http://www.promedmail.org/pls/apex/..._BACK_PAGE,F2400_P1001_PUB_MAIL_ID:1000,88936
Archive Number 20110616.1840
Published Date 16-JUN-2011
Subject PRO/EDR> Cholera - USA: (NY): RFI
CHOLERA - USA: (NEW YORK): REQUEST FOR INFORMATION
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 16 Jun 2011
From: Larry Lutwick MD, ProMED Bacterial Disease Moderator
<lutwick@promedmail.org>
On 12 Jun 2011, a 63-year-old insulin-dependent diabetic,
African-American male was admitted to one of our affiliated hospitals
[in Brooklyn, NY] with profuse, watery diarrhea for 4 days without
vomiting, fever, blood in the stool or substantial abdominal pain. He
had purchased clams at a store in Brooklyn, NY and ate them on 6 and 7
Jun 2011. His wife did not eat the clams and did not become ill when
the patient did on 8 Jun 2011. The clams were said to have been
cooked, but neither the methodology of the cooking nor whether the
cooked clams were exposed to the pre-cooked container are clear.
There was no travel history, no exposure to individuals from Haiti,
the Dominican Republic or Germany or exposure to pets. He had been
treated for _H. pylori_ gastritis in mid-March 2011 with a regimen
containing amoxicillin and clarithromycin for 2 weeks, which ended 6
weeks prior to the illness.
He was non-febrile with a normal blood count but had a serum
creatinine of 3.9 mg/dL. He continued to have prominent watery, green
colored diarrhea without blood or mucus at a rate of 4-6 L/day and was
hospitalized in the ICU for aggressive fluid and electrolyte
resuscitation. Initially, a PCR for _C. difficile_ toxin was positive,
and he was begun on oral vancomycin but had no evidence of colitis on
CT scan.
The sheer amount of watery diarrhea, especially in a patient with
questionably adequately cooked clams, made the infectious diseases
consultant suspect a cholera or cholera-like disease.
Stool culture revealed a curved-shaped Gram negative bacillus which
was identified biochemically as _Vibrio cholerae_. O type is pending.
No other similar cases are known to the Department of Health. His
renal failure was felt to be due to profound fluids depletion, and his
creatinine rose as high as 9.7 before starting to decrease.
--
ProMED-mail
<promed@promedmail.org>
[The PCR for _C. difficile_ was positive; the illness was not a
colitis, and although enteritis due to this organism has been rarely
reported (1,2), it was thought that an alternative diagnosis was
likely. The isolation of _V. cholerae_ confirmed this notion. Somatic
antigen typing is pending, and it is possible that this isolate,
despite the degree of diarrhea, is a non-O1, non-O139 isolate. A
recent outbreak of O75 _V. cholerae_ was reported in ProMED from raw
oysters in Florida (Cholera O75 - USA: (FL) raw oysters, warning
20110511.1443). Certainly, cases of cholera have been imported into
the USA related to the ongoing cholera epidemic on the island of
Hispaniola as well as from countries with endemic disease, but no
clear epidemiological links were elicited, except for the clam
ingestion.
ProMED would appreciate any information regarding similar cases.
1. Holmer C, ZurBuchen UK Siegmund B, et al: Clostridium difficile
infection of the small bowel -- two case reports with a literature
review. Int J Colorectal Dis. 2011;26: 245-251.
2. Frieler JF, Durning B, Ender PT: Clostridium difficile small bowel
enteritis occurring after total colectomy. Clin Infect Dis 2001;33:
1429-1432.
- Mod.LL]
Archive Number 20110616.1840
Published Date 16-JUN-2011
Subject PRO/EDR> Cholera - USA: (NY): RFI
CHOLERA - USA: (NEW YORK): REQUEST FOR INFORMATION
**************************************************
A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
<http://www.isid.org>
Date: Thu 16 Jun 2011
From: Larry Lutwick MD, ProMED Bacterial Disease Moderator
<lutwick@promedmail.org>
On 12 Jun 2011, a 63-year-old insulin-dependent diabetic,
African-American male was admitted to one of our affiliated hospitals
[in Brooklyn, NY] with profuse, watery diarrhea for 4 days without
vomiting, fever, blood in the stool or substantial abdominal pain. He
had purchased clams at a store in Brooklyn, NY and ate them on 6 and 7
Jun 2011. His wife did not eat the clams and did not become ill when
the patient did on 8 Jun 2011. The clams were said to have been
cooked, but neither the methodology of the cooking nor whether the
cooked clams were exposed to the pre-cooked container are clear.
There was no travel history, no exposure to individuals from Haiti,
the Dominican Republic or Germany or exposure to pets. He had been
treated for _H. pylori_ gastritis in mid-March 2011 with a regimen
containing amoxicillin and clarithromycin for 2 weeks, which ended 6
weeks prior to the illness.
He was non-febrile with a normal blood count but had a serum
creatinine of 3.9 mg/dL. He continued to have prominent watery, green
colored diarrhea without blood or mucus at a rate of 4-6 L/day and was
hospitalized in the ICU for aggressive fluid and electrolyte
resuscitation. Initially, a PCR for _C. difficile_ toxin was positive,
and he was begun on oral vancomycin but had no evidence of colitis on
CT scan.
The sheer amount of watery diarrhea, especially in a patient with
questionably adequately cooked clams, made the infectious diseases
consultant suspect a cholera or cholera-like disease.
Stool culture revealed a curved-shaped Gram negative bacillus which
was identified biochemically as _Vibrio cholerae_. O type is pending.
No other similar cases are known to the Department of Health. His
renal failure was felt to be due to profound fluids depletion, and his
creatinine rose as high as 9.7 before starting to decrease.
--
ProMED-mail
<promed@promedmail.org>
[The PCR for _C. difficile_ was positive; the illness was not a
colitis, and although enteritis due to this organism has been rarely
reported (1,2), it was thought that an alternative diagnosis was
likely. The isolation of _V. cholerae_ confirmed this notion. Somatic
antigen typing is pending, and it is possible that this isolate,
despite the degree of diarrhea, is a non-O1, non-O139 isolate. A
recent outbreak of O75 _V. cholerae_ was reported in ProMED from raw
oysters in Florida (Cholera O75 - USA: (FL) raw oysters, warning
20110511.1443). Certainly, cases of cholera have been imported into
the USA related to the ongoing cholera epidemic on the island of
Hispaniola as well as from countries with endemic disease, but no
clear epidemiological links were elicited, except for the clam
ingestion.
ProMED would appreciate any information regarding similar cases.
1. Holmer C, ZurBuchen UK Siegmund B, et al: Clostridium difficile
infection of the small bowel -- two case reports with a literature
review. Int J Colorectal Dis. 2011;26: 245-251.
2. Frieler JF, Durning B, Ender PT: Clostridium difficile small bowel
enteritis occurring after total colectomy. Clin Infect Dis 2001;33:
1429-1432.
- Mod.LL]
