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(A) Gram stain showing Gram-negative curved bacilli (×1000). (B) Blood agar showing β-hemolytic colonies.
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Non-O1, non-O139 Vibrio cholerae (NOVC) does not agglutinate with O1 and O139 antisera and can cause intestinal and extraintestinal infections in immunocompromised individuals. NOVC bacteremia has the highest mortality among NOVC infections, and the number of reports has increased in recent years. Nevertheless, some clinicians are poorly informed a...
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Vibrio cholerae plays a global role in health of human, it causes cholera that is a severe diarrheal illness. The developing parts of the world and application of suitable water treatment measures leads to control and restricted this disease. V. cholerae can be transmitted and adhered to normal flora by raw shellfish that considered as a vehicle. C...
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... Te non-O1/non-O139 strains of V. cholerae generally lack the two classical virulence factors (the cholera toxin and [9,10]. However, serious life-threatening infection with those strains is being increasingly reported in immunocompromised patients [10,11]. Non-O1/non-O139 V. cholerae infection is often associated with the exposure to contaminated seawater or seafood. ...
Over 200 different serogroups of Vibrio cholerae based on O-polysaccharide specificity have been described worldwide, including the two most important serogroups, O1 and O139. Non-O1/non-O139 V. cholerae serogroups generally do not produce the cholera-causing toxin but do sporadically cause gastroenteritis and extra-intestinal infections. Recently, however, bloodstream infections caused by non-O1/non-O139 V. cholerae are being increasingly reported, and these infections are associated with high mortality in immunocompromised hosts. We describe a case of non-O1/non-O139 V. cholerae bacteremia in a patient with autoimmune pancreatitis and stenosis of the intra- and extrahepatic bile ducts. The clinical manifestations of bacteremia were fever and mild digestive symptoms. The blood cultures showed V. cholerae, which was identified as a non-O1, non-O139 serogroup by slide agglutination tests and PCR. The bloodstream infection of the patient was likely caused by the consumption of contaminated seafood at a banquet. The patient recovered after the administration of a third-generation cephalosporin. Non-O1/non-O139 V. cholerae infection presents with or without gastrointestinal manifestations; close attention should be paid to the possibility of disseminated non-O1/non-O139 V. cholerae infection in high-risk patients.
... Between 2009 and 2014, a statistical analysis of 83 NOV-infected patients in Taiwan revealed that gastroenteritis was the most prevalent NOVC-related illness (54.2%), followed by biliary tract infection (14.5%), and primary bacteremia (13.3%) [4]. Despite being uncommon, NOVC bacteremia has the greatest fatality rate of up to 39% [4,5]. Between 1980 and 2014, 175 cases of NOVC bacteremia were reported with high incidence rates in Asia (59%), followed by Europe (14%), United States (11%), and other countries (15%) [6]. ...
... Most of these cases (45%) originated in Taiwan, 20% in the United States, and 6% in Spain. Although the number of cases has risen worldwide in recent years [5,8,9], only four documented reports of V. cholerae bacteremia have been confirmed in Africa, specifically in Malawi, Mauritius, and South Africa [10][11][12][13]. Four other reports could be traced to African origin but diagnosed and/or confirmed in Europe [7,[14][15][16]. ...
... While NOVC bacteremia presents with a wide number of clinical manifestations; fever, epigastric discomfort, chills, low blood pressure, nausea, overall weakness, occasional vomiting, dizziness, mild diarrhea, and sensations of lethargy were among the common clinical symptoms reported to the hospital from a clinical study [5]. Infected persons usually do not present the typical profuse watery diarrhea symptoms as in the case of cholera [80]. ...
Cholera is highly endemic in many sub-Saharan African countries. The bacterium Vibrio cholerae is responsible for this severe dehydrating diarrheal disease that accounts for over 100,000 deaths each year globally. In recent years, the pathogen has been found to invade intestinal layers and translocate into the bloodstream of humans. The non-toxigenic strains of V. cholerae (non-O1/O139), also known as NOVC, which do not cause epidemic or pandemic cases of cholera, are the major culprits of V. cholerae bacteremia. In non-cholera-endemic regions, clinical reports on NOVC infection have been noted over the past few decades, particularly in Europe and America. Although low–middle-income countries are most susceptible to cholera infections because of challenges with access to clean water and inappropriate sanitation issues, just a few cases of V. cholerae bloodstream infections have been reported. The lack of evidence-based research and surveillance of V. cholerae bacteremia in Africa may have significant clinical implications. This commentary summarizes the existing knowledge on the host risk factors, pathogenesis, and diagnostics of NOVC bacteremia.
... In the previous studies, the ratio of male to female patients was 2:1 in Taiwan [26] and 3.6:1 (84.8%) in mainland China [27]. The results of these studies indicated that Vibrio infection is more likely to occur in males. ...
Background: Vibrio is a genus of Gram-negative bacteria found in various aquatic environments, including saltwater and freshwater. Vibrio bacteremia can lead to sepsis, a potentially life-threatening condition in which the immune system enters overdrive in response to the disease, causing widespread inflammation and damage to tissues and organs. V. vulnificus had the highest case fatality rate (39%) of all reported foodborne infections in the United States and a high mortality rate in Asia, including Taiwan. Numerous scoring systems have been created to estimate the mortality risk in the emergency department (ED). However, there are no specific scoring systems to predict the mortality risk of Vibrio bacteremia. Therefore, this study modified the existing scoring systems to better predict the mortality risk of Vibrio bacteremia. Methods: Cases of Vibrio bacteremia were diagnosed based on the results from at least one blood culture in the ED. Patient data were extracted from the electronic clinical database, covering January 2012 to December 2021. The primary outcome was in-hospital mortality.This study used univariate and multivariate analyses to evaluate the mortality risk. Results: This study enrolled 36 patients diagnosed with Vibrio bacteremia, including 23 males (63.9%) and 13 females (36.1%), with a mean age of 65.1 ± 15.7 years. The in-hospital mortality rate amounted to 25% (9/36), with 31.5% in V. vulnificus (6/19) and 17.6% in V. non-vulnificus (3/17). The non-survivors demonstrated higher MEDS (10.3 ± 2.4) than the survivors (6.2 ± 4.1) (p = 0.002). Concerning the qSOFA, the survivors scored 0.3 ± 0.5, and the non-survivors displayed a score of 0.6 ± 0.7 (p = 0.387). The AUC of the ROC for the MEDS and qSOFA was 0.833 and 0.599, respectively. This study modified the scoring systems with other predictive factors, including BUN and pH. The AUC of the ROC for the modified MEDS and qSOFA reached up to 0.852 and 0.802, respectively. Conclusion: The MEDS could serve as reliable indicators for forecasting the mortality rate of patients grappling with Vibrio bacteremia. This study modified the MEDS and qSOFA to strengthen the predictive performance of mortality risk for Vibrio bacteremia. We advocate the prompt initiation of targeted therapeutic interventions and judicious antibiotic treatments to curb fatality rates.
... Three hundred and fifty cases of bacteremia caused by NOVC were identified until 2015 in the literature, as reviewed by Deshayes et al. 2015 [2]. Another team reviewed 23 cases of NOVC bacteremia from 2015 to 2019 [59]. They showed that these Vibrio spp. ...
In recent years, a global increase in the number of reports of human vibriosis involving V. cholerae non-O1/O139 (NOVC) and other Vibrio spp. has been observed. In this context, the Belgian National Reference Center for Vibrio conducted an assessment of the presence of Vibrio spp. in recreational waters. Water sampling was performed monthly in different lakes in Wallonia and Flanders, including the North Sea. The collected water was then filtrated and cultured, and Vibrio spp. was quantified according to the Most Probable Number (MPN). Presumptive colonies were confirmed via MALDI-TOF, and PCR for virulence genes was applied if justified. No Vibrio spp. was found in the analyzed water bodies in Wallonia. However, NOVC was isolated from three different lakes in Flanders and from coastal water. In addition, V. alginolyticus and V. parahaemolyticus were also detected in coastal water. No clear impact of the pH and temperature was observed on Vibrio spp. occurrence. Our study demonstrates the presence of Vibrio spp. in different bathing water bodies, mostly in the north of Belgium, and supports the recommendation to include Vibrio spp. as a water quality indicator for bathing water quality assessment to ensure the safety of water recreational users in Belgium.
... Although non-O1/non-O139 bacteremias are uncommon, they have the highest mortality rate among the infections produced by these serogroups (up to 39%) (10,13). For this reason, the infection's clinical and epidemiological aspects should be fully elucidated to improve early diagnosis and establish adequate therapeutic strategies (14,15). ...
Bacteremia by non-O1/non-O139 Vibrio cholerae is a rare entity associated with high mortality rates. We report a case of non-O1/non-O139 V. cholerae bacteremia confirmed by polymerase chain reaction and agglutination tests. The clinicoepidemiological characteristics and therapeutic options for this infection are also described.
... 4,5 It may be related to factors such as increased intestinal permeability, weakened liver detoxification function in cirrhosis, and increased serum iron level. 6 These extraintestinal infections have high mortality and should be paid attention to. 7 At present, the pathogenic mechanism of NOVC is still unclear. ...
Non-O1, non-O139 Vibrio cholerae (NOVC) can cause cholera-like diarrhea, but it rarely causes extraintestinal infection, so it is easily overlooked. In this report, we present a case of NOVC detected through blood culture in a 58-year-old male patient with cirrhosis, resulting in severe infection. The patient had been diagnosed with cirrhosis seven years prior and was admitted to the hospital due to abdominal distension and gastrointestinal bleeding. Gram-negative bacilli were isolated from blood cultures and identified as V. cholerae using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and average nucleotide identity (ANI). Moreover, the serum agglutination test showed that the strain was non-O1/non-O139. Further whole genome sequencing and analysis of the strain showed that the strain mainly carried virulence genes tox R, RTX, hly A, T3SS/T6SS, but no resistant genes such as sulII, dfrA1, strB were detected. It provides information for the study of the pathogenic mechanism and drug resistance mechanism of V. cholerae. The patient had severe symptoms and a poor prognosis, indicating that although the NOVC strain infected in this patient had few virulence genes, it was not weak in pathogenicity. It may be caused by the effect of some virulence genes, which should be paid attention to.
... Because of its rare occurrence, the epidemiology, clinical manifestations, and pathogenesis of NOVC infection, particularly bacteremia, remain unclear [15]. Currently, existing knowledge on NOVC bacteremia is mainly from limited cases [16,17]. ...
Non-O1/non-O139 Vibrio cholerae (NOVC) causes various illnesses ranging in severity from mild to life-threatening but were ignored previously. Knowledge of the NOVC infection, particularly bacteremia, is limited because of its rarity. Here we first retrospectively reported the demographic, clinical, and therapy characteristics of patients with NOVC infection. Isolated NOVC stains were identified by a series of biochemical, mass spectrometry (MS), and serum agglutination tests. The results of 11 patients with NOVC infection (including 8 with bacteremia) with a median age of 68 years were included in this report. Most isolated NOVC strains had antibiotic susceptibility. Patients with NOVC-positive were distributed in various departments, most occurring in gastroenterology (6 cases). Hepatic disease was the most common comorbid disease, followed by diabetes (3 cases) and biliary tract disease (3 cases). Two cases were previously healthy. The most common symptom at presentation was fever. All patients presented with abnormal changes in hematology and inflammatory parameters. Cephalosporins were the most frequently used antibiotics. Ten patients had a favorable outcome after treatment; one died from complicated underlying diseases. In summary, we recommend the timely identification of NOVC strains using MALDI-TOF-MS. The suspicion of NOVC bacteremia cannot be ruled out regardless of the host’s immune status. An alternative therapeutic regimen for this infection may be β-lactam antibiotics or combined with β-lactamase inhibitors. Regardless, the specific therapeutic regimen should be based on the antibiogram data.
... Actualmente se han registrado más de 200 serogrupos de V. cholerae de los cuales, O1/O139 ctxA+, son los agentes causales del cólera, enfermedad diarreica infecciosa aguda, epidémica y con alta tasa de mortalidad, mientras que los demás serogrupos han sido tipificados como noO1/noO139 (Boore et al., 2011). Reportes recientes señalan que cepas de V. cholera noO1/ noO139 pueden causar diarrea con un incremento de casos de bacteremias y defunciones por septicemia y fascitis necrozante (Zhang et al., 2020). En contraste, la gastroenteritis causada por V. parahaemolyticus, aguda o subaguda, ocurre en las primeras 24 h después de la ingestión, acompañada de vómito y diarrea, pudiendo causar shock y muerte especialmente en pacientes inmunocomprometidos (Guillod et al., 2019). ...
El objetivo del estudio fue predecir el riesgo potencial de exposición a V. cholerae y V. parahaemolyticus asociado al consumo de ostión americano (Crassostrea virginica) crudo colectado del Sistema Lagunar Mandinga (SLM), en restaurantes, coctelerías y puestos ambulantes. El riesgo se estimó como casos esperados/100,000 porciones con el modelo de la FDA. En ostiones del SLM el riesgo estimado por consumir ostiones contaminados con V. cholerae noO1/noO139 chxA+ sin refrigerar 10 h en verano fue bajo (99×10-5 casos); V. parahaemolyticus tdh+ y tdh+/trh+ representaron un riesgo estimado alto en primavera (2,200×10-5 y 4,000×10-5 casos, respectivamente) y la cepa pandémica orf8+ un riesgo medio (110×10-5 casos) en invierno. El consumo de ostión crudo sin refrigerar 10 h contaminado con V. cholerae noO1/noO139 chxA+ representó un riesgo promedio bajo (0.87×10-5 y 0.44×10-5 casos) para restaurantes y coctelerías, respectivamente, alto para cocteles expendidos en puestos ambulantes a temperatura ambiente 24 h (2,500×10-5 casos) y bajo a V. parahaemolyticus tdh+ en restaurantes (0.21×10-5 casos) y coctelerías (1.1×10-5 casos). El porcentaje patogénico, el sitio de venta y el tiempo sin refrigerar fueron las variables que incrementaron el riesgo de enfermar, siendo primavera la estación con el mayor riesgo para el consumidor.
... Cholera, caused by the bacteria V. cholerae, is a life-threatening watery diarrhea associated with the rapid onset of dehydration and hypovolemia (11). Notwithstanding, the routine treatment (fluid and electrolyte replacement) is employed for the patients with secretory diarrhea regardless of etiology (12), but rapid identification of the agent can affect the subsequent course of a potential epidemic outbreak, profoundly. Isolation of V. cholerae by a stool specimen culture remains the gold standard for confirmatory diagnosis (13), but it suffers from certain draw-backs like: transport media, requirement of incubation period, and selective and differential media. ...
Background: The purpose of this survey was to develop a novel and rapid isothermal nucleic acid based detection assay of Vibrio cholerae by polymerase spiral reaction (PSR) in emergency situations.
Methods: The current study was conducted in Baqiyatallah University of Medical Sciences, Tehran, Iran in 2021. The conserved ctxA gene sequence of V. cholerae was used as a target of designed two pairs of primers. Amplification of nucleic acids performed under isothermal temperature of 65 oC in 55 min by using Bst DNA polymerase. PSR amplified products were real-time visualized under UV transilluminator and also on agarose gel electrophoresis.
Results: Seven non- V. cholerae bacteria were negative for detection, which indicated the specificity of PSR assay was 100%. A 10- fold serial dilution of V. cholerae genomic DNA was subjected to conventional polymerase chain reaction (PCR) and real-time PCR to compare their sensitivities with PSR. The detection limit of PSR was 3 × 10-5 ng/ μL within 60 min, which 100-fold higher than that of PCR (3 × 10-3 ng/μL), but the sensitivity of real-time PCR was found as same as it.
Conclusion: The PSR assay developed in this study can provide a simple, cost-effective, rapid, and precise diagnosis technique in endemic cholera outbreaks, especially in low-income with limited access provinces.
... 1,2 Based on its surface O antigens, V. cholerae can be classified into more than 200 serotypes. 3 Cholera epidemics or pandemics are only caused by the O1 and O139 serogroups, and the non-O1/non-O139 serogroups are mainly associated with gastroenteritis or parenteral infections, such as bacteremia, 4 skin and soft tissue infections, 5 and meningitis. 6,7 Notably, non-O1/non-O139 V. cholerae bacteremia is a serious disease with high mortality, and is considered a global health threat, especially in patients with a history of alcohol abuse and/or cirrhosis. ...
The type VI secretion system (T6SS) and hemolysin HlyA are important virulence factors in Vibrio cholerae. The forkhead-associated (FHA) domain is a conserved phosphopeptide binding domain that exists in many regulatory modules. The FHA domain protein-encoding gene is conserved in the T6SS gene cluster and regulates the assembly and secretion of the T6SS. This study shows for the first time that the FHA domain protein TagH plays a role in controlling the hemolytic activity of V. cholerae, in addition to regulating the T6SS. TagH negatively regulates HlyA expression at the transcriptional and post-translational levels. The phosphopeptide binding sites of the FHA domain of TagH play a key role in the regulation of hemolytic activity. The deletion of tagH enhances the intestinal pathogenicity and extraintestinal invasion ability of V. cholerae, which mainly depend on the expression of HlyA. This study provides evidence that helps unravel the novel regulatory role of TagH in HlyA and provides critical insights which will aid in the development of strategies to manage HlyA.
