Abstract
In mainland China, the clinical, epidemiological and genetic features of non-O1/non-O139 Vibrio cholerae (NOVC) bacteraemia have been scarcely investigated. Herein, we describe a patient with NOVC bacteraemia diagnosed in our hospital and present a retrospective analysis of literature reports of 32 other cases in China, detailing the clinical epidemiology, antibiotic resistance and molecular characteristics of isolates. Most patients were male (84.8%; median age, 53 years) and had predisposing factors, such as cirrhosis, malignant tumours, blood diseases and diabetes. In addition to fever, gastroenteritis was the most frequent presenting symptom. The mortality rate during hospitalisation was 12.1%. NOVC bacteraemia cases were more common in June-August, with the majority in coastal provinces and the Yangtze River basin. Only 42.4% of cases were attributed to consumption of marine (aquatic) products. Tetracycline, third-generation cephalosporins, and fluoroquinolones were the most effective antimicrobial agents, and the highest frequencies of resistance were recorded for ampicillin/sulbactam (37.5%), amoxicillin/clavulanic acid (33.3%), ampicillin (29.2%) and sulfamethoxazole (20%). Multi-drug resistant isolates were not detected. Limited data indicate that ctxAB and tcpA genes were absent in all NOVC isolates but other putative virulence genes (hlyA, toxR, hap and rtxA) were common. Ten multilocus sequence types were identified with marked genetic heterogeneity between different isolates. As clinical manifestations of NOVC bacteraemia may vary widely, and isolates exhibit genetic diversity, clinicians and public health experts should be alerted to the possibility of infection with this pathogen because of the high prevalence of liver disease in China.
Highlights
Vibrio cholerae is a pathogenic Gram-negative bacillus, which is widely distributed in water environments
Clinical and epidemiological data pertaining to non-O139 V. cholerae (NOVC) bacteraemia cases are scarce from mainland China with little information on the distribution of virulence-associated genes and genetic relationships among isolates
We present a case of bacteraemia due to a NOVC strain in an elderly male with underlying alcoholic liver cirrhosis, and a retrospective analysis of related reports of 32 other cases in mainland China
Summary
Vibrio cholerae is a pathogenic Gram-negative bacillus, which is widely distributed in water environments. He presented with a history of previous hypertension, alcoholic cirrhosis and diabetes mellitus, but had not been exposed to uncooked seafood or contaminated water, or a history of travel to cholera-endemic areas. On admission, his temperature was 37.0 °C; heart rate, 72/min; blood pressure, 148/77 mmHg. Physical examination revealed icteric skin sclera, mild ascites, splenomegaly, tremor in both upper limbs and positive for Romberg’s Sign. The patient was diagnosed with hepatic encephalopathy, bacteraemia, decompensated alcoholic cirrhosis, hypertension, type 2 diabetes, right lung nodules, right pleural effusion, anaemia, thrombocytopaenia, coagulopathy and peritoneal effusion He was transferred to the local infectious disease hospital for further treatment, and repeat blood cultures proved negative with no recurrence of fever at 1-month follow-up
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