Changes in Vibrio cholerae O1 strains isolated in Romania during 1977-95.

Six hundred and twenty-four Vibrio cholerae O1 strains, 623 serotype Ogawa and one serotype Inaba, isolated in Romania between 1977-95 were tested to detect all changing traits concerning serogroup, serotype, biotype, phage type and resistotype patterns and subsequently, the possible epidemiological relationship among these strains. Biotyping revealed one classical, 580 eltor strains and 43 intermediary variants. When tested with Mukerjee phages, 546 (87%) strains were sensitive and 78 (13%) resistant. One phage type (M4) dominated during 1977-90, two phage types (M4 and M5) exhibited the same high frequencies during 1991, a diversity of types occurred during 1993-4 whereas in 1995, two phage types (M4 and M5) showed similar distributions again. Five patterns of drug susceptibility were successively described during 1977-95. The most prominent changes in Vibrio cholerae O1 strains were noticed during 1993-4: the highest number of non-typable strains and intermediary variants, the widest spectrum of phage types and of multidrug resistance. In 1995, the strains reverted to the previous typable forms but a new drug resistance pattern was noticed.     

Phenotypic and genetic analyses of 111 clinical and environmental O1, O139, and non-O1/O139 Vibrio cholerae strains from different geographical areas

A total of 111 clinical and environmental O1, O139 and non-O1/O139 Vibrio cholerae strains isolated between 1978 and 2008 from different geographical areas were typed using a combination of methods: antibiotic susceptibility, biochemical test, serogroup, serotype, biotype, sequences containing variable numbers of tandem repeats (VNTRs) and virulence genes ctxA and tcpA amplification. As a result of the performed typing work, the strains were organized into four clusters: cluster A1 included clinical O1 Ogawa and O139 serogroup strains (ctxA(+) and tcpA(+)); cluster A2 included clinical non-O1/O139 strains (ctxA(-) and tcpA(-)), as well as environmental O1 Inaba and non-O1/O139 strains (ctxA(-) and tcpA(-)/tcpA(+)); cluster B1 contained two clinical O1 strains and environmental non-O1/O139 strains (ctxA(-) and tcpA(+)/tcpA(-)); cluster B2 contained clinical O1 Inaba and Ogawa strains (ctxA(+) and tcpA(+)). The results of this work illustrate the advantage of combining several typing methods to discriminate between clinical and environmental V. cholerae strains.     

Preferential association of the heat-stable enterotoxin gene (stn) with environmental strains of Vibrio cholerae belonging to the O14 serogroup

Toxigenic Vibrio cholerae O1 and O139 serogroups have the capacity of causing epidemic and pandemic cholera but are infrequently found in the environment. The other serogroups are abundant in aquatic environments but do not possess the virulence genes necessary for causing the disease. Of the 559 environmental strains of V. cholerae, collected during different periods from environmental samples in Calcutta, 9 (1.6%) harboured the heat-stable enterotoxin gene (stn). Six of the 9 strains belonged to the O14 serogroup. Thus, V. cholerae strains carrying the stn gene revealed preferential association with the O14 serogroup. Three of the six strains harboured the tcpA gene of the E1 Tor type, which is an unusual feature among environmental V. cholerae strains. A strain that possessed the E1 Tor type tcpA also had the CTX prophage. Pulsed field gel electrophoresis (PFGE) revealed that the stn gene positive O14 strains of V. cholerae were not clonal.     

Phenotypic and molecular characterization of Vibrio cholerae O1 isolated in Samutsakorn,Thailand before,during and after the emergence of V. cholerae O139.

Seventy clinical strains of Vibrio cholerae O1 isolated from 1982-96 in Samutsakorn, a port city 30 km southwest of Bangkok where cholera occurs at low levels with regular seasonality, were characterized to investigate if there were any differences among the O1 strains isolated before, during and after the 0139 epidemic. Pulsed-field gel electrophoresis (PFGE) typing, ribotyping and southern blot hybridization with a cholera toxin probe (CT genotyping) demonstrated several genotypes among O1 strains isolated before the emergence of V. cholerae 0139. However, O1 strains isolated during and after the advent of 0139 showed identical ribotypes which were distinctly different from the types identified in strains isolated before the emergence of 0139. Ribotypes identified in strains during and after the advent of 0139 were also demonstrated by O1 strains isolated immediately before the emergence of 0139. Considering the seasonality of cholera in Samutsakorn, the identical ribotype and CT genotype and the closely related PFGE types shown by all O1 strains isolated during and after the appearance of 0139 is remarkable and suggest that the V. cholerae O1 strain may reemerge from an environmental source. A subgroup of V. cholerae O1 strains isolated before the emergence of the 0139 epidemic had a ribotype identical to a type demonstrated by 0139 strains isolated in Thailand. Our results support similar findings in Bangladesh and India that a distinct O1 strain appeared during the 0139 epidemic. However, compared with the apparent identical strain which replaced 0139 in Bangladesh and India, the emerged O1 strain in Samutsakorn showed a different ribotype and CT genotype.     

Distribution and virulence of Vibrio cholerae belonging to serogroups other than O1 and O139: a nationwide survey.

The distribution and virulence of Vibrio cholerae serogroups other than O1 and O139 in India before, during and after the advent of O139 serogroup was investigated. A total of 68 strains belonging to 31 different ''O'' serogroups were identified during the study period. With the exception of O53, there was no spatial or temporal clustering of any particular non-O1 non-O139 serogroup at any given place. Two of the 68 strains examined produced cholera toxin (CT) which could only be partially absorbed with anti-CT immunoglobulin G. Tissue culture assay revealed that some of the non-O1 non-O139 strains produced factors which evoked either a cell rounding or cell elongation response depending upon the medium used. This study indicates that serogroups other than O1 and O139 should also be continuously monitored.     

嘉兴市霍乱弧菌分离株检测分析

目的比较分析嘉兴市霍乱弧菌菌株的血清型、毒力基因和分子分型特征。方法采用血清学和分子生物学方法对近年来分离到13株霍乱弧菌菌株进行血清型分布、毒力基因(ctxA、ace、zot、tcpA、cri和rtxA)携带和ERIC-PCR分型研究。结果 13株霍乱弧菌菌株,2株为O139群霍乱弧菌,11株为O1群霍乱弧菌,其中小川型9株,稻叶型2株。2株O139群霍乱弧菌菌株携带3种毒力基因;11株O1群霍乱弧菌菌株,除1株携带4种毒力基因外,其余10株携带全部6种毒力基因。ERIC-PCR分型分析显示,不同的霍乱弧菌菌株之间ERIC-PCR型别表现出一定的遗传多样性。结论嘉兴市霍乱弧菌菌株大多携带多种毒力基因,而且来源多样,防控工作任重而道远。     

Rapid spread of the new clone of Vibrio cholerae O1 biotype El Tor in cholera endemic areas in India.

Using molecular techniques, we investigated whether the clone of Vibrio cholerae O1 biotype El Tor which appeared in Calcutta, India, in 1994 has spread to other cholera endemic areas in the country. The ribotype of 31 of the 33 strains isolated from different parts of India during 1996 and 1997 was identical to the ribotype displayed by the new clone of V. cholerae O1 which emerged in Calcutta in 1994. Likewise, 12 of the 15 strains examined by pulsed-field gel electrophoresis (PFGE) showed identical profile to that exhibited by the new clone of O1. The restriction fragment length polymorphism (RFLP) of CTX genetic element of these strains also matched with the new clone of O1 which emerged after the outbreak of V. cholerae 0139 in Calcutta. However, two strains (AH042 and AH046) isolated from an outbreak in Ahmedabad (western India) showed different CTX RFLP but had the same ribotype and PFGE profile as the new clone, whereas one strain from Goa (G2) showed distinct ribotype and PFGE profile and the CTX RFLP was identical to the O1 strains which prevailed before the genesis of 0139 in Calcutta. The drug resistance pattern of most of the O1 strains examined in this study, except strain G2, was similar to that of the new clone of V. cholerae O1. None of the strains in this study carried plasmids. Molecular studies clearly show that the new expanded drug resistant clone of V. cholerae O1 has spread to all cholera endemic areas in India and also provide evidence for the evolution of new clones of the O1 serogroup.     

Notes from the field: Identification of Vibrio cholerae serogroup O1, serotype Inaba, biotype El Tor strain - Haiti, March 2012

On October 20, 2010, an outbreak of cholera was confirmed in Haiti for the first time in more than a century. As of April 10, 2012, a total of 534,647 cases, 287,656 hospitalizations, and 7,091 deaths have been reported in Haiti as a result of the outbreak. The Vibrio cholerae strain that caused the Haiti epidemic has been characterized as toxigenic V. cholerae, serogroup O1, serotype Ogawa, biotype El Tor.     

海宁市霍乱弧菌检出结果分析

[目的]掌握我市外环境中霍乱弧菌的存在状况及预测未来霍乱发病趋势以便采取适当的防病措施。[方法]依据GB15984-1995《霍乱诊断标准及处理原则》和外环境水样标本分离霍乱弧菌程序对不同样品进行检测,并对33份阳性菌株进行噬菌体-生物分型鉴定。[结果]对不同样品进行检测,其中水样579份阳性31份,阳性水源11处。感染确诊病例18例（其中1例为输入病例）,其中O139型2例,稻叶型16例。33份阳性菌株经噬菌体-生物分型,1 f 21株、2 f 2株、1 d 1株、1 e 1株、5k 1株、19k 1株,0139型6株。埃尔托霍乱弧菌中流行株,共计25株,25/27（92.6%）。[结论]海宁市外环境中存在多种霍乱弧菌,并发现在同一水源中同时检出2种不血清型的霍乱弧菌;本次流行仍以稻叶型、O139型霍乱为主;菌株鉴定存在流行株（1f、2f、1d和1e）。未来几年仍有霍乱暴发流行和散发的可能。防控形势非常严峻,必须采取有力措施。     

Expanding multiple antibiotic resistance among clinical strains of Vibrio cholerae isolated from 1992-7 in Calcutta, India

Antimicrobial susceptibilities of Vibrio cholerae strains isolated from cholera patients admitted to the Infectious Diseases Hospital, Calcutta, India for 6 years were analysed to determine the changing trends; 840 V. cholerae strains isolated in 1992-1997 were included in this study. Among V. cholerae serogoup O1 and O139, ampicillin resistance increased from 1992 (35 and 70%, respectively) to 1997 (both serogroups 100%). Resistance to furazolidone and streptomycin was constantly high among V. cholerae O1 strains with gradual increase in resistance to other drugs such as ciprofloxacin, co-trimoxazole, neomycin and nalidixic acid. V. cholerae O139 strains exhibited susceptibilities to furazolidone and streptomycin comparable with those of O1 strains. However, after initial increase in resistance to chloramphenicol and co-trimoxazole, all the V. cholerae O139 strains became susceptible to these two drugs from 1995 onwards. Both V. cholerae O1 and O139 remained largely susceptible to gentamicin and tetracycline. V. cholerae non-O1, non-O139 strains, in contrast, exhibited high levels of resistance to virtually every class of antimicrobial agents tested in this study especially from 1995. Kruskal-Wallis one-way analysis showed that V. cholerae O1 Ogawa serogroup exhibited significant yearly increase in resistance to nine antibiotics followed by non-O1 non-O139 and O139 strains to six antibiotics and two antibiotics respectively. Interesting observation encountered in this study was the dissipation of some of the resistant patterns commonly found among V. cholerae non-O1 non-O139 or O1 serogroups to the O139 serogroup and vice versa during the succeeding years.     

Survey of Vibrio cholerae O1 and its survival over the winter in marine water of Port of Osaka

The survey of Vibrio cholerae O1 in marine area was carried out in the Port of Osaka, Japan in 1987-2001, and 51 V. cholerae O1 strains were isolated. All strains were identified to be of El Tor biotype, Ogawa serotype and classic Ubon Kappa-phage type, and were cholera toxin (CT)-negative and CT gene-negative. In order to clarify certain ecological aspects of V. cholerae O1 in the marine environment of the temperate zone, we performed molecular analysis of the isolated strains using pulsed-field gel electrophoresis (PFGE) with NotI and SfiI restriction enzymes. We found the indistinguishable strains by DNA analysis using PFGE with strains passed for 1 year, and also found the closely related strains with that passed for 3 and 12 years. Those results indicated that V. cholerae O1 can survive over one winter at least, and that it survives in marine water for a long time by undergoing continuous mutation.     

Characterization of Vibrio cholerae 01 recently isolated in Bangladesh

91 strains of Vibrio cholerae O1, isolated in Bangladesh in January 1986, were examined for their biological behaviour and sensitivity to 6 antimicrobial agents. Biotyping indicated that 60 of the isolates belonged to the classical biotype and 31 to the El Tor biotype. 21 El Tor strains revealed beta-haemolysis on blood agar plates, but only 8 showed complete haemolysis in broth. Serotyping indicated 79 Ogawa, 10 Inaba, and 2 Hikojima. Phage typing showed that all classical vibrios belonged to Mukerjee's phage type 1. El Tor vibrios were classified into 4 groups: one strain each in type 1 and type 5, 19 in type 4, and 10 in an untypable group. Prophage typing of El Tor vibrios identified 14 strains of Ubol type, 16 of cured Celebes type, and one of original Celebes type. No strain was resistant to tetracycline, minocycline, chloramphenicol, streptomycin, amoxicillin or nalidixic acid. The classical vibrios differed from those isolated before 1973 in toxin production pattern.     

Comparison of amplified fragment length polymorphism and pulsed-field gel electrophoresis for subtyping of Vibrio cholerae serogroups O1 and O139

Molecular typing of Vibrio cholerae strains is a powerful tool for the surveillance of cholera. Amplified fragment length polymorphism (AFLP) is considered to be a powerful subtyping technique to distinguish bacterial strains at the genetic level. Optimization and standardization of AFLP protocol is required to allow data comparisons across different laboratories in a surveillance network. Here, we performed AFLP using different restriction enzymes and primer pairs for subtyping of V. cholerae serogroups O1 and O139 and compared the optimized AFLP protocol with pulsed-field gel electrophoresis (PFGE) to evaluate the applicability of AFLP for conducting epidemiological surveillance of cholera. The discriminatory index (D-value) of PFGE for serogroup O1 strains was similar when digested with NotI and SfiI, whereas that for O139 strains was higher for NotI digestion than for SfiI. EcoRI-G/MseI-T was the restriction enzyme and primer combination with highest discriminatory index used in the AFLP analysis. Capillary electrophoresis-based AFLP showed higher discriminatory power than that of polyacrylamide gel electrophoresis-based AFLP. When the two methods were compared using 72 epidemiologically unrelated serogroup O1 El Tor isolates, AFLP had a lower D-value than PFGE with NotI and SfiI digestions, respectively. For 54 epidemiologically unrelated serogroup O139 isolates, NotI PFGE had the highest discriminatory power, and SfiI PFGE and AFLP yielded almost the same but lower discriminatory power. We conclude that NotI and SfiI are both suitable for the PFGE of V. cholerae serogroup O1, whereas NotI should be defined as the primary enzyme for serogroup O139. The applicability of AFLP in V. cholerae subtyping and outbreak investigations is limited.     

Diversity of Vibrio cholerae strains isolated in Delhi, India, during 1992-2000

The National Institute of Communicable Diseases (NICD), Delhi, India, conducts a laboratory-based surveillance of cholera cases referred from the Infectious Disease Hospital, Delhi. The prevalence and antimicrobial susceptibilities of Vibrio cholerae O1, O139, and others, isolated from cholera patients for nine years, were analyzed to determine the changing trends in their isolation and drug-resistance patterns. In total, 29,196 stool samples or rectal swabs, collected during April 1992-December 2000, were included in this study. Of these, 13,730 (47%) were positive for V. cholerae: 11,091 for V. cholerae O1 (80.7%) and 1,943 (14%) for V. cholerae O139, and 696 (5%) were non-O1 and non-O139. V. cholerae O1 was the dominant serotype during 1992-1993, when V. cholerae O139 emerged as a new serotype but, thereafter, remained low from 1994 to 1999. Phenotypically, re-emerged V. cholerae O139 in 2000 displayed a difference compared to those that appeared in 1992-1993, in that the current O139 strains were sensitive to co-trimoxazole. Resistance to nalidixic acid and furazolidone was constantly high (100%) among strains of V. cholerae O1 and O139. All strains of V. cholerae were uniformly susceptible to chloramphenicol, tetracycline, amikacin, and norfloxacin. Molecular studies revealed different clones of V. cholerae O1 and O139 prevailing in the country with the re-emergence of V. cholerae O139 of a different clonality in Delhi in 2000, which is likely to play a critical role in temporal antigenic variation among the serogroups of V. cholerae.     

珠江河口水体O1群和O139群霍乱弧菌监测

目的 分析珠江河口水体O1群和O139群霍乱弧菌菌型特征,探讨环境水体监测的方法和疫情监测中的作用.方法 2006年3月至2007年2月,在珠江河口选择24个水样采集点,每月采集一次,进行O1群和O139群霍乱弧菌的分离培养,并利用实时PCR监测样品增菌液中的O1群和O139群霍乱弧菌.采样同时测定气温、水温等气象资料.用脉冲场凝胶电泳(PFGE)对分离菌株进行分型分析.结果 监测期间共采样862份,霍乱弧菌分离阳性率7.77%,实时PCR阳性率为26.33%.按月的水样检测阳性率与水温变化趋势相似;城区监测点阳性率高于其他区域,在一家海产品批发市场排水口下游检测到产毒O139群菌株;菌株的菌型构成中,分离菌株主要为非产毒株;O1群E1 Tor小川和稻叶型以及O139群菌株的分离无季节变化趋势;PFGE分析75株分离株被分为49种带型,相似性为57.4%～100%,表现出明显的多样性.结论 霍乱弧菌在珠江河口水体中广泛存在,并呈现多样性.水体监测提供产毒菌株的指示,可作为环境危险评价的指标,且能在霍乱弧菌的监测和霍乱疫情预警中发挥作用.     

An epidemic of cholera due to Vibrio cholerae O139 in Dhaka, Bangladesh: clinical and epidemiological features.

We describe the disease spectrum and socio-demographic and epidemiological features of an epidemic of cholera due to a new pathogen, Vibrio cholerae O139, in patients attending a very large hospital in the metropolitan city of Dhaka, Bangladesh. This hospital treats 70,000-90,000 patients a year with diarrhoeal diseases. A 4% systematic sample of 1854 patients attending from January to April 1993 were studied. Five hundred and two (27%) of the 1854 patients were culture positive for V. cholerae O139 and 63 (3%) were culture positive for V. cholerae O1 biotype El Tor. Patients with V. cholerae O139 were mainly adults with a short history of watery diarrhoea. Eight-three percent of patients had moderate to severe dehydration. All recovered except one 80-year-old man with compromised renal function who died. Seventy-eight percent of patients required initial intravenous rehydration followed by oral rehydration therapy with rice ORS; they also received tetracycline to reduce diarrhoea severity. Most patients were from urban slums with inadequate sanitation facilities and hygiene practices. The newly recognized V. cholerae O139 infection produced an epidemic of severe dehydrating diarrhoea indistinguishable from clinical cholera in a population which experiences two epidemic peaks of cholera in a year due to V. cholerae O1. Infection with the latter does not appear to confer any cross-protection from V. cholerae O139. The new pathogen suppressed, albeit temporarily, V. cholerae O1. Unlike other non-O1 serogroups of V. cholerae this new serogroup appears to have epidemic potential.     

Cholera in a developing megacity; Karachi,Pakistan.

Despite rapid urbanization and increasing affluence in Karachi, cases of cholera are frequent. We analysed computerized isolation data from the AKUH Clinical Microbiology Laboratory, Karachi, from 1990-6 to examine microbiological, temporal and demographic trends in Vibrio cholerae infections. During this period 888 strains of V. cholerae (566 V. cholerae serogroup O1, and 204 V. cholerae serogroup O139) were isolated from specimens from 886 patients; 214/464 were adult inpatients, and 250/464 paediatric inpatients, the remaining 422 outpatients. Isolations peaked between June and August. Overlapping epidemics occurred in 1993 and 1994 of serogroup O1 (May to August), and serogroup O139 (August to October). All ages and social and economic strata were affected. Forty-four percent of all isolates were from children under the age of 5 years. The mean age of all patients with serogroup O1 infections was 19.6 years (+/-0.9) compared with 367 (+/-1.7) for serogroup O139 infections (P < 0.0001, t test). More than a quarter (27%) of all serogroup O1 isolates were from babies under 2 years of age. One patient had a serogroup O1 infection followed by a serogroup O139 infection 1 year later. Another patient was infected with serogroup O1 strains 5 years apart. Emergence of resistant strains was observed, but by 1996 serogroup O139 had disappeared. An aquatic organism, cholera nevertheless continues to take its toll in this city of 11 million situated in a desert.     

Fluoroquinolone-resistant Vibrio cholerae isolated during a cholera outbreak in India

During the cholera epidemic of 2002 in and around Hubli, south India, Vibrio cholerae strains resistant to fluoroquinolones were isolated. Among the isolates of V. cholerae non-O1, non-O139 serogroups, 55.9% and 47.1% were resistant to norfloxacin and ciprofloxacin, respectively. However, only 12.5% of the O1 serogroup strains were resistant to both norfloxacin and ciprofloxacin. Though the O139 serogroup strains were susceptible to these antibiotics, they exhibited multidrug resistance. Emergence of fluoroquinolone-resistant V. cholerae that also exhibited multidrug resistance is of great significance in the epidemiology and control of cholera.     

Molecular evidence of clonality amongst Vibrio cholerae O1 biotype El Tor during an outbreak in Malaysia

Forty-three clinical strains of V. cholerae O1 biotype E1 Tor were isolated between 3 May and 10 June 1998 during an outbreak in the metropolitan area of Kuala Lumpur and its suburbs. With the exception of three Inaba strains that were restricted to three members of a family, all the others belonged to the Ogawa serotype. The strains were analysed for clonality using ribotyping and pulsed-field gel electrophoresis (PFGE). Two ribotypes, V/B21a and B27, were identified among 40 Ogawa isolates using BglI restriction endonuclease. Ribotype V/B21a has been described previously from Taiwan and Colombia and several Asian countries while B27 has been reported among isolates from Senegal. The three Inaba strains belonged to one ribotype, designated type A, not previously reported. PFGE analysis using NotI revealed that all isolates within a ribotype had identical profiles demonstrating clonality amongst the strains. Dice coefficient analysis of the two Ogawa genotypes revealed 89% similarity on ribotype patterns and 91.3% on PFGE profiles. Ribotype V/B21a isolates were associated with cases from dispersed areas of Kuala Lumpur and its suburbs while ribotype B27 was restricted to cases from one particular area suggesting a common-source outbreak.     

Association of a disease approximating cholera caused by Vibrio cholerae of serogroups other than O1 and O139.

One hundred and six patients suffering from severe dehydrating diarrhoea were studied of whom 36 patients were positive for Vibrio cholerae. Out of 36, 15 were positive for V. cholerae O1, 10 for V. cholerae O139 and 11 for V. cholerae non-O1 non-O139. O1 and O139 were positive for the 301-bp ctxA amplicon and 471-bp tcpA amplicon indicating that the strains possessed toxigenic capability whereas no non-O1 non-O139 strain possessed ctxA or tcpA genes. Post-admission severity of purging and amount of ORS required were less in the V. cholerae non-O1 non-O139 group (P < 0.05) compared to the V. cholerae O1 and O139 groups. It appears from this study that a cholera-like clinical condition can be caused in the absence of CT as exemplified by strains of non-O1 non-O139.