topics: Anti-Bacterial Agents; Ceftriaxone; Cholera; Ciprofloxacin; Doxycycline; Drug Resistance, Bacterial; Erythromycin; Humans; Microbial Sensitivity Tests; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O1; Vibrio cholerae O139

Cholera is an acute intestinal infection caused by Vibrio cholerae 01. When an infected person presents severe dehydration and is not adequately treated, he or she will develop hypovolemic shock and eventually could died. There is scarce information concerning this disease in the Pediatric group. Herein we report on eight cases of Pediatric cholera, in children 17 month to four years of age. Seven patients out of eight were admitted presenting dehydration. Four presenting mild or moderate dehydration and three presenting hypovolemic shock. These three patients were rehydrated by intravenous route and thereafter the hydration was maintained by oral therapy. The outcome was uneventful in six patients. One patient developed abdominal distention probably due to hypopotassemia, and another patient presented hyponatremia and seizures. All the patients recovered within five days after admission.

Topics: Acute Disease; Child, Preschool; Cholera; Combined Modality Therapy; Feces; Female; Fluid Therapy; Humans; Infant; Male; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

Topics: Anti-Infective Agents, Urinary; Antidiarrheals; Chloramphenicol; Chlorpromazine; Cholera; Diarrhea; Drug Combinations; Enterotoxins; Escherichia coli; Escherichia coli Infections; Fluid Therapy; Furazolidone; Humans; Sulfamethoxazole; Tetracycline; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Water-Electrolyte Balance

The purpose of the study reported here was to compare the bactericidal effectiveness of tetracycline and co-trimoxazole (a combination of sulfamethoxazole and trimethoprim) in treating cholera. The study, an open-ended random trial using adult patients with cholera cases confirmed by stool culture, was carried out in March 1993 at the Cholera Treatment Unit (CTU) of the Hospital de Apoyo Departmental María Auxiliadora in Lima, Peru. A total of 107 subjects were divided into two groups (A and B). The 50 in Group A received 500 mg of tetracycline orally every 6 hours for 3 days; the 57 in Group B received co-trimoxazole (160 mg of trimethoprim and 800 mg of sulfamethoxazole) orally every 12 hours for 3 days. The two groups were comparable in terms of age, sex, duration of symptoms prior to hospital admission, time at which antibiotic treatment was initiated, and clinical evolution. Control stool cultures of specimens obtained after treatment showed Vibrio cholerae O-1 present in 2% of the Group A and 12.3% of the Group B patients, and also showed V. cholerae non-O-1 present in 2% of the Group A patients and 3.5% of the Group B patients. Overall, it was concluded that both therapeutic treatment regimens were effective and that the strains of V. cholerae observed in the southern sector of the city of Lima were still susceptible to both antibiotics.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Cholera; Drug Therapy, Combination; Female; Humans; Male; Middle Aged; Prospective Studies; Single-Blind Method; Tetracycline; Tetracycline Resistance; Trimethoprim, Sulfamethoxazole Drug Combination

To evaluate the efficacy of erythromycin and trimethoprim-sulphamethoxazole (TMP-SMX) in the treatment of cholera in children aged 1-8 years, a randomised clinical trial was conducted at a diarrhoea treatment centre in Bangladesh from December 1991 to June 1992. Fifteen children received erythromycin, 50 mg/kg per day, in four equally divided doses, 18 children received 10 mg/kg per day of trimethoprim and 50 mg/kg per day of sulphamethoxazole in two equally divided doses (12 hourly) for five days, and 15 children received no antibiotic; children in all three groups received intravenous cholera saline for severe dehydration and for mild to moderate dehydration, a rice-based oral rehydration solution. The mean stool volumes in mL/kg body weight in the two treatment groups were less than that of the control group, and there were no significant differences in stool volume among the two treatment groups. However, 67% of the children in the erythromycin group and 82% in the TMP-SMX group recovered within 72 hours compared to 33% in the control group (p < 0.01). Similarly, the bacteriological cures were 80% in the erythromycin group and 83% in the TMP-SMX group compared to only 27% in the control group (p < 0.001). These results confirm that both erythromycin and trimethoprim-sulphamethoxazole are effective antimicrobials in the treatment of cholera. These drugs are of value specially in younger children in whom tetracycline is contraindicated or when the infecting Vibrio cholerae are resistant to tetracycline.

Topics: Anti-Bacterial Agents; Anti-Infective Agents; Child; Child, Preschool; Cholera; Erythromycin; Humans; Infant; Male; Pilot Projects; Treatment Outcome; Trimethoprim, Sulfamethoxazole Drug Combination

In a double-blind, randomized clinical trial with 78 adults with acute watery diarrhea and severe dehydration, 37 subjects were positive for Vibrio cholerae. In conjunction with rehydration therapy, 13 patients received norfloxacin, 12 received trimethoprim-sulfamethoxazole (TMP-SMX), and 12 received a placebo. Norfloxacin was superior to TMP-SMX and to the placebo in reducing stool output, duration of diarrhea, fluid requirements, and vibrio excretion. TMP-SMX was no better than the placebo.

Topics: Adult; Cholera; Double-Blind Method; Feces; Humans; Male; Norfloxacin; Randomized Controlled Trials as Topic; Trimethoprim, Sulfamethoxazole Drug Combination

The comparative efficacy of antibacterial therapy with pivmecillinam or cotrimoxazole and general supportive care only was studied in patients with severe bacterial gastroenteritis. Overall, treatment with antibiotics proved significantly superior to rehydration alone in 42 children. Active therapy also had a statistically beneficial effect in children infected with Vibrio cholerae and V. parahaemolyticus. Pivmecillinam and co-trimoxazole were equally effective. Pivmecillinam and oral mecillinam appeared to be of equal value in a further 22 adults infected by Vibrio spp. No side-effects were recorded in any of the subjects treated. Further investigations with pivmecillinam and oral mecillinam are advocated.

Topics: Adult; Amdinocillin; Amdinocillin Pivoxil; Child, Preschool; Cholera; Drug Combinations; Enterobacteriaceae Infections; Gastroenteritis; Humans; Penicillanic Acid; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio Infections; Vibrio parahaemolyticus

The efficacy of commonly used antibiotics for treating severe cholera has been compromised over time because of the reduced antibiotic susceptibility. This study aimed to describe the rate of detection of

Topics: Adult; Anti-Bacterial Agents; Azithromycin; Bangladesh; Child; Cholera; Ciprofloxacin; Drug Resistance, Bacterial; Erythromycin; Female; Furazolidone; Hospitals, Special; Humans; Male; Microbial Sensitivity Tests; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O1

Topics: Adolescent; Adult; Aged; Anti-Bacterial Agents; Burkina Faso; Child; Child, Preschool; Chloramphenicol; Cholera; Diarrhea; Disease Outbreaks; Drug Resistance, Bacterial; Female; Humans; Hygiene; Male; Middle Aged; Retrospective Studies; Trimethoprim, Sulfamethoxazole Drug Combination; Urbanization; Vibrio cholerae; Young Adult

Vibrio cholerae isolates recovered from cholera outbreaks in Bhind district of Madhya Pradesh and Delhi, Northern India were characterized. The O1 serogroup isolates from Bhind outbreak were of Inaba serotype whereas both Ogawa and Inaba serotypes were recovered from Delhi. PCR analysis revealed that only O1 serogroup V. cholerae isolates carried the virulence-associated genes like ctxA, tcpA, ace, and zot. Molecular typing by repetitive sequence based ERIC, VCR1, and VC1 PCR's revealed similar DNA profile for both Inaba and Ogawa serotypes. A discrete VC1-PCR band identified among the El Tor strains had greater similarity (>97%) to the V. cholerae genome sequence and therefore has the potential to be used as a marker for the identification of the V. cholerae strains. Non-O1 strains recovered from Bhind region differed among themselves as well as from that of the O1 isolates. All the O1 serogroup isolates possessed SXT element and were uniformly resistant to the antibiotics nalidixic acid, polymyxin-B, furazolidone, cloxacilin, trimethoprim-sulfamethaxazole, and vibriostatic agent 0129. Inaba strains from both Delhi and Bhind differed from Ogawa strains by their resistance to streptomycin despite sharing similar DNA patterns in all the three rep-PCRs. Though Delhi and Bhind are separate geographical regions in Northern India, Inaba strains from both these places appear to be closely related owing to their similarity in antibiogram and genetic profile.

Topics: Anti-Bacterial Agents; Cholera; Cloxacillin; Disease Outbreaks; DNA Fingerprinting; Endopeptidases; Fimbriae Proteins; Furazolidone; Genes, Bacterial; Humans; India; Microbial Sensitivity Tests; Nalidixic Acid; Polymyxin B; Pteridines; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O1

The occurrence of drug-resistant Vibrio cholerae is being reported with increasing frequency worldwide. Spread of resistant strains has been attributed, in part, to class I integrons and sulfamethoxazole trimethoprim-constin (SXT-C). Sixty clinical V. cholerae isolates were isolated from four different provinces in Iran, which were subjected to antibiotic susceptibility testing, polymerase chain reaction amplification of class I integron and SXT-C, and sequencing of the amplified fragments. Ribotyping technique was used to assess the clonality of the isolates. The highest and the least levels of antibiotic resistance were seen to SXT, streptomycin, and chloramphenicol (95%, 95%, and 92%, respectively) and doxycycline, gentamicin, and oxytetracycline (0%, 3%, and 3%, respectively). The results showed that out of the total of 60 isolates, only 1 contained class I integron, which harbored streptomycin resistance gene cassette (aadA2). This isolate showed ribotype pattern similar to the other strains (lacking class I integron) obtained in the same year (2006). On the contrary, the SXT-C was found in 95% of the isolates. These isolates showed three different but related ribotype patterns. Overall, the results of this study showed insignificant contribution of class I integron in antibiotic resistance of our V. cholerae isolates. On the other hand, V. cholerae resistance to SXT, streptomycin, and chloramphenicol could be, in part, due to wide distribution of SXT-C among the isolates. In addition, the ribotype data suggest that the clinical V. cholerae population from 2004 to 2006 were homogeneous.

Topics: Anti-Bacterial Agents; Bacterial Proteins; Chloramphenicol; Cholera; Conjugation, Genetic; DNA Transposable Elements; Drug Resistance, Bacterial; Humans; Integrons; Iran; Microbial Sensitivity Tests; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae non-O1; Vibrio cholerae O1

Vibrio cholerae O1 from a 2006 outbreak in Accra were commonly resistant to multiple antimicrobials and, in particular, to trimethoprim/sulfamethoxazole, drugs commonly used in the treatment of cholera. We sought to determine the genetic basis for trimethoprim/sulfamethoxazole resistance in outbreak isolates.. Twenty-seven isolates from the outbreak were screened by PCR and sequencing for class 1 and 2 integrons and for the SXT element.. Twenty-one of the 27 isolates examined, all from the Accra metropolitan area, carried both SXT, an integrated chromosomal element, and a class 2 integron bearing dfrA1, sat and aadA1 cassettes. All these isolates had identical random amplification of polymorphic DNA profiles and two of them also carried a class 1 integron.. Most strains characterized carried multiple elements conferring resistance to trimethoprim. This suggests that trimethoprim/sulfamethoxazole should not be used empirically in cholera treatment.

Topics: Adult; Anti-Bacterial Agents; Bacterial Proteins; Child; Child, Preschool; Cholera; Cluster Analysis; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Bacterial; Female; Ghana; Humans; Integrons; Interspersed Repetitive Sequences; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; Random Amplified Polymorphic DNA Technique; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O1

Predicting cholera epidemics through monitoring the environment for the presence of pathogenic Vibrio cholerae is complicated by the presence in water of a large number of mostly nonpathogenic V. cholerae strains. V. cholerae strains causing recent cholera epidemics in Bangladesh carry the sulfamethoxazole-trimethoprim (SXT) element, which encodes resistance to several antibiotics. Here, we show that the use of a culture medium containing streptomycin, sulfamethoxazole, and trimethoprim (the antibiotic selection technique [AST]) can significantly enhance the isolation of environmental V. cholerae O1 with epidemic potential (P<.001). The AST was also used to monitor the recent emergence and spread of a new multiple-antibiotic-resistant strain of V. cholerae in Bangladesh. The results of this study support the hypothesis that pre-epidemic amplification of pathogenic V. cholerae occurs in the human host and leads to the start of an epidemic cycle dominated by a single clone of V. cholerae that spreads rapidly through environmental waters.

Topics: Anti-Bacterial Agents; Bacteriological Techniques; Bangladesh; Cholera; Culture Media; Disease Outbreaks; DNA Fingerprinting; DNA, Bacterial; Drug Resistance, Multiple, Bacterial; Humans; Molecular Epidemiology; Polymerase Chain Reaction; Ribotyping; Selection, Genetic; Streptomycin; Trimethoprim Resistance; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O1; Water Microbiology

The hemagglutinin/protease (HA/P) seems to be an attractive locus for the insertion of heterologous tags in live cholera vaccine strains. A deltaCTXphi spontaneous mutant derived from a pathogenic strain of O139 Vibrio cholerae was sequentially manipulated to obtain hapA Colon, two colons celA derivatives which were later improved in their environmental safety by means of a thyA mutation. All the strains here obtained showed similar phenotypes in traits known to be remarkable for live cholera vaccines irrespective of their motility phenotypes, although the hapA mutants had a 10-fold decrease in their colonisation capacity compared with their parental strains in the infant mouse cholera model. However, the subsequent thyA mutation did not affect their colonisation properties in the same model. These preliminary results pave the way for further clinical assays to confirm the possibilities of these vaccine prototypes as safe and effective tools for the prevention of O139 cholera.

Topics: Animals; Antibodies, Bacterial; Bacterial Capsules; Cellulase; Cholera; Cholera Toxin; Cholera Vaccines; Clostridium; Drug Resistance; Drug Resistance, Multiple, Bacterial; Genes, Synthetic; Hemagglutination Tests; Immunoglobulin G; Metalloendopeptidases; Mutagenesis, Insertional; O Antigens; Rabbits; Safety; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O139

Vibrio cholerae O139 Bengal emerged as a second aetiologic agent of cholera in South Asia in late 1992. This new serogroup arose from a Vibrio cholerae O1 strain by deletion of the chromosomal region encoding O1 specificity and acquisition of a novel 35-kb region encoding the O139 specificity. Previous studies indicated significant phenotypic and genotypic changes in O139 isolates over the years since its first appearance. This prompted us to study possible polymorphism in the 35-kb novel region encoding the O139 specificity. A total of 17 V. cholerae O139 isolates originating from different countries and years in South Asia and China, and a single unrelated V. cholerae O139 isolate from Argentina were studied. The 35-kb chromosomal region was amplified as two fragments of 12 and 23 kb in an extended PCR from all isolates. These amplicons were then treated separately with seven different restriction enzymes and separated by agarose gel electrophoresis. The South Asian and Chinese isolates gave identical patterns for the same enzymes, but different patterns for different enzymes, thus exhibiting no polymorphism in the 35-kb region. However, the Argentine isolate gave distinct patterns for most of the enzymes confirming its different origin. This data indicated that the portion of the chromosome encoding the O139 antigen specificity is highly conserved. As found in previous studies, the early O139 isolates were resistant to trimethoprim-sulfamethoxazole (TMP-SMX) and vibriostatic compound, O/129, and CAMP- haemolysin positive. The isolates of later years diverged exhibiting different patterns by pulsed-field gel electrophoresis (PFGE), and becoming susceptible to TMP-SMX and O/129, and CAMP-haemolysin negative.

Topics: Anti-Bacterial Agents; Argentina; Asia; China; Cholera; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Hemolysis; Humans; O Antigens; Polymorphism, Genetic; Pteridines; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae O139

During the months of May, June and through early part of July 1994, an unusual occurrence of severe dehydrating watery diarrhoea cases and deaths were reported from Aizwal town, the capital of Mizoram, a North-Eastern state of India. Vibrio cholerae 01 biotype Eltor, the causative agent responsible for this outbreak, was isolated from 50.0% of hospitalised cases. The disease affected older children and adults more (52.9%) than younger children below five years of age. Vibrio cholerae 01 strains isolated were uniformly resistant to furazolidone and co-trimoxazole, which are commonly advocated in the treatment of cholera specially in children of developing countries. Emergence of such resistant strain is alarming and is of great public health importance.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Child; Child, Preschool; Cholera; Diarrhea; Disease Outbreaks; Drug Resistance, Microbial; Drug Resistance, Multiple; Furazolidone; Hospitalization; Humans; India; Infant; Middle Aged; Monoamine Oxidase Inhibitors; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

The authors describe the case of a fifty-nine-year-old white man, previously in good health, who initiated his present illness with acute episode of enterocolitis characterized by mild fever and, in the next eight hours, twenty-four episodes of watery diarrhea, nausea and vomiting, as well as generalized sweating and severe weakness secondary to hypovolemia and electrolyte disorder. These complications were corrected in seventy-two hours in the intensive care unit. Two days later, when the patient was stable hemodynamically, under cardiac monitoring and with normal laboratory studies including serum electrolytes, he developed electrocardiographic changes characterized by trifascicular block (prolonged P-R interval, complete right bundle branch block [CRBBB] and left posterior hemiblock [LPH]) with a cardiac rate of thirty beats per minute, for which a temporary pacemaker was inserted. Endomyocardial biopsy showed histopathologic signs of myocarditis and the immunologic study of the cardiac tissue revealed positive polymerize chain reaction (PCR+) with the presence of antitoxine choleric antibodies (AcTCA). After three weeks, the same conduction disturbances remained, for which a permanent pacemaker was inserted. On top of intravenous fluid replacement and electrolyte supplements, the patient was managed with tetracycline 2 g a day for one week and sulfamethoxazole-trimethoprim 800/160 mg a day for two weeks. The purpose of this study is to present a rare and very well-documented myocarditis by cholera in a patient with enteric disease, in whom several cardiac complications occurred.

Topics: Anti-Bacterial Agents; Antibodies, Bacterial; Bradycardia; Bundle-Branch Block; Cholera; Diarrhea; Electrocardiography; Enterocolitis; Humans; Male; Middle Aged; Myocarditis; Nausea; Pacemaker, Artificial; Polymerase Chain Reaction; Sweating; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae; Vomiting

Topics: Amoxicillin; Anti-Bacterial Agents; Anti-Infective Agents, Urinary; Cholera; Drug Resistance, Microbial; Ecuador; Erythromycin; Humans; Nitrofurans; Nitrofurantoin; Penicillins; Polymyxin B; Tetracycline; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

Vibrio cholerae O139 is the first non-O1 serogroup of V. cholerae to give rise to epidemic cholera. Apparently, this new serogroup arose from an El Tor O1 strain of V cholerae, but V. cholerae O139 is distinguishable from V. cholerae El Tor O1 by virtue of its novel antigenic structure and also its characteristic pattern of resistances to the antibiotics sulfamethoxazole, trimethoprim, streptomycin, and furazolidone. We found that the first three of these antibiotic resistances are carried on an approximately 62-kb self-transmissible, chromosomally integrating genetic element which we have termed the SXT element. This novel conjugative transposon-like element could be conjugally transferred from V. cholerae O139 to V cholerae O1 and Escherichia coli strains, where it integrated into the recipient chromosomes in a site-specific manner independent of recA. To study the potential virulence properties of the SXT element as well as to improve upon the live attenuated O139 vaccine strain Bengal-2, a large internal deletion in the SXT element was crossed on to the Bengal-2 chromosome. The resulting strain, Bengal-2.SXT(s), is sensitive to sulfamethoxazole and trimethoprim and colonizes the intestines of suckling mice as well as wild-type strains do, suggesting that the SXT element does not encode a colonization factor. Derivatives of Bengal-2.SXT(s) are predicted to be safe, antibiotic-sensitive, live attenuated vaccines for cholera due to the O139 serogroup.

Topics: Animals; Anti-Bacterial Agents; Cholera; Cholera Vaccines; Conjugation, Genetic; DNA Transposable Elements; Drug Resistance, Microbial; Drug Resistance, Multiple; Escherichia coli; Gene Transfer Techniques; Genes, Bacterial; Genetic Linkage; Intestines; Mice; O Antigens; Species Specificity; Streptomycin; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

Topics: Anti-Bacterial Agents; Cholera; Drug Resistance, Microbial; Furazolidone; Humans; India; Infant; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

Within 24 hours of returning from a five-week holiday in Pakistan a 15-year-old girl developed vomiting and massive diarrhoea leading to severe dehydration with hypovolaemic shock. The diastolic blood pressure was no longer measurable and prerenal renal failure occurred with a serum creatinine of 4.4 mg/dl and metabolic acidosis (pH 7.21, base excess-16.9 mmol). Initially treatment consisted of rehydration (day 1: 9280 ml, day 2: 4850 ml). The patient's condition rapidly improved and she had voluminous stools. A concurrent urinary infection due to Klebsiella pneumoniae was first treated with cotrimoxazole. As a new strain of Vibrio cholerae, serogroup O 139, was isolated from stool, treatment was changed to tetracycline (50 mg/kg daily). Regaining a good general state she was transferred to an isolation ward on the 6th hospital day. The isolated cholera organism belongs to a nonagglutinating serogroup which is indistinguishable clinically and epidemiologically from the classical Vibrio strains which cause cholera. Since the end of 1992 this new serogroup has been causing an explosive spread of cholera in Bangladesh and India.

Topics: Adolescent; Agglutination Tests; Cholera; Dehydration; Feces; Female; Fluid Therapy; Germany; Humans; Klebsiella Infections; Klebsiella pneumoniae; Pakistan; Serotyping; Shock; Tetracycline; Travel; Trimethoprim, Sulfamethoxazole Drug Combination; Urinary Tract Infections; Vibrio cholerae

In a 84-year-old woman extraintestinal infection by non-OI Vibrio cholerae was diagnosed. She had septicaemia with cholangitis and cholecysto- and choledocholithiasis. Until now 26 patients with non-OI V. cholerae septicaemia have been reported. Most had an underlying disease, usually a chronic liver disease or haematological malignancy. These disorders were not present in our patient. She was treated with co-trimoxazole and afterwards she underwent a cholecystectomy and common bile duct exploration. At the time of operation no non-OI V. cholerae could be isolated from the gallbladder or the bile from the common bile duct. A possible cause of the infection was a herring which the patient had eaten six weeks before hospital admission.

Topics: Aged; Aged, 80 and over; Cholangitis; Cholelithiasis; Cholera; Female; Gallstones; Humans; Serotyping; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae

The persistence of Vibrio cholerae, biotype el tor, in a patient treated with trimethoprim-sulfamethoxazole was due to the acquisition of a conjugative resistance plasmid. The plasmid, with a molecular size of 72 megadaltons, belonged to incompatibility group 6-C and conferred resistance to ampicillin, chloramphenicol, sulfonamide, and trimethoprim.

Topics: beta-Lactamases; Chloramphenicol; Cholera; Conjugation, Genetic; Drug Combinations; Drug Resistance, Microbial; Escherichia coli; Feces; Humans; R Factors; Sulfamethoxazole; Trimethoprim; Trimethoprim, Sulfamethoxazole Drug Combination; Vibrio cholerae