Multiple Drug-Resistant Vibrio Cholerae Responsible for Cholera Outbreak among Migrant Domestic Workers in Kerala, South India

Abstract

Cholera outbreaks are prevalent in countries with a low Human Development Index (HDI) where people have limited access to safe drinking water, sanitation and hygiene (WASH). Intriguingly, the state of Kerala which records the highest HDI in India is endemic to cholera. We discuss the epidemiology of a cholera outbreak reported among migrant workers of Kerala in 2017. Virulence genes of Vibrio cholerae, toxR and ctxA, were detected in the river and ground water samples collected from the outbreaks sites which indicates need of enhanced awareness on WASH practices among migrant workers. The pathogenic Vibrio cholerae isolated from four patients in two districts had a similar DNA band pattern when analysed using repetitive extragenic palindromic-PCR (BOX), which indicates their single clonal origin. The four isolates were serotyped as O1 Ogawa. These isolates were resistant to multiple antibiotics including the carbapenem like imipenem. Nevertheless, isolates of these pathogenic bacteria were susceptible to tetracycline, identical to clinical isolates of Vibrio cholera reported earlier from this region. The current study highlights the importance of generating awareness on WASH protocols among migrant workers to prevent the outbreaks and considers community-based data as socioeconomic variable to predict the incidence of cholera.

Evaluation of Antibiogram Profile of Vibrio cholerae Isolates from Sea Foods and Water Samples from Cross River State, Nigeria

“…Multi Drug-Resistance [MDR] was demonstrated by all the V. cholerae isolated from CRS environment though this was at varying degrees. The resistance recorded in the present study against SP, CPX, FEF], and OFX, is in line with the report given by Krishna et al [30], who also noted that V. cholerae isolates showed resistance against quinolones like Nalidixic, norfloxacin, Gatifloxacin, Moxifloxacin as well as gentamicin; a macrolide whose resistance has not been reported so easily. Also, MDR was observed in this study against Septrin [SXT] and Hydroxy-ampicillin [AM], streptomycin [S].…”

The Distribution of Fecal Contamination in an Urbanized Tropical Lake and Incidence of Acute Diarrheal Disease

“…The multiple antibiotic resistance seen among the E. coli isolates also underlines the anthropogenic role on the prevalence of fecal contaminants in the lake. Similar resistance patterns of bacteria have been reported from elsewhere, mostly from clinical isolates, veterinary sources, and sewage treatment systems. − The resistance among the majority of isolates (>60%) to Erythromycin, Gentamicin, and Moxifloxacin found in this study is not surprising as a similar resistance to these antibiotics has been reported earlier in E. coli isolated from both clinical and environmental sources from various locations and is attributed to the common use of these antibiotics. − However, resistance to the Carbapenem class of antibiotics (Meropenem) among a small number (<10%) of isolates is a matter of concern, as estuaries can function as a medium for gene exchange and increase the risk of spreading antibiotic-resistant bacteria in the environment and then back to humans . These high levels of multiple antibiotic resistance, combined with a high prevalence of E. coli in the lake waters, points to the importance of containing this contamination.…”

Vibrio cholerae O1 associated with recent endemic cholera shows temporal changes in serotype, genotype, and drug-resistance patterns in Bangladesh

“…Recent studies have reported compromised drug susceptibility pattern of V. cholerae O1 against newer drugs, including those which are not commonly used for the treatment of cholera [ 41 , 42 , 45 ]. For example, recently isolated V. cholerae O1 strains were reported to be resistant against extended spectrum beta-lactam antibiotics, such as the fourth generation cephalosporins.…”

“…For example, recently isolated V. cholerae O1 strains were reported to be resistant against extended spectrum beta-lactam antibiotics, such as the fourth generation cephalosporins. Although the underlying molecular mechanism for the drug resistance is yet to be elucidated, it is presumed to be attributed to the activity of either extended spectrum of β-lactamase (ESBL) or AmpC β-lactamase [ 41 , 45 ]. Beta-Lactams are broad-spectrum drugs used to treat a wide range of infectious diseases and in post-operative infection management [ 46 ].…”