Abstract

We analyzed 1,093 Vibrio cholerae isolates from the Democratic Republic of the Congo during 1997–2012 and found increasing antimicrobial drug resistance over time. Our study also demonstrated that the 2011–2012 epidemic was caused by an El Tor variant clonal complex with a single antimicrobial drug susceptibility profile.

Highlights

  • Cholera and dysentery have afflicted humankind for centuries

  • The two most common types of epidemic diarrhea in developing countries are watery diarrhea caused by Vibrio cholerae serogroup O1 and bloody diarrhea caused by Shigella dysenteriae serotype 1 (Sd1)

  • For quality control of Desoxycholate citrate agar (DCA), the following organisms should be adequate for confirmation of selective and inhibitory growth characteristics: E. coli may be somewhat inhibited, depending on the particular formulation used, but will produce pink colonies surrounded by a zone of precipitated bile; S. flexneri and S. dysenteriae 1 will produce fair to good growth of colorless colonies

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Summary

Introduction

Cholera and dysentery have afflicted humankind for centuries. The epidemics they cause have affected the outcome of wars and the fates of countries. Two etiologic agents are responsible for most epidemic diarrhea: toxigenic Vibrio cholerae serogroup O1, which causes watery diarrhea, and Shigella dysenteriae serotype 1, which causes bloody diarrhea. Two additional organisms have emerged to cause epidemic diarrhea, Vibrio cholerae serogroup O139, which causes watery diarrhea, and Escherichia coli serotype O157:H7, which causes bloody diarrhea. The latter is a common agent of diarrhea only in developed countries. The procedures described are not new; most have been used for a number of years These procedures were selected for testing specimens from outbreaks rather than for general use in a clinical microbiology laboratory.

Epidemic Diarrhea
Epidemic cholera
Epidemic dysentery
Public Health Role of the Laboratory
Initial identification of the organism causing the epidemic
Determining antimicrobial susceptibility patterns of epidemic organisms
Monitoring for changes in antimicrobial susceptibility
Defining the duration of the epidemic
Other duties of the laboratory during an epidemic
Chapter 2 Collection and Transport of Fecal Specimens
Collection of Stool
Collection of rectal swabs
Transport media
Storage of specimens in transport medium
Unpreserved specimens
Preparing Specimens for Shipment
Refrigerated specimens
Frozen specimens
Chapter 3 Epidemiology of Dysentery Caused by Shigella
Epidemiology of Shigella
Clinical Manifestations
Treatment
Chapter 4 Isolation and Identification of Shigella
Isolation Methods
Inoculation of selective agar
Biochemical Screening Tests
Kligler iron agar and triple sugar iron agar
Additional biochemical screening tests
Slide agglutination
Media for Isolation and Identification of Shigella
Desoxycholate citrate agar
Hektoen enteric agar
Lysine iron agar
MacConkey agar
Motility medium
Sulfide-indole-motility medium
Urea medium
Xylose lysine desoxycholate agar
Chapter 5 Etiology and Epidemiology of Cholera
Historical Background
Epidemiology
Cholera Vaccine
Chapter 6 Isolation and Identification of Vibrio cholerae Serogroups O1 and O139
Enrichment in alkaline peptone water
Isolation from TCBS selective agar
Presumptive identification using O1 and O139 antisera
Slide agglutination procedures
Oxidase reagent
Chapter 7 Epidemiology of Escherichia coli Serotype O157:H7
Chapter 8 Isolation and Identification of Escherichia coli Serotype O157:H7
Preparation and Quality Control of Sorbitol-MacConkey agar
Considerations for Antimicrobial Susceptibility Testing
Mueller-Hinton susceptibility test agar
McFarland turbidity standard
Preparation of inoculum
Recording and interpreting results
Quality control
Preparation and Quality Control of Media and Reagents
Chapter 10 Storage of Isolates
Short-term Storage
Long-term Storage
Chapter 11 Quality Control of Media and Reagents
Considerations for quality control of media
Methods for quality control of media
Sources of quality control strains
Quality Control of Reagents
Advantages of Centralized Acquisition of Media and Reagents
Chapter 12 Standard Safety Practices in the Microbiology Laboratory
Standard Microbiological Safety Practices
Special Practices
Protective Clothing and Equipment
Preparation for Transport of Infectious Specimens and Cultures
Regulatory organizations
Initial confirmation of the outbreak
Surveillance for antimicrobial susceptibility of Vibrio cholerae isolates
District level
Regional level
Reference level
Referral to international reference laboratories
Feedback of Results
Additional components for network
Findings
Methods
Full Text
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