Non-O1/non-O139 Vibrio cholerae bacteraemia and cholangitis: an unusual case in an oncological patient in Lecco Hospital, Italy

• Published in: The New microbiologica Vol. 47; no. 3; p. 289
• Main Authors: Gemignani, Nicole, Molteni, Chiara, Villa, Federica, Briozzo, Elena, Pontiggia, Silvia, Tonolo, Silvia, Mainardi, Ilaria, Marchetti, Giulia Carla, Piconi, Stefania
• Format: Journal Article
• Language: English
• Published: 01-11-2024
• ISSN: 1121-7138

Only toxigenic serogroups O1 and O139 Vibrio cholerae have been associated with widespread cholera epidemics. Other serogroups (non-O1/non-O139 Vibrio cholerae or NOVC) most often cause sporadic gastrointestinal manifestations. Rarely, NOVC can result in severe extraintestinal manifestations in immunocompromised hosts. Although the presence of Vibrio cholerae is well documented in Mediterranean waters, it is not routinely tested in food sources in European countries. Here we report the case of a 46-year-old woman with a history of Von Hippel-Lindau syndrome who had previously undergone major hepatic and pancreatic surgeries and was on Everolimus, which caused neutropenia and mucositis. She was admitted to our emergency department with fever, chills, nausea, and abdominal pain, and was diagnosed with sepsis and acute cholangitis. Empiric piperacillin/ tazobactam was started, and blood cultures later identified non-O1/non-O139 Vibrio cholerae, linked to recent oyster consumption. The ongoing therapy resulted in initial clinical stabilization and microbiological clearance. However, fever persisted, along with the onset of diarrhoea (with negative stool cultures), leukopenia, thrombocytopenia, and elevated CRP levels. Ciprofloxacin was then added to the regimen, resulting in improved condition, fever resolution, normalization of bowel function, relief from abdominal pain, and radiological resolution of cholangitis. She was discharged in stable condition after 15 days of treatment. NOVC systemic infections are rising globally. Physicians should think of this pathogen in patients with risk factors, suggestive symptoms, and seafood ingestion. The literature shows significant heterogeneity in antimicrobial strategies, but association of beta-lactam antibiotic with ciprofloxacin proved to be an effective choice.Only toxigenic serogroups O1 and O139 Vibrio cholerae have been associated with widespread cholera epidemics. Other serogroups (non-O1/non-O139 Vibrio cholerae or NOVC) most often cause sporadic gastrointestinal manifestations. Rarely, NOVC can result in severe extraintestinal manifestations in immunocompromised hosts. Although the presence of Vibrio cholerae is well documented in Mediterranean waters, it is not routinely tested in food sources in European countries. Here we report the case of a 46-year-old woman with a history of Von Hippel-Lindau syndrome who had previously undergone major hepatic and pancreatic surgeries and was on Everolimus, which caused neutropenia and mucositis. She was admitted to our emergency department with fever, chills, nausea, and abdominal pain, and was diagnosed with sepsis and acute cholangitis. Empiric piperacillin/ tazobactam was started, and blood cultures later identified non-O1/non-O139 Vibrio cholerae, linked to recent oyster consumption. The ongoing therapy resulted in initial clinical stabilization and microbiological clearance. However, fever persisted, along with the onset of diarrhoea (with negative stool cultures), leukopenia, thrombocytopenia, and elevated CRP levels. Ciprofloxacin was then added to the regimen, resulting in improved condition, fever resolution, normalization of bowel function, relief from abdominal pain, and radiological resolution of cholangitis. She was discharged in stable condition after 15 days of treatment. NOVC systemic infections are rising globally. Physicians should think of this pathogen in patients with risk factors, suggestive symptoms, and seafood ingestion. The literature shows significant heterogeneity in antimicrobial strategies, but association of beta-lactam antibiotic with ciprofloxacin proved to be an effective choice.