Clinical Characteristics, Laboratory Profile and Outcome of Children with Vibrio Cholerae Gastroenteritis (Both O1 and Non-O1/Non-O139) and Vibrio Cholerae (Non-O1/Non-O139) Bacteraemia- A Retrospective Single Centre Study

Introduction: Vibrio cholerae (V. cholerae) infection (O1, O139, and non-O1/non-O139) in children can occur in the form of gastroenteritis and bacteraemia. Aim: To describe and compare the clinical characteristics, laboratory profile and outcome of children with gastroenteritis due to V. cholerae O1, O139 and V. cholerae non-O1/non-O139 and to present a case series describing the clinical and laboratory profile and outcome of children with V. cholerae non-O1/non-O139 bacteraemia. Materials and Methods: A retrospective study was conducted on the medical records of children under 15 years of age in whom V. cholerae was identified in stool culture or blood culture. The children who presented from January 2010 to November 2018 in Christian Medical College and Hospital, Vellore, India were included. The following details were noted: symptoms and signs (including vital signs and state of dehydration) at presentation, co-morbidities, anthropometry, complete blood counts, serum electrolytes, creatinine, reports of stool culture, blood culture and antibiotic susceptibility, details of treatment given (including hospital admission, IV fluids and antibiotics) and outcome. The group-wise comparison for continuous variables was done using Independent t-test. The categorical data among the groups were compared using the chi-square test. Results: Among the 8990 stool cultures and 1,23,005 blood cultures done in children during the study period for various reasons, V. cholerae had grown in stool culture of 105 children and blood culture of six children. Children with V. cholerae O1 were more tachypnoeic/acidotic (44.8% vs. 10.0%; p<0.001), had dehydration and shock (65.5% vs. 6.6%; p<0.001) at presentation and required hospital admission more often (87.3% vs. 18.1%, p<0.001) compared to V. cholerae non-O1/non-O139. Both isolates in stool culture were susceptible to cefotaxime, norfloxacin and tetracycline. All six children with V. cholerae non-O1/non-O139 bacteraemia had co-morbidities and 66% of them had chronic liver disease. About 50% of these children (n=3) succumbed to the illness in the first week of illness itself and 2 of them were infants. Conclusion: The gastroenteritis due to V. cholerae O1 was more severe than that with V. cholerae non-O1/non-O139. Children with chronic liver disease and immunodeficiency were particularly susceptible to non-O1/non-139 V. cholerae bacteraemia.