Occurrence of Vibrio cholerae serogroups other than O1 and O139 in Austria

Abstract

From 2000 to 2005, 13 infections due to non-O1/non-O139 Vibrio cholerae were documented in Austria. Twelve patients (8 years to 65 years old; 7 male) had symptomatic infections: diarrhea x 5, otitis x 6, septicemia once. All 5 patients who acquired their infections abroad, suffered from diarrhea. The 8 persons without travel history outside of Austria had otitis media (n = 4) or otitis externa (n = 2); the lethal case of septicemia affected a fisherman with underlying malignancy. One isolate was from an asymptomatic child. Detailed data on travel history inside Austria was available for 5 of these 8 patients: all 5 had visited or lived near Austria's largest lake. The concentration of salt in this westernmost steppe lake in Europe is approximately one-twentieth of that of sea water. Why otitis and not diarrhea is the dominating manifestation of non-O1/non-O139 infection acquired in Austria remains to be elucidated. We hypothesize that diarrhea due to Vibrio cholerae serogroups other than O1 and O139 acquired in Austria may simply be unrecognized by the standard operating procedures employed in clinical microbiology laboratories. Testing for Vibrio cholerae is not considered necessary for domestically acquired diarrhea. Only in patients who acquired diarrhea abroad, do physicians sometimes consider cholera as a differential diagnosis, thereby prompting the laboratory to use thiosulfate citrate bile salt sucrose (TCBS) agar plates.

Ecology and Genetic Structure of a Northern Temperate Vibrio cholerae Population Related to Toxigenic Isolates

“…Any isolates from which these genes were amplified were confirmed as V. cholerae by 16S V2-3 amplification and sequencing (40). Additional accessory virulence genes whose products contribute to disease, including zot, ace, tcpA, and the major toxin-encoding gene ctxA, were subsequently amplified by following published protocols (8,22,62).…”

Rapid Growth of Planktonic Vibrio cholerae Non-O1/Non-O139 Strains in a Large Alkaline Lake in Austria: Dependence on Temperature and Dissolved Organic Carbon Quality

“…interest since 2001 because of several reports of ear infections caused by this pathogen in people bathing in the lake Neusiedler See (22). Since then, the lake has been tested for the presence of V. cholerae at regular intervals.…”

“…In only a very few cases has it been reported that non-O1/non-O139 strains were positive for ctx and tcp (7), and thus, it can be assumed that, at least during the study period, no choleratoxigenic strains were present in the lake. In fact, all clinical strains isolated during that period from patients with a history of being in the lake were also non-O1/non-O139 V. cholerae (22), including the one which caused lethal septicemia. Cholera cases have been reported occasionally in Austria during the past 10 years, but all of them were imported from non-European countries (56,58,59).…”

“…In the past 5 years, 13 cases of V. cholerae non-O1/non-O139 infections were documented in Austria, of which 8 had a local history (22). Five cases could be explicitly associated with recreational activities at the study area, the lake Neusiedler See, with four cases of otitis and one of lethal septicemia.…”

Travellers' diarrhoea – pros and cons of different prophylactic measures

“…Exceptions with atypical manifestations (e.g. otitis media) occur even in countries with high hygienic standards (like in Austria [13]). Generally, tourists from industrialized countries fi nd themselves at a favourable position and are rarely aff ected by cholera, as their general health condition is normally very good.…”