V cholerae non-01: implications for man?

Abstract

The view that only strains of Vibrio cholerae Ol were capable of causing epidemics of cholera was held until 1992, when an epidemic caused by a V cholerae non-Ol strain (now designated V cholerae O139) occurred in India and Bangladesh. 1 Shimada T Nair GB Deb BC Albert MJ Sack RB Takeda Y Serological clonality of the outbreak strains of Vibrio cholerae non-O1 from India and Bangladesh; assignment of a new serogroup O139 synonym Bengal. Lancet. 1993; 341: 1347 Abstract PubMed Scopus (15) Google Scholar Sporadic cases of diarrhoea caused by V cholerae non-O1 had been recognised worldwide for many years. However, until the 1992 epidemic of V cholerae O139, there had been only three reports of large outbreaks attributable to these organisms. The vehicle of infection was food in two of these and water in one. The first, in 1965, was in an adult training centre in Czechoslovakia. 2 Aldova E Laznickova K Stepankova E Lietava J Isolation of nonagglutinable vibrios from an enteritis outbreak in Czechoslovakia. J Infect Dis. 1968; 118: 25-31 Crossref PubMed Scopus (78) Google Scholar Of the 56 cases in this outbreak, 42 were bacteriologically proven. The causative strain was V cholerae serogroup O5, and potato salad was implicated as the outbreak vehicle. No deaths were recorded. The second, in 1968, was in Sudan 3 Kamal AM Outbreak of gastroenteritis by non-agglutinable (NAG) vibrios in the republic of the Sudan. J Egypt Public Health Assoc. 1971; 46: 125-133 Google Scholar and was centred round a village to the south of Khartoum. The discovery of water in an arid region by the tapping of an artesian well resulted in a pilgrimage of some 30 000 people to this village. Symptoms included rice-water stools, and there were 544 cases with 31 deaths. The cause of this outbreak turned out to be human faecal contamination of the well water with V cholerae serogroup O37. The third was in 1973, on an aeroplane flight between London and Australia. 4 Dakin WPH Howell DJ Sutton RGA et al. Gastroenteritis due to non-agglutinable (non-cholera) vibrios. Med J Aust. 1974; ii: 487-490 Google Scholar A meal of chopped egg and asparagus salad, taken on board during a stopover in Bahrain, was implicated as the vehicle of infection. Symptoms included nausea, vomiting, and watery diarrhoea.