VIBRIO CHOLERA O1 OGAWA BACTEREMIA WITH EXTRAINTESTINAL MANIFESTATION

Abstract

Intro: O1 Ogawa Vibrio cholerae is rarely reported to cause extraintestinal manifestation. Here, we report a case of O1 Ogawa Vibrio cholerae bacteremia with bullous cellulitis of the left leg. The patient acquired the infection through a small skin prick on her leg from contaminated soil that served as an environmental reservoir for Vibrio cholerae. Methods: A 63-year-old Chinese lady with an underlying Thalassemia trait, SLE and hepatitis B presented with severe pain and swelling of her left leg. She accidentally hit a tree branch on the ground, pricking her left leg and leaving a small wound over the left anterior shin. Examination revealed a swollen left leg from below the knee level until above the ankle, with a small discharging wound on the shin with serous discharge. Blood investigation showed WBC of 24 × 10^9/ L, Hb of 7.9 g/dL, and platelets of 276 × 10^9/L. C-reactive Protein was 20 mg/L. Radiological examination of the left leg revealed no gas shadow. Findings: Her blood culture was positive for Vibrio cholerae. The isolate was sent to the National Public Health Laboratory Sungai Buloh for confirmation and serotyping, and the result came back as Vibrio cholerae serotype O1 Ogawa. The patient was treated with oral cotrimoxazole four tab BD, and her wound was put on a daily dressing. She completed ten days of oral cotrimoxazole in the ward and remained afebrile. Repeated blood culture, pus and tissue cultures revealed no growth. Discussion: O1 Ogawa Vibrio cholerae may cause non-diarrheal disease in an immunocompromised patient with atypical clinical manifestations. This infrequent strain of O1 Ogawa Vibrio cholerae does exist in the local environment as their natural reservoir. Conclusion: To our knowledge, this is the first case of the O1 Ogawa strain of Vibrio cholerae reported to cause bullous cellulitis and septicemia in Malaysia.