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Archives of Disease in Childhood 1994; 71: 161-162 161
Vibrio cholerae 0139 in Calcutta
S K Bhattacharya, M K Bhattacharya, D Dutta, S Garg, A K Mukhopadhyay, M Deb,
A Moitra, G B Nair
Abstract Table 1 Clinicalfeatures of 28 V cholerae 0139 cases
Vibrio cholerae 0139 was recovered
from 28 of 79 children with acute watery No (%)
diarrhoea. Clinically, they presented with Median (range) age in months 48 (2-96)
watery diarrhoea (100%), vomiting (79%), 95% CI 36 to 66
Male:female 13:15
abdominal cramps (61%), anorexia (61%), Watery stools 28 (100)
dehydration (100%)/) and absence of fever. Median stool frequency/day 8
95%/CI 5to 10
Both clinical and blood biochemical para- Vomiting 22 (79)
meters of these cases were similar to the Median preadmission duration of diarrhoea (hours) 9
95%CI 7to12
illness caused by the new strain in adults. Abdominal cramps 17 (61)
Hypoglycaemia was seen in 40% of those Fever (>38°C) 0 (0)
Anorexia 17 (61)
screened. Dehydration:
(Arch Dis Child 1994; 71: 161-162) None 0
Mild to moderate 10 (36)
Severe 18 (64)
The aetiological agent of several cholera-like CI=confidence interval.
outbreaks in the Indian subcontinentl 2 has
been identified as Vibrio cholerae that does
not agglutinate with 0 1 antiserum and Before any antibiotic treatment a faecal
hence was categorised as non-0 1. Serological sample was collected from each child using a
studies have established the clonal origin of sterile rectal catheter into a sterile MaCartney
the V cholerae non-0 1 strains from diverse bottle and immediately sent to the laboratory.
geographical areas and a new serogroup 0139 V cholerae was isolated following a standard
with the synonym Bengal was created to procedure and serogrouped using the slide
accommodate these strains. V cholerae 0139 agglutination technique as described previ-
Bengal, much like the 01 serogroup, produces ously. Production of cholera toxin was
large amount of cholera toxin which is unusual determined by a highly sensitive bead-enzyme
for a non-0 1 serovar. During a large epidemic linked immunosorbent assay (ELISA).' A
that occurred in Calcutta, 84% of the cases blood sample was also obtained on admission
were adults and the clinical profile of the cases for estimation of concentrations of sodium,
infected with the new epidemic strain led us potassium, chloride, total carbon dioxide,
to designate the disease as cholera.3 While urea, and glucose from a representative
cholera has been thought not to be a problem number of cases.
in children below 2 years of age, we recently
documented that as many as 31% of
Results
hospitalised children with watery diarrhoea in
an endemic area had cholera.4 During A total of 79 cases of acute watery diarrhoea
September to November 1993 we isolated were screened of which 28 cases were bacterio-
V cholerae 0139 from 28 cases in children logically and serologically confirmed for
and the present report deals with the clinicalV cholerae 0139 and this group constituted
presentation of 0139 cholera in children in the study population. All the 28 strains of
Calcutta. V cholerae 0139 recovered from the same
National Institute of number of cases were found to produce
Cholera and Enteric cholera toxin by bead-ELISA. The children
Diseases, Calcutta, Subjects and methods had watery stools (100%)/, vomiting (79%),
India
S K Bhattacharya Children below the age of 12 years suffering abdominal cramps (61%)/, anorexia (61%),
M K Bhattacharya from acute diarrhoea with no history of dehydration (100%), and absence of fever
D Dutta prior antibiotic treatment, admitted to the (table 1).
S Garg
A K Mukhopadhyay Infectious Diseases Hospital, Calcutta, The results of estimation of serum elec-
M Deb between 0600 and 1300 hours, during the trolytes in 13 cases and the same of blood
G B Nair period September to November 1993, were urea and glucose in the peripheral blood of 10
Infectious Diseases selected and included in the study. Upon
Hospital, Calcutta, admission, history was obtained from the Table 2 Biochemistry results of V cholerae 0139 cases
India patients or their accompanying mothers or (serum/blood)
A Moitra other relatives, followed by a thorough
Correspondence to: physical examination, and the findings Mean (SD) Normal range
Dr S K Bhattacharya,
National Institute of Cholera were recorded in a specially designed form. Sodium (mmol/l) 140-8 (5 3) 138-145
and Enteric Diseases, P-33, The children were assessed and treated Potassium(mmol/l)
Chloride
(mmol/l) 4-7 (1-1)
106-3 (4-2)
3-4-4-7
98-106
CIT Road, Scheme XM,
Beliaghata, Calcutta 700010, according to World Health Organisation Total carbon dioxide (mmol/A) 14-6 (5 3) 20-28
India. (WHO) guidelines for management of Urea (mmolIl)
Glucose (mmol/l)
6-2 (4-1)
4-4 (1 9)
1-8-6-4
3-3-5-5
Accepted 16 May 1994 cholera.
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162 Bhattacharya, Bhattacharya, Dutta, Garg, Mukhopadhyay, Deb, Moitra, Nair
cases are shown in table 2. Four patients had feature of cholera-like illness caused by the
hypoglycaemia. non-0 1 serogroups of V cholerae and of cholera
All the children studied were successfully caused by V cholerae 0139 in adults as
rehydrated with oral (oral rehydration salt previously documented by us.3 It is, therefore,
solution using the WHO formula) and/or suggested that the differential diagnosis of
intravenous fluid and electrolyte (Ringer's children presenting with cholera-like illness
lactate) solution. Eighteen children (64%) were should include cholera caused by V cholerae
given intravenous fluids. None of the cases died. 0139. Further, presence of abdominal cramps
The average hospital stay was 40 hours. should not exclude cholera caused by the new
serogroup. Hypoglycaemia, a well recognised
complication of acute diarrhoea including
Discussion cholera in children,6 was seen in 40°/ of cases
Since September 1993, when the 0139 cholera screened.
epidemic was waning, we isolated
BT/TF/9/63/9
V cholerae 0139 from 28 cases of 79 children This work was partly supported by grants (NoDelhi, India. 1)
from the Department of Biotechnology, New
screened. Lindenbaum et al reported that
cholera in children is similar to that in adults.5
The clinical features and biochemical changes 1 Ramamurthy of Vibrio cholerae with epidemic potential of
novel strain
T, Garg S, Sharma R, et al. Emergence
in
in the blood of children infected with Vcholerae southem and eastern India. Lancet 1993; 341: 703-4.
2 Albert MJ, Ansaruzzaman M, Bardhan PK, et al. Large
0139 were similar to that already reported by epidemic of cholera-like disease in Bangladesh caused by
us for adults infected by the same serogroup3 Vibrio cholerae 0139 synonym Bengal. Lancet 1993; 342:
387-90.
and were indistinguishable from cholera caused 3 Bhattacharya SK, Bhattacharya MK, Nair GB, et al.
by V cholerae belonging to the 01 serogroup. A Clinical profile of acute diarrhoea cases infected with the
new epidemic strain of Vibrio cholerae 0139: designation
notable exception, however, was the presence of the disease as cholera. Jl Infect 1993; 27: 11-5.
of abdominal pain in 61% of the cases which 4 Bhattacharya SK, Bhattacharya MK, Ramamurthy T, et al.
was higher than that observed in 0139 cholera Cholera in young children in an endemic area. Lancet
1992; 340: 1549.
in adults (440/o).3 Abdominal cramps observed 5 Lindenbaum J, Gordon RS Jr, Hirschhron N, Akbar R,
in these cases could not be attributed to Greenough WB III, Islam MR. Cholera in children. Lancet
1966; i: 1066-8.
hypokalaemia because even after correction 6 Bennish ML, during diarrhoea in childhood: prevalence,
Hypoglycemia
Azad AK, Rahman 0, Phillips RE.
of electrolyte imbalances abdominal cramps pathophysiology, and outcome. N Engl J7 Med 1990; 322:
persisted. Abdominal cramp is not an unusual 1357-63.
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Vibrio cholerae O139 in Calcutta.
S K Bhattacharya, M K Bhattacharya, D Dutta, et al.
Arch Dis Child 1994 71: 161-162
doi: 10.1136/adc.71.2.161
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