Published on May 11 in the International Journal of Infectious Diseases, researchers led by Yingying Hao reported on their follow-up phenotypic and sequencing analysis regarding a case of septicemia and meningitis in an eleven day old infant girl from July 2014.

Vibrio cholerae

The case had been infected with a non-01/non-0139 serogroup of Vibrio cholera not associated with epidemic cholera.  Non-01/non-0139 is the third most commonly reported serogroup of V. cholera, after serogroups 01 and 0139 which are the only two varieties known to cause epidemic cholera.  This case had presented at Qingdao Maternal and Child Health Care Hospital without gastroenteritis, which would typically be expected from infection with epidemic cholera serogroups and potentially in a far less severe manifestation with some non-01/non-0139 strains.

The child had initially suffered from minor symptoms such as fever, lethargy and refusal to feed, but her symptoms rapidly progressed to seizures and other serious complications, including hemorrhaging in the brain.

Sepsis is a potential manifestation of non-01/non-0139 V. cholerae, and organisms of this serogroup were detected in this case’s blood and CSF by culture.  Infection with V. cholera is generally acquired via ingestion of contaminated food or water, and this is believed to be how this case became ill: she had been delivered by cesarean section, so it is unlikely she had been infected at birth.

According to the authors of this study, this was only the seventh known case of sepsis in an infant from infection with a non-01/non-0139 strain of V. cholera.  Fortunately this case’s strain of organisms were found to be susceptible to a wide range of antibiotics, and the child ultimately survived unlike two previous cases, however with some neurological sequelae, as occurred in three other cases.

Hao’s team working with the Department of Clinical Laboratory, Shandong Provincial Hospital affiliated with Shandong University in Jinan, China, found that although this strain was incapable of producing enterotoxin, it possessed genes believed to enhance pathogenicity in Vibrios such as high haemolytic, protease and cytotoxic and moderate hemagglutination activity.

Finally, the researchers discovered in this strain new alleles of several highly conserved genes found within all V. cholera strains.  The authors of this study conclude that screening for non-01/non-0139 V. cholera should be included in diagnosis of cases of septicemia and meningitis in newborns.

Steven Smith, M.Sc. is an Infectious diseases epidemiologist