Giuseppe
Emeritus
[Source: ProMedMail.org, full page: (LINK). Edited.]
Published Date: 2012-08-01 14:56:21
Subject: PRO/EDR> NDM-1 carrying Vibrio cholerae ? India
Archive Number: 20120801.1224333
NDM-1 CARRYING VIBRIO CHOLERAE - INDIA
**************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Subject: PRO/EDR> NDM-1 carrying Vibrio cholerae ? India
Archive Number: 20120801.1224333
NDM-1 CARRYING VIBRIO CHOLERAE - INDIA
**************************************
A ProMED-mail post
http://www.promedmail.org
ProMED-mail is a program of the
International Society for Infectious Diseases
http://www.isid.org
Date: Sat 28 Jul 2012
Source: Deccan Chronicle [edited] http://www.deccanchronicle.com/node/144375
In a major cause for concern, a new strain of cholera bacteria resistant to 3rd generation antibiotics has been found to be circulating in India. This cholera bacterial strain contains 2 super bug genes including the notorious New Delhi Metallo beta-lactamase-1 (blaNDM-1). The other super bug gene is plasmid-mediated beta-lactamase-1 (blaDHA-1). Thanks to these 2 super bug genes, the new cholera bacterial strain (O1 El Tor Ogawa) has developed resistance to a majority of known antibiotics.
The blaNDM-1, discovered a couple of years ago from hospitals in New Delhi, created ripples in the health sector worldwide. The gene was then found in _Escherichia coli_ strains. This is the 1st time that doctors have found the super bug gene blaNDM-1 in the cholera bacteria _Vibrio cholerae_.
A team of doctors led by Dr Jharna Mandal from Jawaharlal Institute of Post-graduate Medical Education and Research (Jipmer), Puducherry, isolated the cholera germ strain from the stool of a 2-year-old patient. It reported the findings in the journal of the Centres for Disease Control and Prevention (CDC), USA.
"_Vibrio cholerae_ [have] developed enormous capabilities to combat antimicrobial drug effects. It possesses efflux pumps that act on multiple classes of antimicrobial drugs and elaborates enzymes that can nullify the impact of complex antimicrobial drugs," the team said.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The news release above refers to a very recent article: Mandal J, Sangeetha V, Ganesan V, et al. Third-Generation Cephalosporin-Resistant _Vibrio cholerae_, India. Emerg Infect Dis 2012;18, (8), 1326-28. Available at http://wwwnc.cdc.gov/eid/article/18/8/pdfs/11-1686.pdf.
Abstract:
"_Vibrio cholerae_ resistance to third-generation cephalosporins is rarely reported. We detected a strain that was negative for extended-spectrum B-lactamase and positive for the AmpC disk test, modified Hodge test, and EDTA disk synergy test and harbored the blaDHA-1 and blaNDM-1 genes. The antimicrobial drug susceptibility profile of V. cholerae should be monitored."
The strain in question was said to be resistant to ampicillin, ceftriaxone, cotrimoxazole, and furoxone and sensitive only to ciprofloxacin and tetracycline. It carried NDM-1 (a gene that encodes a carbapenemase and thereby resistance to carbapenems, as well as other beta-lactam antibiotics) and AmpC beta-lactamase (a gene that encodes for resistance to extended-spectrum cephalosporins e.g., ceftriaxone).
However, this pattern of drug resistance is not an issue for treatment of cholera.
Cholera can be successfully treated by immediate replacement of the fluid and salts lost through diarrhea and then maintenance of normal hydration status by replacing ongoing losses. Patients are preferably treated with a prepackaged oral rehydration solution that contains a mixture of sugar and salts to be mixed with water and drunk in large amounts.
Patients too ill for oral hydration are given intravenous fluids.
With prompt rehydration, less than one percent of cholera patients die (http://www.who.int/cholera/technical/en/).
Use of antibiotics is only an adjunct to rehydration. Antibiotics are not recommended for patients with cholera who have only mild or no diarrhea and dehydration. In severe cases, an effective antibiotic reduces shedding of _Vibrio cholerae_ in feces from over 5 days to 1-2 days and reduces the volume of diarrheic stool and the duration of illness, hastening recovery, and decreasing the chances of disease spread. Doxycycline is recommended as a first-line treatment for adults, while azithromycin is recommended as first-line treatment for children and pregnant women (http://www.cdc.gov/cholera/treatment/antibiotic-treatment.html ).
Other antibiotics that are effective when _V. cholerae_ are susceptible to them include cotrimoxazole, erythromycin, ciprofloxacin, chloramphenicol and furazolidone. Antimicrobial agents typically are administered for 3-5 days. However, resistance to the tetracyclines and other antimicrobial agents among _V. cholerae_ has been has been increasing.
Resistance can be acquired through the accumulation of selected mutations over time, or the acquisition of transmissible genetic elements such as plasmids, which confer rapid spread of resistance. Surveillance for antibiotic resistance among bacterial isolates in a cholera outbreak is essential for maintaining effective therapy and minimizing the spread of resistance.
NDM-1 appears to have developed in the Indian subcontinent where NDM-1 has been found in drinking water and sewage and where cholera is endemic. The highly transmissible plasmid carrying NDM-1 gene, which encodes a carbapenemase, also carries linked genes that encode wide-spectrum antimicrobial resistance that can be transferred at the same time. Many prior isolates of other bacterial species displaying NDM-1 have been resistant to tetracyclines as well as multiple other antibiotics, so it is not surprising that NDM-1 would be found to have caused multidrug resistance in _V. cholera_ in India. - Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]
See Also
Acinetobacter - Chile: (Santiago) burn unit, drug-resistant 20120629.1184441
NDM-1 carrying Enterobacteriaceae - USA: (RI) ex Viet Nam 20120621.1175799
NDM-1 carrying Enterobacteriaceae - China: (HK) ex Thailand 20120612.1165421
NDM carrying bacilli - Canada: (Alberta) nosocomial, fatal 20120520.1138608
NDM-1 carrying Acinetobacter - Czech Rep ex Egypt 20120219.1044883
Gram negative bacilli, MDR - Chile: ex Italy, KPC, nosocomial 20120319.1074688
NDM-1 carrying Enterobacteriaceae - Ireland: 1st rep, ex India 20120217.1044861
2011
----
NDM-1 carrying Enterobacteriaceae - India (03): comment 20111230.3708
NDM-1 carrying Enterobacteriaceae - Guatemala: 1st rep, PAHO 20111128.3472
NDM-1 carrying Enterobacteriaceae - Italy: link to India 20111127.3466
Gram negative bacilli, MDR - South Africa: NDM-1, nosocomial 20111018.3117
NDM-1 carrying Enterobacteriaceae - India (02): nosocomial infections 20111006.3009
NDM-1 carrying Enterobacteriaceae - India, China: govt. response 20110412.1156
NDM-1 carrying Enterobacteriaceae - India: (New Delhi) water supply 20110411.1145
2010
----
Gram negative bacilli, resistant, update (01): NDM-1, KPC 20101028.3908
NDM-1 carrying Enterobacteriaceae (04): Taiwan ex India 20101005.3604
NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan (02) 20100914.3325
NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan 20100817.2853
NDM-1 carrying Enterobacteriaceae - N America, UK ex India 20100815.2812]
.................................................ml/msp/dk
?2001,2008 International Society for Infectious Diseases All Rights Reserved.
Read our privacy guidelines. Use of this web site and related services is governed by the Terms of Service.
- ------Source: Deccan Chronicle [edited] http://www.deccanchronicle.com/node/144375
In a major cause for concern, a new strain of cholera bacteria resistant to 3rd generation antibiotics has been found to be circulating in India. This cholera bacterial strain contains 2 super bug genes including the notorious New Delhi Metallo beta-lactamase-1 (blaNDM-1). The other super bug gene is plasmid-mediated beta-lactamase-1 (blaDHA-1). Thanks to these 2 super bug genes, the new cholera bacterial strain (O1 El Tor Ogawa) has developed resistance to a majority of known antibiotics.
The blaNDM-1, discovered a couple of years ago from hospitals in New Delhi, created ripples in the health sector worldwide. The gene was then found in _Escherichia coli_ strains. This is the 1st time that doctors have found the super bug gene blaNDM-1 in the cholera bacteria _Vibrio cholerae_.
A team of doctors led by Dr Jharna Mandal from Jawaharlal Institute of Post-graduate Medical Education and Research (Jipmer), Puducherry, isolated the cholera germ strain from the stool of a 2-year-old patient. It reported the findings in the journal of the Centres for Disease Control and Prevention (CDC), USA.
"_Vibrio cholerae_ [have] developed enormous capabilities to combat antimicrobial drug effects. It possesses efflux pumps that act on multiple classes of antimicrobial drugs and elaborates enzymes that can nullify the impact of complex antimicrobial drugs," the team said.
--
Communicated by:
ProMED-mail Rapporteur Mary Marshall
[The news release above refers to a very recent article: Mandal J, Sangeetha V, Ganesan V, et al. Third-Generation Cephalosporin-Resistant _Vibrio cholerae_, India. Emerg Infect Dis 2012;18, (8), 1326-28. Available at http://wwwnc.cdc.gov/eid/article/18/8/pdfs/11-1686.pdf.
Abstract:
"_Vibrio cholerae_ resistance to third-generation cephalosporins is rarely reported. We detected a strain that was negative for extended-spectrum B-lactamase and positive for the AmpC disk test, modified Hodge test, and EDTA disk synergy test and harbored the blaDHA-1 and blaNDM-1 genes. The antimicrobial drug susceptibility profile of V. cholerae should be monitored."
The strain in question was said to be resistant to ampicillin, ceftriaxone, cotrimoxazole, and furoxone and sensitive only to ciprofloxacin and tetracycline. It carried NDM-1 (a gene that encodes a carbapenemase and thereby resistance to carbapenems, as well as other beta-lactam antibiotics) and AmpC beta-lactamase (a gene that encodes for resistance to extended-spectrum cephalosporins e.g., ceftriaxone).
However, this pattern of drug resistance is not an issue for treatment of cholera.
Cholera can be successfully treated by immediate replacement of the fluid and salts lost through diarrhea and then maintenance of normal hydration status by replacing ongoing losses. Patients are preferably treated with a prepackaged oral rehydration solution that contains a mixture of sugar and salts to be mixed with water and drunk in large amounts.
Patients too ill for oral hydration are given intravenous fluids.
With prompt rehydration, less than one percent of cholera patients die (http://www.who.int/cholera/technical/en/).
Use of antibiotics is only an adjunct to rehydration. Antibiotics are not recommended for patients with cholera who have only mild or no diarrhea and dehydration. In severe cases, an effective antibiotic reduces shedding of _Vibrio cholerae_ in feces from over 5 days to 1-2 days and reduces the volume of diarrheic stool and the duration of illness, hastening recovery, and decreasing the chances of disease spread. Doxycycline is recommended as a first-line treatment for adults, while azithromycin is recommended as first-line treatment for children and pregnant women (http://www.cdc.gov/cholera/treatment/antibiotic-treatment.html ).
Other antibiotics that are effective when _V. cholerae_ are susceptible to them include cotrimoxazole, erythromycin, ciprofloxacin, chloramphenicol and furazolidone. Antimicrobial agents typically are administered for 3-5 days. However, resistance to the tetracyclines and other antimicrobial agents among _V. cholerae_ has been has been increasing.
Resistance can be acquired through the accumulation of selected mutations over time, or the acquisition of transmissible genetic elements such as plasmids, which confer rapid spread of resistance. Surveillance for antibiotic resistance among bacterial isolates in a cholera outbreak is essential for maintaining effective therapy and minimizing the spread of resistance.
NDM-1 appears to have developed in the Indian subcontinent where NDM-1 has been found in drinking water and sewage and where cholera is endemic. The highly transmissible plasmid carrying NDM-1 gene, which encodes a carbapenemase, also carries linked genes that encode wide-spectrum antimicrobial resistance that can be transferred at the same time. Many prior isolates of other bacterial species displaying NDM-1 have been resistant to tetracyclines as well as multiple other antibiotics, so it is not surprising that NDM-1 would be found to have caused multidrug resistance in _V. cholera_ in India. - Mod.ML
A HealthMap/ProMED-mail map can be accessed at: http://healthmap.org/r/1pSH.]
See Also
Acinetobacter - Chile: (Santiago) burn unit, drug-resistant 20120629.1184441
NDM-1 carrying Enterobacteriaceae - USA: (RI) ex Viet Nam 20120621.1175799
NDM-1 carrying Enterobacteriaceae - China: (HK) ex Thailand 20120612.1165421
NDM carrying bacilli - Canada: (Alberta) nosocomial, fatal 20120520.1138608
NDM-1 carrying Acinetobacter - Czech Rep ex Egypt 20120219.1044883
Gram negative bacilli, MDR - Chile: ex Italy, KPC, nosocomial 20120319.1074688
NDM-1 carrying Enterobacteriaceae - Ireland: 1st rep, ex India 20120217.1044861
2011
----
NDM-1 carrying Enterobacteriaceae - India (03): comment 20111230.3708
NDM-1 carrying Enterobacteriaceae - Guatemala: 1st rep, PAHO 20111128.3472
NDM-1 carrying Enterobacteriaceae - Italy: link to India 20111127.3466
Gram negative bacilli, MDR - South Africa: NDM-1, nosocomial 20111018.3117
NDM-1 carrying Enterobacteriaceae - India (02): nosocomial infections 20111006.3009
NDM-1 carrying Enterobacteriaceae - India, China: govt. response 20110412.1156
NDM-1 carrying Enterobacteriaceae - India: (New Delhi) water supply 20110411.1145
2010
----
Gram negative bacilli, resistant, update (01): NDM-1, KPC 20101028.3908
NDM-1 carrying Enterobacteriaceae (04): Taiwan ex India 20101005.3604
NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan (02) 20100914.3325
NDM-1 carrying Enterobacteriaceae - worldwide ex India, Pakistan 20100817.2853
NDM-1 carrying Enterobacteriaceae - N America, UK ex India 20100815.2812]
.................................................ml/msp/dk
?2001,2008 International Society for Infectious Diseases All Rights Reserved.
Read our privacy guidelines. Use of this web site and related services is governed by the Terms of Service.