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Agyei FK, Scharf B, Duodu S. Vibrio cholerae Bacteremia: An Enigma in Cholera-Endemic African Countries. Trop Med Infect Dis 2024; 9:103. [PMID: 38787036 PMCID: PMC11125774 DOI: 10.3390/tropicalmed9050103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 05/25/2024] Open
Abstract
Cholera is highly endemic in many sub-Saharan African countries. The bacterium Vibrio cholerae is responsible for this severe dehydrating diarrheal disease that accounts for over 100,000 deaths each year globally. In recent years, the pathogen has been found to invade intestinal layers and translocate into the bloodstream of humans. The non-toxigenic strains of V. cholerae (non-O1/O139), also known as NOVC, which do not cause epidemic or pandemic cases of cholera, are the major culprits of V. cholerae bacteremia. In non-cholera-endemic regions, clinical reports on NOVC infection have been noted over the past few decades, particularly in Europe and America. Although low-middle-income countries are most susceptible to cholera infections because of challenges with access to clean water and inappropriate sanitation issues, just a few cases of V. cholerae bloodstream infections have been reported. The lack of evidence-based research and surveillance of V. cholerae bacteremia in Africa may have significant clinical implications. This commentary summarizes the existing knowledge on the host risk factors, pathogenesis, and diagnostics of NOVC bacteremia.
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Affiliation(s)
- Foster K. Agyei
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra LG54, Ghana;
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA;
| | - Birgit Scharf
- Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061, USA;
| | - Samuel Duodu
- West African Centre for Cell Biology of Infectious Pathogens, University of Ghana, Accra LG54, Ghana;
- Department of Biochemistry, Cell and Molecular Biology, University of Ghana, Accra LG54, Ghana
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Singh KA, Anandan S, Sharma A, Kumar SE, Solaimalai D, Veeraraghavan B, Goel A, Eapen CE, Zachariah UG. High Mortality With Non-O1/Non-O139 Vibrio cholera Bacteraemia in Patients With Cirrhosis. J Clin Exp Hepatol 2024; 14:101346. [PMID: 38371607 PMCID: PMC10869911 DOI: 10.1016/j.jceh.2024.101346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 01/12/2024] [Indexed: 02/20/2024] Open
Abstract
Background Data on non-O1/non-O139 Vibrio cholera (NOVC) infection in liver disease is limited. We studied the clinical features and outcome of patients with cirrhosis with non-NOVC bacteraemia and/or spontaneous bacterial peritonitis (SBP) when compared to non-extended spectrum beta lactamase (non-ESBL) Escherichia coli (E. coli). Methods Hospital information system of patients with cirrhosis admitted with bacteraemia and/or SBP from 2010 to 2020 was searched to include patients with NOVC infection. Non-ESBL E. coli bacteraemia/bacterascites were chosen as a comparator group, matched for the date of admission within 5 days of index case. Propensity score matching (PSM) was done for patient's age and Child score to compare outcome at discharge between NOVC-infected and E. coli-infected cirrhotic patients. Results There were 2545 patients admitted with bacteraemia and/or SBP during the study period; 29 had NOVC isolated (M:F = 23:6; age: 39, 18-54 years; median, range; model for end-stage liver disease [MELD] score: 25, 12-38; Child score: 11, 10-12.5) from either blood (26), ascites (3), or both (8). Of these, 26 isolates were pan-sensitive to antibiotic sensitivity tests. Fifty-three patients with non-ESBL E. coli were isolated (M: F = 43:10; age: 48; 18-69 years; MELD score: 25, 20-32; Child score:12,11-13) from blood (31), ascites (17), or both (5) within the selected time frame. Of these, 48 isolates were sensitive to the empirical antibiotics initiated.After PSM, in comparison with 29 non-ESBL E. coli patients (age: 41, 18-55 years; MELD score: 24, 19-31; Child score: 12, 11-13), NOVC patients had higher incidence of circulatory failure at admission (14 [49 %] vs 4 [13 %]; P: 0.01) and significantly higher in-hospital mortality (15 [52 %] vs 6 [20 %];P: 0.028]. Conclusions Bacteraemia due to non-O1/non-O139 strains of V. cholera, is an uncommon cause of bacteraemia or bacterascites in patients with cirrhosis and is associated with high incidence of circulatory failure and significant mortality.
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Affiliation(s)
- Kunwar A. Singh
- Departments of Hepatology, Christian Medical College, Vellore, India
| | - Shalini Anandan
- Departments of Microbiology, Christian Medical College, Vellore, India
| | - Anand Sharma
- Departments of Hepatology, Christian Medical College, Vellore, India
| | - Santhosh E. Kumar
- Departments of Hepatology, Christian Medical College, Vellore, India
| | | | | | - Ashish Goel
- Departments of Hepatology, Christian Medical College, Vellore, India
| | | | - Uday G. Zachariah
- Departments of Hepatology, Christian Medical College, Vellore, India
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Rodríguez JY, Duarte C, Rodríguez GJ, Montaño LA, Benítez-Peñuela MA, Díaz P, López O, Álvarez-Moreno CA. Bacteremia by non-O1/non-O139 Vibrio cholerae: Case description and literature review. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2023; 43:323-329. [PMID: 37871571 PMCID: PMC10615443 DOI: 10.7705/biomedica.6716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 08/29/2023] [Indexed: 10/25/2023]
Abstract
Bacteremia by non-O1/non-O139 Vibrio cholerae is a rare entity associated with high mortality rates. We report a case of non-O1/non-O139 V. cholerae bacteremia confirmed by polymerase chain reaction and agglutination tests. The clinicoepidemiological characteristics and therapeutic options for this infection are also described.
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Affiliation(s)
- José Y Rodríguez
- Grupo de Infectología, Centro de Investigaciones Microbiológicas del Cesar, Valledupar, Colombia; Departamento de Medicina Interna, Facultad de Medicina, Universidad Cooperativa de Colombia, Santa Marta, Colombia; Grupo de Microbiología, Clínica Alta Complejidad del Caribe, Valledupar, Colombia.
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, D.C., Colombia.
| | - Gerson J Rodríguez
- Grupo de Infectología, Centro de Investigaciones Microbiológicas del Cesar, Valledupar, Colombia.
| | | | - Miguel A Benítez-Peñuela
- Grupo de Infectología, Centro de Investigaciones Microbiológicas del Cesar, Valledupar, Colombia.
| | - Paula Díaz
- Grupo de Microbiología, Instituto Nacional de Salud, Bogotá, D.C., Colombia.
| | - Olga López
- Grupo de Microbiología, Clínica Alta Complejidad del Caribe, Valledupar, Colombia.
| | - Carlos A Álvarez-Moreno
- Programa de Infectología, Facultad de Medicina, Universidad Nacional de Colombia, Bogotá,D.C., Colombia; Grupo de Infectología, Clínica Universitaria Colombia, Clínica Colsanitas, Bogotá, D.C., Colombia.
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Tang J, Li S, Zhang M, Li F, Tang Y, Yang F. Whole Genome Analysis of a Non-O1, Non-O139 Vibrio cholerae Detected from Human Blood in China. Infect Drug Resist 2023; 16:5453-5461. [PMID: 37638066 PMCID: PMC10454767 DOI: 10.2147/idr.s420095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/10/2023] [Indexed: 08/29/2023] Open
Abstract
Non-O1, non-O139 Vibrio cholerae (NOVC) can cause cholera-like diarrhea, but it rarely causes extraintestinal infection, so it is easily overlooked. In this report, we present a case of NOVC detected through blood culture in a 58-year-old male patient with cirrhosis, resulting in severe infection. The patient had been diagnosed with cirrhosis seven years prior and was admitted to the hospital due to abdominal distension and gastrointestinal bleeding. Gram-negative bacilli were isolated from blood cultures and identified as V. cholerae using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and average nucleotide identity (ANI). Moreover, the serum agglutination test showed that the strain was non-O1/non-O139. Further whole genome sequencing and analysis of the strain showed that the strain mainly carried virulence genes tox R, RTX, hly A, T3SS/T6SS, but no resistant genes such as sulII, dfrA1, strB were detected. It provides information for the study of the pathogenic mechanism and drug resistance mechanism of V. cholerae. The patient had severe symptoms and a poor prognosis, indicating that although the NOVC strain infected in this patient had few virulence genes, it was not weak in pathogenicity. It may be caused by the effect of some virulence genes, which should be paid attention to.
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Affiliation(s)
- Jinrong Tang
- Department of Clinical Laboratory, Mianyang Hospital of Traditional Chinese Medicine/Mianyang Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Sheng Li
- Department of Clinical Laboratory, Mianyang Hospital of Traditional Chinese Medicine/Mianyang Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Manli Zhang
- Department of Clinical Laboratory, Mianyang Hospital of Traditional Chinese Medicine/Mianyang Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Fengzhi Li
- Department of Clinical Laboratory, Mianyang Hospital of Traditional Chinese Medicine/Mianyang Hospital Affiliated to Chengdu University of Traditional Chinese Medicine, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Ying Tang
- Youxian District Center for Disease Control and Prevention of Mianyang City, Mianyang, Sichuan, 621000, People’s Republic of China
| | - Fangfang Yang
- Department of Clinical Laboratory, The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang, Sichuan, 621000, People’s Republic of China
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Ibangha IAI, Digwo DC, Ozochi CA, Enebe MC, Ateba CN, Chigor VN. A meta-analysis on the distribution of pathogenic Vibrio species in water sources and wastewater in Africa. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 881:163332. [PMID: 37028683 DOI: 10.1016/j.scitotenv.2023.163332] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 06/01/2023]
Abstract
Vibrio species are waterborne ubiquitous organisms capable of causing diseases in humans and animals and the occurrence of infections caused by pathogenic Vibrio species among humans have increased globally. This reemergence is attributed to environmental impacts such as global warming and pollution. Africa is most vulnerable to waterborne infections caused by these pathogens because of lack of good water stewardship and management. This study was carried out to provide an in-depth inquiry into the occurrence of pathogenic Vibrio species in water sources and wastewater across Africa. In this regard, a systematic review and meta-analysis was conducted by searching five databases: PubMed, ScienceDirect, Google Scholar, Springer Search and African Journals Online (AJOL). The search yielded 70 articles on pathogenic Vibrio species presence in African aquatic environments that fit our inclusion criteria. Based on the random effects model, the pooled prevalence of pathogenic Vibrio species in various water sources in Africa was 37.6 % (95 % CI: 27.7-48.0). Eighteen countries were represented by the systematically assessed studies and their nationwide prevalence in descending order was: Nigeria (79.82 %), Egypt (47.5 %), Tanzania (45.8 %), Morocco (44.8), South Africa (40.6 %), Uganda (32.1 %), Cameroon (24.5 %), Burkina Faso (18.9 %) and Ghana (5.9 %). Furthermore, 8 pathogenic Vibrio species were identified across water bodies in Africa with the highest detection for V. cholerae (59.5 %), followed by V. parahaemolyticus (10.4 %), V.alginolyticus (9.8 %), V. vulnificus (8.5 %), V. fluvialis (6.6 %), V. mimicus (4.6 %), V. harveyi (0.5 %) and V. metschnikovii (0.1 %). Evidently, pathogenic Vibrio species occurrence in these water sources especially freshwater corroborates the continuous outbreaks observed in Africa. Therefore, there is an urgent need for proactive measures and continuous monitoring of water sources used for various purposes across Africa and proper treatment of wastewater before discharge into water bodies.
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Affiliation(s)
- Ini-Abasi I Ibangha
- Water and Public Health Research Group (WPHRG), Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Daniel C Digwo
- Water and Public Health Research Group (WPHRG), Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Chizoba A Ozochi
- Water and Public Health Research Group (WPHRG), Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria
| | - Matthew C Enebe
- Water and Public Health Research Group (WPHRG), Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria; Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2735, South Africa
| | - Collins N Ateba
- Water and Public Health Research Group (WPHRG), Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria; Food Security and Safety Niche Area, Faculty of Natural and Agricultural Sciences, North-West University, Private Bag X2046, Mmabatho 2735, South Africa
| | - Vincent N Chigor
- Water and Public Health Research Group (WPHRG), Department of Microbiology, Faculty of Biological Sciences, University of Nigeria, Nsukka, Enugu State, Nigeria.
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Al-Farsi F, Al-Siyabi T, Al-Adawi B, Al-Tai A. Favourable outcomes of non-O1, non-O139 Vibrio cholerae bacteraemia in vulnerable populations: a case series. IJID REGIONS 2022; 3:76-78. [PMID: 35755472 PMCID: PMC9216316 DOI: 10.1016/j.ijregi.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 02/21/2022] [Accepted: 03/08/2022] [Indexed: 11/28/2022]
Abstract
Definitive management guidelines are lacking for non-O1 Vibrio cholerae. Predisposing factors include diabetes mellitus, chronic liver disease and malignancies. Asymptomatic human carriage may act as a source of infection. Prompt appropriate antimicrobial therapy can improve patient outcomes.
Background Aim Methods Results Conclusions
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Affiliation(s)
- Fatma Al-Farsi
- Medical Microbiology Residency Programme, Oman Medical Specialty Board, Muscat, Oman
- Corresponding author: Medical Microbiology Residency Programme, Oman Medical Specialty Board, Al Azaiba, 130 Muscat, Oman.
| | - Turkiya Al-Siyabi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Badriya Al-Adawi
- Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Amal Al-Tai
- Department of Microbiology, The Royal Hospital, Muscat, Oman
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Ogura K, Yahiro K, Moss J. Cell Death Signaling Pathway Induced by Cholix Toxin, a Cytotoxin and eEF2 ADP-Ribosyltransferase Produced by Vibrio cholerae. Toxins (Basel) 2020; 13:toxins13010012. [PMID: 33374361 PMCID: PMC7824611 DOI: 10.3390/toxins13010012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/20/2020] [Accepted: 12/22/2020] [Indexed: 12/14/2022] Open
Abstract
Pathogenic microorganisms produce various virulence factors, e.g., enzymes, cytotoxins, effectors, which trigger development of pathologies in infectious diseases. Cholera toxin (CT) produced by O1 and O139 serotypes of Vibrio cholerae (V. cholerae) is a major cytotoxin causing severe diarrhea. Cholix cytotoxin (Cholix) was identified as a novel eukaryotic elongation factor 2 (eEF2) adenosine-diphosphate (ADP)-ribosyltransferase produced mainly in non-O1/non-O139 V. cholerae. The function and role of Cholix in infectious disease caused by V. cholerae remain unknown. The crystal structure of Cholix is similar to Pseudomonas exotoxin A (PEA) which is composed of an N-terminal receptor-recognition domain and a C-terminal ADP-ribosyltransferase domain. The endocytosed Cholix catalyzes ADP-ribosylation of eEF2 in host cells and inhibits protein synthesis, resulting in cell death. In a mouse model, Cholix caused lethality with severe liver damage. In this review, we describe the mechanism underlying Cholix-induced cytotoxicity. Cholix-induced apoptosis was regulated by mitogen-activated protein kinase (MAPK) and protein kinase C (PKC) signaling pathways, which dramatically enhanced tumor necrosis factor-α (TNF-α) production in human liver, as well as the amount of epithelial-like HepG2 cancer cells. In contrast, Cholix induced apoptosis in hepatocytes through a mitochondrial-dependent pathway, which was not stimulated by TNF-α. These findings suggest that sensitivity to Cholix depends on the target cell. A substantial amount of information on PEA is provided in order to compare/contrast this well-characterized mono-ADP-ribosyltransferase (mART) with Cholix.
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Affiliation(s)
- Kohei Ogura
- Advanced Health Care Science Research Unit, Institute for Frontier Science Initiative, Kanazawa University, Kanazawa 920-0942, Japan
- Correspondence: (K.O.); (K.Y.); Tel.: +81-76-265-2590 (K.O.); +81-43-226-2048 (K.Y.)
| | - Kinnosuke Yahiro
- Department of Molecular Infectiology, Graduate School of Medicine, Chiba University, Chiba 260-8670, Japan
- Correspondence: (K.O.); (K.Y.); Tel.: +81-76-265-2590 (K.O.); +81-43-226-2048 (K.Y.)
| | - Joel Moss
- Pulmonary Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1590, USA;
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Zhang X, Lu Y, Qian H, Liu G, Mei Y, Jin F, Xia W, Ni F. Non-O1, Non-O139 Vibrio cholerae (NOVC) Bacteremia: Case Report and Literature Review, 2015-2019. Infect Drug Resist 2020; 13:1009-1016. [PMID: 32308442 PMCID: PMC7156264 DOI: 10.2147/idr.s245806] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Accepted: 03/22/2020] [Indexed: 12/22/2022] Open
Abstract
Non-O1, non-O139 Vibrio cholerae (NOVC) does not agglutinate with O1 and O139 antisera and can cause intestinal and extraintestinal infections in immunocompromised individuals. NOVC bacteremia has the highest mortality among NOVC infections, and the number of reports has increased in recent years. Nevertheless, some clinicians are poorly informed about this disease. Herein, we describe a documented case of NOVC bacteremia in a male patient with impaired liver function. Blood cultures revealed the presence of V. cholerae, but this strain showed self-coagulation on the serum agglutination test. To our knowledge, this phenomenon is unreported among cases of NOVC infections. This pathogen was finally confirmed as NOVC via PCR. Because the patient worked as a garbage transporter, he was likely infected after contact with contaminated water through a foot wound. The patient developed septic shock shortly after admission and ultimately died from the illness. This paper reviews 23 cases of NOVC bacteremia from 2015 to 2019. To improve the accuracy of identifying NOVC and analyze its virulence factors, relevant detection methods were reviewed and analyzed.
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Affiliation(s)
- Xiaohui Zhang
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
| | - Yanfei Lu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
| | - Huimin Qian
- Key Laboratory of Enteric Pathogenic Microbiology of Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, People's Republic of China
| | - Genyan Liu
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
| | - Yaning Mei
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
| | - Fei Jin
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
| | - Wenying Xia
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
| | - Fang Ni
- Department of Laboratory Medicine, Jiangsu Province Hospital and Nanjing Medical University First Affiliated Hospital, Nanjing, People's Republic of China.,National Key Clinical Department of Laboratory Medicine, Nanjing, People's Republic of China
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