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Muacevic A, Adler JR. Acute Kidney Injury Associated With Cholera. Cureus 2023; 15:e34101. [PMID: 36843768 PMCID: PMC9946370 DOI: 10.7759/cureus.34101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2023] [Indexed: 01/25/2023] Open
Abstract
Cholera is an acute infectious disease caused by Vibrio cholerae. Its clinical course varies from mild diarrhea to severe complications with hypokalemia, hyponatremia or hypernatremia, hypocalcemia, metabolic acidosis, and acute kidney injury. This is a case of a 20-year-old Asian man with recent travel history from Bangladesh who presented to the emergency department with abdominal pain and multiple episodes of watery diarrhea. He developed acute renal failure secondary to severe gastroenteritis, the cause of which was later confirmed to be cholera.
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McCarty J, Bedell L, De Lame PA, Cassie D, Lock M, Bennett S, Haney D. Update on CVD 103-HgR single-dose, live oral cholera vaccine. Expert Rev Vaccines 2021; 21:9-23. [PMID: 34775892 DOI: 10.1080/14760584.2022.2003709] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cholera remains endemic in >50 countries, putting millions at risk, especially young children for whom killed vaccines offer limited protection. An oral, live attenuated vaccine - CVD 103-HgR (Vaxchora vaccine) - was licensed by the US FDA in 2016 for adults aged 18-64 years traveling to endemic regions, based on clinical trials in human volunteers showing the vaccine was well tolerated and conferred 90% efficacy within 10 days. The evidence base for Vaxchora vaccine has expanded with additional clinical trial data, in older adults (aged 46-64 years) and children (aged 2-17 years), demonstrating that the vaccine produces a strong vibriocidal antibody response. Over 68,000 doses have been administered in the United States, with no new safety signals. The dose volume has been reduced in children to improve acceptability, and cold chain requirements are less st ringent, at +2°C─+8°C. The vaccine has recently been licensed in the Untied States for children aged 2-17 years, in Europe for individuals aged ≥2 years, and for home administration in Europe. Next steps include a Phase 4 study in infants (6-23 months). Additional information is needed regarding duration of immunity, the need for and timing of revaccination, and efficacy data from lower-middle-income countries.
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Affiliation(s)
- James McCarty
- Stanford University School of Medicine, 291 Campus Drive, Stanford, California, USA
| | - Lisa Bedell
- Emergent Travel Health, Redwood City, California, USA
| | | | - David Cassie
- Emergent Travel Health, Redwood City, California, USA
| | - Michael Lock
- Emergent Travel Health, Redwood City, California, USA
| | - Sean Bennett
- Adjuvance Technologies, Inc., Lincoln, Nebraska, USA
| | - Douglas Haney
- Emergent Travel Health, Redwood City, California, USA
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Retrospective Study on Acute Kidney Injury among Cholera Patients in an Outbreak in Whitefield, Bengaluru. Int J Nephrol 2021; 2021:6682838. [PMID: 34194844 PMCID: PMC8203381 DOI: 10.1155/2021/6682838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/04/2021] [Accepted: 05/25/2021] [Indexed: 11/28/2022] Open
Abstract
Introduction Cholera is gastroenteritis caused by Vibrio cholerae. It presents with vomiting, severe secretory diarrhoea, and dehydration. It can cause severe complications with severe electrolyte imbalances and oligoanuric acute kidney injury due to acute tubular necrosis secondary to dehydration or infection itself. However, cholera presenting with significant proteinuria and acute kidney injury has not been reported. Hence, this study was conducted. Aims and Objectives. This aim of this study was to assess clinical features, treatment, and prognosis of AKI in cholera patients; to correlate proteinuria with AKI in cholera patients; and to compare cholera patients with normal kidney function and those with AKI. Material and Methods. It was a retrospective observational study involving patients with cholera. Information regarding cholera patients with acute kidney injury, proteinuria, and prognosis were collected. Results Most of the patients had significant vomiting, moderate-to-severe diarrhoea, dehydration, and hypovolaemic shock. Cholera caused severe complications such as severe electrolyte imbalances including hyponatraemia and hypokalaemia, acute kidney injury, and proteinuria secondary to dehydration or infection. A surprising finding noted was the lack of significant association between the onset of acute kidney injury and usual risk factors such as hypovolaemic shock and dehydration. It was found that proteinuria had influenced the onset of acute kidney injury, but it did not influence recovery. As there was complete recovery in kidney function, none of the cases required kidney biopsy. There was no mortality noted. Conclusions This study points towards the rare occurrence of proteinuria and acute kidney injury in Vibrio cholerae infection with spontaneous remission of kidney disease with appropriate therapy.
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McCarty JM, Gierman EC, Bedell L, Lock MD, Bennett S. Safety and Immunogenicity of Live Oral Cholera Vaccine CVD 103-HgR in Children and Adolescents Aged 6-17 Years. Am J Trop Med Hyg 2020; 102:48-57. [PMID: 31769402 PMCID: PMC6947768 DOI: 10.4269/ajtmh.19-0241] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The attenuated recombinant Vibrio cholerae O1 vaccine strain CVD 103-HgR, redeveloped as PXVX0200, elicits a rapid serum vibriocidal antibody (SVA) response and protects against cholera-induced diarrhea in adult volunteer challenge trials but has not been studied in children in developed countries. We performed a phase 4, placebo-controlled, double-blind, multicenter study to assess the safety, immunogenicity, and tolerability of a single, oral dose of PXVX0200 in children and adolescents aged 6–17 years in the United States and bridged immunogenicity to adults aged 18–45 years from a separate lot consistency study. Volunteers were randomized to receive a single dose of 1 × 109 colony forming units (CFU) of PXVX0200 or placebo. Immunogenicity endpoints included SVA levels on days 1, 11, and 29 in volunteers aged 6–17 years and also on days 91 and 181 in volunteers aged 12–17 years. Safety was assessed by comparing solicited signs and symptoms on days 1–8, unsolicited adverse events (AEs) through day 29, and serious AEs through day 181. A total of 374 participants were enrolled, comprising 321 vaccine and 53 placebo recipients. The SVA seroconversion rates 10 days after immunization were 98.6% and 2.1% in vaccine and placebo recipients, respectively, and the vaccine seroconversion rate was non-inferior to the 93.5% rate seen in adults aged 18–45 years. Most reactogenicity was mild to moderate, and there were no vaccine-related serious AEs. The complete dose was consumed in 95.3% and 98.1% of vaccine and placebo recipients, respectively. PXVX0200 appears safe, immunogenic, and well tolerated in children and adolescents aged 6–17 years.
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Affiliation(s)
- James M McCarty
- Stanford University School of Medicine, Stanford, California
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Connor BA, Dawood R, Riddle MS, Hamer DH. Cholera in travellers: a systematic review. J Travel Med 2019; 26:5651069. [PMID: 31804684 PMCID: PMC6927393 DOI: 10.1093/jtm/taz085] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 10/25/2019] [Accepted: 11/06/2019] [Indexed: 01/02/2023]
Abstract
Exposure to cholera is a risk for individuals and groups travelling to endemic areas, and the bacteria can be imported to cholera-free countries by returning travellers. This systematic review of the literature describes the circumstances in which cholera infection can occur in travellers and considers the possible value of the cholera vaccine for prevention in travellers. PubMed and EMBASE were searched for case reports of cholera or diarrhoea among travellers, with date limits of 1 January 1990-30 April 2018. Search results were screened to exclude the following articles: diarrhoea not caused by cholera, cholera in animals, intentional cholera infection in humans, non-English articles and publications on epidemics that did not report clinical details of individual cases and publications of cases pre-dating 1990. Articles were reviewed through descriptive analytic methods and information summarized. We identified 156 cases of cholera imported as a consequence of travel, and these were reviewed for type of traveller, source country, serogroup of cholera, treatment and outcomes. The case reports retrieved in the search did not report consistent levels of detail, making it difficult to synthesize data across reports and draw firm conclusions from the data. This clinical review sheds light on the paucity of actionable published data regarding the risk of cholera in travellers and identifies a number of gaps that should drive additional effort. Further information is needed to better inform evidence-based disease prevention strategies, including vaccination for travellers visiting areas of cholera risk. Modifications to current vaccination recommendations to include or exclude current or additional traveller populations may be considered as additional risk data become available. The protocol for this systematic review is registered with PROSPERO (registration number: 122797).
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Affiliation(s)
- Bradley A Connor
- Weill Cornell Medical College and the New York Center for Travel and Tropical Medicine, New York, NY, USA
| | | | - Mark S Riddle
- University of Nevada, Reno School of Medicine, Reno, NV, 89557, USA
| | - Davidson H Hamer
- Department of Global Health, Boston University School of Public Health, Boston, MA, USA.,Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA
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Malaiyan J, Balakrishnan A, Nasimuddin S, Mohan K, Meenakshi-Sundaram P, Mamandur-Devarajan S, Gnanadesikan S, Kandasamy M, Jayakumar N, Elumalai D, Ra GG. Novel gas producing Vibrio cholerae: a case report of gastroenteritis with acute kidney injury. Access Microbiol 2019; 1:e000005. [PMID: 32974506 PMCID: PMC7470351 DOI: 10.1099/acmi.0.000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 01/10/2019] [Indexed: 11/21/2022] Open
Abstract
Background Bacterial characterization is important in clinical and epidemiological studies. We herein report the first case of gas-producing Vibrio cholera gastroenteritis with acute kidney injury. Case presentation A 30-year-old female presented to the emergency department with complaints of about ten episodes of watery diarrhea, four episodes of vomiting and elevated serum urea/creatinine levels. Although the bacteria were first misidentified as Vibrio furnissii by gas production on carbohydrate fermentation and triple sugar iron agar, it was later confirmed as Vibrio cholerae by 16 S rRNA gene sequencing and specific PCR. The treatment regimen was followed as for Vibrio species with intravenous fluids, ciprofloxacin and doxycycline. The patient recovered without relapse. Conclusions Literature survey from the PubMed database shows no gas-producing Vibrio cholerae isolate being reported in the world. Further, genotype studies are warranted to look into the gas production of Vibrio cholerae.
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Affiliation(s)
- Jeevan Malaiyan
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Anandan Balakrishnan
- Department of Genetics, Dr. ALM Post Graduate Institute of Basic Medical Sciences, University of Madras, Taramani campus, Chennai 600113, India
| | - Sowmya Nasimuddin
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Kamalraj Mohan
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - PradeepRaj Meenakshi-Sundaram
- Department of General Medicine, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Selvam Mamandur-Devarajan
- Department of General Medicine, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Sumathi Gnanadesikan
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Mohanakrishnan Kandasamy
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Nithyalakshmi Jayakumar
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Dhevahi Elumalai
- Department of Microbiology, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
| | - Gokul G Ra
- Department of General Medicine, Sri Muthukumaran Medical College Hospital and Research Institute, Affiliated to The Tamil Nadu Dr. M.G.R. Medical University, Chikkarayapuram, Chennai 600 069, India
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McCarty JM, Lock MD, Hunt KM, Simon JK, Gurwith M. Safety and immunogenicity of single-dose live oral cholera vaccine strain CVD 103-HgR in healthy adults age 18-45. Vaccine 2018; 36:833-840. [PMID: 29317118 DOI: 10.1016/j.vaccine.2017.12.062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/09/2017] [Accepted: 12/19/2017] [Indexed: 11/29/2022]
Abstract
The attenuated recombinant Vibrio cholerae O1 vaccine strain CVD 103-HgR, re-developed as PXVX0200, elicits a rapid serum vibriocidal antibody (SVA) response and protects against cholera diarrhea in volunteer challenge studies. We performed a phase 3, placebo controlled, double blind, multi-center study to further assess the safety, immunogenicity, and lot-to-lot consistency of PXVX0200. Adult volunteers 18-45 years of age were randomized 8:1 to receive a single dose of 1 × 109 CFU of PXVX0200 from three production lots or saline placebo. Immunogenicity endpoints included SVA and anti-cholera toxin (CT) antibody levels on days 1, 11, 29, 91 and 181. Safety was assessed by comparing solicited signs and symptoms on days 1-8, unsolicited adverse events through day 29 and serious adverse events through day 181. A total of 3146 participants were enrolled, including 2795 vaccine and 351 placebo recipients. The SVA seroconversion rates at day 11 were 94% and 4% in the PXVX0200 and placebo recipients, respectively (P < .0001). Cumulative SVA seroconversion occurred among 96% of vaccine recipients. PXVX0200 SVA GMTs peaked on day 11 and remained significantly higher than placebo through day 181 while the fold-rise over baseline in PXVX0200 anti-CT antibody was significantly greater than placebo at every post-vaccination time point. Most reactogenicity was mild and resolved within 1-3 days with headache and diarrhea more frequently reported in PXVX0200 recipients. There were no differences in unsolicited adverse events and no study-related serious adverse events. Immunogenicity and safety endpoints were equivalent between the three production lots. PXVX0200 is immunogenic and well tolerated across multiple production lots. CLINICAL TRIALS REGISTRATION Clinicaltrials.gov NCT02094586.
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Affiliation(s)
- James M McCarty
- Stanford University School of Medicine, 291 Campus Drive, Stanford, CA 94305, USA
| | - Michael D Lock
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065, USA
| | - Kristin M Hunt
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065, USA
| | - Jakub K Simon
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065, USA
| | - Marc Gurwith
- PaxVax, Inc., 555 Twin Dolphin Drive, Ste. 360, Redwood City, CA 94065, USA.
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Gupta S, Pannu HS, Jain NP, Sandhu JS, Kumar A. Profile and outcome of acute renal failure due to tropical infections – A prospective study. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2016. [DOI: 10.1016/j.injms.2016.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Vibriosis is a group of intestinal and extraintestinal infections caused by marine-dwelling bacteria of the genus Vibrio. Infections range from indolent illnesses to fulminant diseases, including cholera and necrotizing fasciitis. Most illnesses result from direct contact with the marine environment or consumption of shellfish, especially oysters. In the United States vibrio infections are increasing but are underreported because of lack of clinical recognition and appropriate detection in the microbiology laboratory. Recent advances to aid in the detection and identification of vibrio illnesses in the laboratory include rapid identification tests, new media, and molecular identification systems.
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Affiliation(s)
- J Michael Janda
- Department of Public Health, Alameda County Public Health Laboratory, 1000 Broadway, Suite 500, Oakland, CA 94607, USA
| | - Anna E Newton
- Enteric Diseases Epidemiology Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA
| | - Cheryl A Bopp
- Enteric Diseases Laboratory Branch, Division of Foodborne, Waterborne and Environmental Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Fillion K, Mileno MD. Cholera in Travelers: Shifting Tides in Epidemiology, Management, and Prevention. Curr Infect Dis Rep 2015; 17:455. [DOI: 10.1007/s11908-014-0455-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
Establishing a programme for the prevention and treatment of acute kidney injury, chronic kidney disease and end-stage renal disease in a developing country involves unique challenges. We became involved in a collaborative effort to improve nephrology care in Haiti after participating in the emergency response to the 2010 earthquake. The focus of this ongoing project is overcoming barriers to implementation with the goal of improving training and resources for Haitian health-care workers and developing programmes for renal disease prevention and treatment in a setting of limited resources. Here, we offer practical advice for nephrologists who would like to help to advance medical care in developing countries. Rather than technical issues related to the prevention and treatment of renal disease, we focus on collaboration, education and the building of partnerships.
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Mascarello M, Deiana ML, Maurel C, Lucarelli C, Luzzi I, Luzzati R. Cholera with severe renal failure in an Italian tourist returning from Cuba, July 2013. Euro Surveill 2013; 18:20572. [DOI: 10.2807/1560-7917.es2013.18.35.20572] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In July 2013, an Italian tourist returning from Cuba was hospitalised in Trieste, Italy, for cholera caused by Vibrio cholerae O1 serotype Ogawa with severe renal failure. An outbreak of cholera was reported in Cuba in January 2013. Physicians should consider the diagnosis of cholera in travellers returning from Cuba presenting with acute watery diarrhoea.
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Affiliation(s)
- M Mascarello
- Department of Infectious Diseases, Hospital of Trieste, Trieste, Italy
| | - M L Deiana
- Department of Microbiology, Hospital of Trieste, Trieste, Italy
| | - C Maurel
- Department of Infectious Diseases, Hospital of Trieste, Trieste, Italy
| | - C Lucarelli
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - I Luzzi
- Department of Infectious, Parasitic and Immune-mediated Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - R Luzzati
- Department of Infectious Diseases, Hospital of Trieste, Trieste, Italy
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