Non-O:1 Vibrio cholerae bacteremia: report of two cases

Vibrio cholerae non-O1 bacteraemia: description of three cases in the Netherlands and a literature review

Vibrio cholerae non-O1 serogroup (VCNO) bacteraemia is a severe condition with a high case-fatality rate. We report three cases diagnosed in the Netherlands, identified during a national microbiological congress, and provide a literature review on VCNO bacteraemia. A search strategy including synonyms for 'VCNO' and 'bacteraemia' was applied to PubMed, Medline, Web of Science and Embase databases. The three cases were reported in elderly male patients after fish consumption and/or surface water contact. The literature search yielded 82 case reports on 90 cases and six case series. Thirty case reports were from Asia (30/90; 33%), concerned males (67/90; 74%), and around one third (38/90; 42%) involved a history of alcohol abuse and/or liver cirrhosis The presenting symptom often was gastroenteritis (47/90; 52%) which occurred after seafood consumption in 32% of the cases (15/47).Aside from the most frequent symptom being fever, results of case series concurred with these findings. Published cases also included rare presentations e.g. endophthalmitis and neonatal meningitis. Based on the limited data available, cephalosporins seemed the most effective treatment. Although mainly reported in Asia, VCNO bacteraemia occurs worldwide. While some risk factors for VCNO were identified in this study, the source of infection remains often unclear. Clinical presentation may vary greatly and therefore a quick microbiological diagnosis is indispensable.

Non-O1, non-O139 Vibrio cholerae bacteraemia: case report and literature review

Non-O1, non-O139 Vibrio cholerae (NOVC) are increasingly frequently observed ubiquitous microorganisms occasionally responsible for intestinal and extra-intestinal infections. Most cases involve self-limiting gastroenteritis or ear and wound infections in immunocompetent patients. Bacteraemia, which have been described in patients with predisposing factors, are rare and poorly known, both on the clinical and therapeutic aspects. We describe a case of NOVC bacteraemia and a systematic literature review in PubMed conducted up to November 2014 using a combination of the following search terms: “Vibrio cholerae non-O1” and “bacter(a)emia”. The case was a 70 year-old healthy male subject returning from Senegal and suffering from NOVC bacteraemia associated with liver abscesses. Disease evolution was favourable after 2 months’ therapy (ceftriaxone then ciprofloxacin). Three hundred and fifty cases of NOVC bacteraemia have been identified in the literature. The majority of patients were male (77 %), with a median age of 56 years and presenting with predisposing conditions (96 %), such as cirrhosis (55 %) or malignant disease (20 %). Diarrhoea was inconstant (42 %). Mortality was 33 %. The source of infection, identified in only 25 % of cases, was seafood consumption (54 %) or contaminated water (30 %). Practitioners should be aware of these infections, in order to warn patients with predisposing conditions, on the risk of ingesting raw or undercooked seafood or bathing in potentially infected waters.

Rare Strain of Vibrio cholerae Septicemia in a Patient with Multiple Myeloma

Introduction. Non-O1/non-O139 is a rare strain of Vibrio cholera that has been documented to cause significant morbidity and mortality in the immunosuppressed population. Case Presentation. A patient with multiple myeloma develops non-O1/non-O139 Vibrio cholera septicemia, leading to multiorgan failure and ultimately death. Discussion. An exceedingly rare strain of Vibrio cholera, non-O1/non-O139, may be an important factor of morbidity and mortality in certain immunosuppressed populations, such as patients with multiple myeloma and malignancies. Conclusion. Bacteremia involving generally noninvasive microbes, such as non-O1/non-O139 Vibrio cholerae, can have significant deleterious effects in the immunosuppressed patients as shown by this case report. Physicians need to be more diligent when treating these patients.

Recurrent non-0:1 Vibrio cholerae bacteremia in a patient with multiple myeloma

BACKGROUND

Episodes of bacteremia with non-0:1 Vibrio cholerae are rarely reported, even though the organism is endemic along the Gulf Coast of the United States. Recurrent episodes of bacteremia with non-0:1 V. cholerae are described even more rarely. A patient is reported who had multiple myeloma and experienced two episodes of bacteremia with non-0:1 V. cholerae.

METHODS

Hospital records and the medical literature were reviewed, and the organism was serotyped by the Alabama State Laboratory.

RESULTS

The patient had no prodromal illnesses or diarrhea with either episode of bacteremia. Treatment with empiric antibiotic therapy resulted in successful resolution of his bacteremia, which is fatal in almost 50% of reported cases in patients with malignant neoplasms.

CONCLUSIONS

This is the first reported case of non-0:1 V. cholerae bacteremia occurring in a patient with multiple myeloma. Both his initial episode and a second episode of bacteremia responded to broad-spectrum antibiotics, which are used as empiric therapy for patients with hematologic malignancies and fever. Emphasis is placed on the paucity of clinical manifestations and the need for empiric therapy for non-0:1 V. cholerae infection in patients with hematologic malignancies.