A Case of Non-O:1 Vibrio cholerae Septicemia with Meningitis, Cerebral Abscess and Unilateral Hydrocephalus in a Preterm Baby

Abstract

Non-O:1 Vibrio cholerae infections present clinically mainly as gastroenteritis (67%), septicemia (15%) or wound infection (8%) [1]. Seafood consumption is very common in the week preceding the onset of symptoms [1], but nosocomial infection may also occur [2]. Non-O:1 Vibrio cholerae septicemia is rare, particularly in the paediatric age group [1]. Eight cases of septicemia in children infected with this microorganism have been reported previously in the English-language literature [2,3,4,5,6,7,8,9], and three of them had meningitis as well [4,5,6] (1 had hydrocephalus, 1 had cerebral abscess-like lesions and 1 died). Reported here is an additional case of an infant who developed non-O:1 Vibrio cholerae septicemia with meningitis, cerebral abscess and unilateral hydrocephalus.The infant, male patient was born at 33 weeks gestation to a primigravida after an uneventful pregnancy and delivery, with a birth weight of 2.2 kg. The baby fed well and was discharged at the age of 24 h. At 60 h of age he was admitted to hospital with a 24-h history of poor feeding and recurrent, brief episodes of central and peripheral cyanosis in the preceding 1 h. Vomiting and diarrhea were absent. His weight was 2.01 kg, head circumference 29.5 cm, length 42 cm (all <50 th percentile), heart rate 140/min, respiratory rate 40/min, and temperature 36.3°C. He was observed to be sucking poorly and was hypotonic. The anterior fontanel was normal, and the physical examination was otherwise unremarkable. Blood and urine cultures were collected before ampicillin and cefotaxime were given intravenously (each in a dose of 200 mg/kg/day in 4 divided doses). Twelve hours later the patient had a generalized tonic-clonic convulsion. Intravenous phenobarbitone was instituted and a noncontrast cerebral computerized tomogram (CT) revealed a haematoma in the left frontal lobe with normalsized ventricles.Examination of the cerebrospinal fluid (CSF) revealed the following: total leukocyte count, 1,170/mm 3 (68% polymorphs, 32% lymphocytes); erythrocyte count, 12,150/mm 3 ; glucose level, 70 mg/dl (concomitant serum glucose, 106 mg/dl); protein level, 1,206 mg/dl. The latex agglutination test was negative for Escherichia coli, group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitidis and Haemophilus influenzae. Other investigations revealed the following: a total leukocyte count of 3,000/mm 3 (neutrophils, 40%; lymphocytes, 27%; monocytes, 23%); hemoglobin, 17.7 gm/dl; platelets, 241,000/mm 3 ; erythrocyte sedimentation rate, 2 mm/h; C-reactive protein, 19.5 mg/l (normal range, <8 mg/l); and total serum bilirubin, 11.7 mg/dl (direct 1). Liver and renal biochemical profiles remained normal. Blood culture grew oxidase-positive, gram-negative rods, which were identified biochemically as Vibrio cholerae and serologically as non-O:1 Vibrio cholerae (Central Microbiology Laboratory, Kuwait Ministry of Health). The organism was sensitive to ampicillin, cefotaxime and most of the other major antibiotics. The CSF, stool and urine cultures revealed no...

Septicemia caused by Vibrio cholerae O1 biotype El Tor, in São Paulo, Brazil

“…Finding this Vibrio in blood culture is rare, it happening only in immunosuppressed patients or those with some base disease [2][3][4][5][6][7][8][9].…”

Isolation of Vibrio cholerae in Homogenized Tissues of Liver, Gall Bladder and Bile in Rabbit Model

“…There were many similar reports with bacteremia also with non O1 Vibrio cholerae in the same year [59][60][61][62]. Santamaria and colleagues reported a case of bacteremia with O1 Vibrio cholerae in neonate with hypovolemic shock [63].…”

Isolation of Vibrio Cholerae from the Brain of a Feedlot Heifer with Meningoencephalitis

“…Unfortunately, further characterization of the organism could not be performed, because culture could neither be revived by the Colorado State Veterinary Diagnostic Laboratory nor the referency laboratory, which is proficient in V. cholerae procedures. Secondly, there is precedence of non-O1/O139 V. cholerae causing cerebral lesions in other species 4,6,8,9,13,14 and severe gastrointestinal disease in lambs, 15,16 as mentioned above. A compromised gastrointestinal mucosal barrier opens the possibility of subsequent septicemia.…”

“…10 More specifically, there have been human case reports of intracerebral abscesses and meningitis associated with non-O1 V. cholerae. 4,6,8,9,13,14 From 1988 to 1998, V. cholerae non-O1 has been found in association with diseases of farm animals 15 times in the Netherlands, including a goat with enterotoxicosis, a bull with abomasitis and enteritis, a heifer with a hemorrhagic diarrhea, and a calf with diarrhea. 15 There have been 2 reports implicating V. cholerae non-O1/non-O139 in lamb diarrheal outbreaks in the Netherlands, though no brain lesions were identified in these situations.…”