Epidemic cholera in Ecuador: multidrug–resistance and transmission by water and seafood

Abstract

SUMMARYTo determine risk factors for cholera in an epidemic-disease area in South America, a case-control investigation was performed in Guayaquil, Ecuador, in July 1991. Residents > 5 years old who were hospitalized for treatment of acute, watery diarrhoea and two matched controls for each were interviewed regarding sources of water and food, and eating, drinking, and hygienic habits. Interviewers inspected homes of case-patients and controls to document water treatment, foodhandling, and hygienic practices. Faecal specimens and shellfish were cultured for Vibrio cholerae 0 1. Isolates were tested for susceptibility to a variety of antimicrobial agents. Drinking unboiled water (odds ratio [OR] = 4 0, confidence interval [CI] = 1 8-7 5), drinking a beverage from a street vendor (OR = 2-8, CI = 1-3-5-9), eating raw seafood (OR = 3.4, CI = 1P4-11-5), and eating cooked crab (OR = 5.1, CI = 1P4-19-2) were associated with illness. Always boiling drinking water at home (OR = 05, CI = 02-0-9) was protective against illness. The presence of soap in either the kitchen (OR = 03, CI = 0-2-08) or bathroom (OR = 04, CI = 02-09) at home was also protective. V. cholerae 0 1 was recovered from a pooled sample of a bivalve mollusc and from 68 % of stool samples from case-patients. Thirty-six percent of the isolates from stool specimens were resistant to multiple antimicrobial agents. Specific prevention measures may prevent transmission through these vehicles in the future. The appearance of antimicrobial resistance suggests the need for changes in current methods of prevention and treatment.

Food Animals and Antimicrobials: Impacts on Human Health

“…Isolates from the child and one of the cows were determined to be the same strain of CMY-2-mediated ceftriaxone-resistant S. enterica (69). It is now believed that the 1992 multiresistant Vibrio cholerae epidemic in Latin America was linked to the acquisition of antibiotic-resistant bacteria arising from heavy antibiotic use in the shrimp industry of Ecuador (13,156).…”

Narrow-Mouthed Water Storage Vessels and in Situ Chlorination in a Bolivian Community: A Simple Method to Improve Drinking Water Quality

“…Investigations of cholera outbreaks in Latin America have implicated the consumption of fecally contaminated surface and municipal water sources as a major risk factor for disease transmission. [1][2][3][4][5] In one investigation, cholera transmission was specifically associated with domestically contaminated water stored in open, widemouthed containers.…”

Evidence Based Treatment of Cholera: A review of Existing Literature

“…Chemoprophylaxis for the prevention of transmission is debated but not recommended at the moment (Framer et al, 2011). Some evidence from past epidemics in Tanzania and Ecuador suggest that chemoprophylaxis may lead to increased bacterial resistance, without compensatory gains in survival (Weber et al,1994).…”