Cholera Outbreaks in South and Southeast Asia: Descriptive Analysis, 2003&amp;ndash;2012

ObjectivesCholera is a major gastroenteric disease with reports on fluctuation and resistance. Hence, the objective is to determine the trend in seasonality, resistance pattern, prevalent biotypes, serotypes and phage types between 2004 and 2013 among Vibrio cholerae isolates.DesignA retrospective cross-sectional study.SettingsA single-centre study was carried out at a tertiary care hospital in a metropolitan city (Mumbai) of a developing country (India).MethodsRecords of stool specimen cultures of patients with suspected cholera from January 2004 to December 2013 were analysed. The organisms were identified as per standard protocol. Antimicrobial susceptibility testing was performed as per Clinical Laboratory Standard Institute. Biotyping, serotyping and phage typing were carried out. From the confirmed cases of cholera, demographic and laboratory details were noted. Descriptive analysis was used and the data were presented in the form of percentages.ResultsVibrio cholerae was predominant in males and was isolated from 9.41% (439/4664) of stool specimens. Variability was found in terms of the gross appearance of stool specimens, seasonal trend and antibiotic resistance pattern. The antimicrobial susceptibility showed a waxing and waning pattern for most of the antibiotics (ampicillin, cefuroxime, chloramphenicol, tetracycline) tested, while for a few others the strains were either uniformly sensitive (gentamicin, norfloxacin) or resistant (trimethoprim-sulfamethoxazole, nalidixic acid). All isolates belonged to subgroup O1 and biotype El Tor. The most common serotype was Ogawa. The predominant phage type was T2 (old scheme) and T27 (new scheme).ConclusionsThe predominant biotype, serotype and phage type were El Tor, Ogawa and T27 phage, respectively. The changing trends in antimicrobial resistance pattern over the years necessitate continued epidemiological and microbiological surveillance of the disease.

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“…The results of this study confirm these reports 38. Studies from India report the emergence of V. cholerae O139 39–42.…”

Section: Discussionsupporting

confidence: 91%

Phenotypic and antibiogram pattern ofV. choleraeisolates from a tertiary care hospital in Mumbai during 2004–2013: a retrospective cross-sectional study

et al. 2016

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“…Three studies were systematic reviews and meta-analyses, two of which were conducted across an international setting while one was conducted in sub-Saharan Africa [ 27 ]. One study was a systematic descriptive analysis (which included a systematic search) of information regarding the epidemiology of cholera outbreaks in Asia and included descriptive analyses regarding increasing antimicrobial resistance patterns [ 28 ]. There were two randomised controlled trials, one open-labelled-controlled clinical trial and one multi-centre study conducted in four sites.…”

Section: Resultsmentioning

confidence: 99%

“…No studies were assessed as high-quality evidence. Three were classified as being of moderate quality [ 19,32,33 ], four as low quality [ 6,27,29,31 ] and one as very low quality [ 28 ].…”

Section: Resultsmentioning

confidence: 99%

Guidelines for the management of paediatric cholera infection: a systematic review of the evidence

Williams

Berkley

2018

Paediatrics and International Child Health

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Background Vibrio cholerae is a highly motile Gram-negative bacterium which is responsible for 3 million cases of diarrhoeal illness and up to 100,000 deaths per year, with an increasing burden documented over the past decade. Current WHO guidelines for the treatment of paediatric cholera infection (tetracycline 12.5 mg/kg four times daily for 3 days) are based on data which are over a decade old. In an era of increasing antimicrobial resistance, updated review of the appropriate empirical therapy for cholera infection in children (taking account of susceptibility patterns, cost and the risk of adverse events) is necessary.MethodsA systematic review of the current published literature on the treatment of cholera infection in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was undertaken. International clinical guidelines and studies pertaining to adverse effects associated with treatments available for cholera infection were also reviewed.ResultsThe initial search produced 256 results, of which eight studies met the inclusion criteria. Quality assessment of the studies was performed as per the Grading of Recommendations Assessment, Development and Evaluation guidelines.ConclusionsIn view of the changing non-susceptibility rates worldwide, empirical therapy for cholera infection in paediatric patients should be changed to single-dose azithromycin (20 mg/kg), a safe and effective medication with ease of administration. Erythromycin (12.5 mg/kg four times daily for 3 days) exhibits similar bacteriological and clinical success and should be listed as a second-line therapy. Fluid resuscitation remains the cornerstone of management of paediatric cholera infection, and prevention of infection by promoting access to clean water and sanitation is paramount.

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“…Worldwide, the most frequent causative pathogen for infectious diarrhea is rotavirus, responsible for approximately 40% of all hospital admissions for diarrhea of infants and young children[ 5 ]. A specific feature of certain Asian countries is the circulation of V. cholerae that may be multidrug-resistant and cause severe diarrhea[ 27 ]. Other major pathogens include E. coli , Shigella, Campylobacter, and Salmonella species, as well as the protozoan pathogen Cryptosporidium that is an important enteric pathogen in children of some Asian Countries[ 5 ].…”

Section: Epidemiology Of Gastrointestinal Diseases In the Asia-pacifimentioning

confidence: 99%

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

Cameron¹,

Hock²,

Kadim³

et al. 2017

WJG

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Recommendations for probiotics are available in several regions. This paper proposes recommendations for probiotics in pediatric gastrointestinal diseases in the Asia-Pacific region. Epidemiology and clinical patterns of intestinal diseases in Asia-Pacific countries were discussed. Evidence-based recommendations and randomized controlled trials in the region were revised. Cultural aspects, health management issues and economic factors were also considered. Final recommendations were approved by applying the Likert scale and rated using the GRADE system. Saccharomyces boulardii CNCM I-745 (Sb) and Lactobacillus rhamnosus GG (LGG) were strongly recommended as adjunct treatment to oral rehydration therapy for gastroenteritis. Lactobacillus reuteri could also be considered. Probiotics may be considered for prevention of (with the indicated strains): antibiotic-associated diarrhea (LGG or Sb); Clostridium difficile-induced diarrhea (Sb); nosocomial diarrhea (LGG); infantile colic (L reuteri) and as adjunct treatment of Helicobacter pylori (Sb and others). Specific probiotics with a history of safe use in preterm and term infants may be considered in infants for prevention of necrotizing enterocolitis. There is insufficient evidence for recommendations in other conditions. Despite a diversity of epidemiological, socioeconomical and health system conditions, similar recommendations apply well to Asia pacific countries. These need to be validated with local randomized-controlled trials.

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Cholera Outbreaks in South and Southeast Asia: Descriptive Analysis, 2003–2012

Cited by 29 publications

References 52 publications

Phenotypic and antibiogram pattern ofV. choleraeisolates from a tertiary care hospital in Mumbai during 2004–2013: a retrospective cross-sectional study

Phenotypic and antibiogram pattern ofV. choleraeisolates from a tertiary care hospital in Mumbai during 2004–2013: a retrospective cross-sectional study

Guidelines for the management of paediatric cholera infection: a systematic review of the evidence

Probiotics for gastrointestinal disorders: Proposed recommendations for children of the Asia-Pacific region

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