Letters.indd

incubated in alkaline peptone water resistance in 2007 when 76% of the (pH 8.6) for 6–8 h at 37°C and then isolates were resistant. Tetracycline plated onto the agar. After overnight resistance was also reported by Mhalu incubation at 37°C, suspected et al. (3), from an epidemic of cholera colonies were tested biochemically in Tanzania, where 76% of isolates and confi rmed by slide agglutination were found to be resistant after 5 To the Editor: Cholera, caused with polyvalent O1 and monovalent months of extensive use of this drug for
by toxigenic strains of Vibrio cholerae Ogawa and Inaba antiserum (Difco treatment and prophylaxis. In a similar O1 or O139, continues to be a major Laboratories, Detroit, MI, USA). cause of illness and death, particularly Antimicrobial drug susceptibility use of tetracycline triggered the rapid in developing countries. Treatment testing was performed by using the emergence and spread of tetracycline-consists of early administration of disk diffusion technique on Mueller- rehydration therapy with appropriate Hinton agar (Difco Laboratories) with (4). Tetracycline is not used for oral or intravenous fl uids. The World commercial disks (Oxoid, Cambridge, prophylaxis in Kolkata, a known Health Organization recommends UK) and appropriate control strains cholera-endemic area. Nonetheless, antimicrobial drug treatment (2). The MIC of tetracycline was the emergence of resistant strains in for severely dehydrated patients determined with 101 randomly our study area is not surprising because with suspected cholera because it selected strains by Etest (AB similar tetracycline-resistant strains substantially shortens the duration Biodisk, Solna, Sweden) following of V. cholerae have been reported of diarrhea by reducing the volume manufacturer’s instructions.
(6), and in another study of Kolkata requirements, and limits transmission veillance period, we isolated 809 V. (7). Notably, tetracycline-resistant V. by decreasing fecal excretion of V. cholerae O1 organisms, among which cholerae O1 strains have also been cholerae (1). The progressive increase 624 (77%) were Ogawa and 185 responsible for major epidemics in in resistance to multiple drugs (23%) were Inaba serotypes. The latter Latin America, Tanzania, Bangladesh, among strains causing clinical cases became the predominant serotype only and Zaire (8). of cholera in developing countries in 2006. In 2007, a sudden upsurge is becoming a serious concern. We in tetracycline resistance was noted tetracycline among V. cholerae O1 report the emergence of tetracycline- among V. cholerae isolates, from isolates was <10% during 2004– resistant V. cholerae O1 in a well- 1% in 2004 to 76% in 2007 before 2006. The reasons for the sudden defi ned population in Kolkata, India, decreasing to ≈50% in 2009. An rise of resistant strains in 2007 and during 2007–2009.
increase in resistance to furazolidone their continued persistence are still imethoprim/sulfamethoxazole unclear. Detailed molecular studies period (2004–2009), we conducted a was also observed during the same are underway to fi nd the explanation. prospective, community-based study period. Of the strains that were Alternative drugs, such as the newer at an impoverished urban site in resistant to tetracycline, 99% were fl uoroquinolones, possess excellent Kolkata. The goals of the study were also resistant to furazolidone and activity against V. cholerae O1 and to estimate the prevalence of cholera, trimethoprim/sulfamethoxazole (on- describe its epidemiology, and identify line Appendix Figure, www.cdc.gov/ potential risk factors that could be EID/content/17/3/568-appF.htm). such as ciprofl oxacin and norfl oxacin, Among the tetracycline-resistant among V. cholerae strains belonging Rectal swabs samples from patient isolates (101 randomly selected to O1 serogroup has also been with diarrhea were obtained, placed strains), 43% had high-level resistance reported (9). in Cary-Blair transport medium, and (MIC >16 μg/mL). In addition, 57% of transported to the laboratory where V. cholerae O1 organisms had reduced antimicrobial drugs represents a they were processed for isolation susceptibility (i.e., MICs ranged from critical public health problem because and identifi cation of Vibrio spp. 8 μg/mL to 16 μg/mL). Tetracycline is the drug of choice result in longer hospital stays for thiosulphate citrate bile salt sucrose for treating cholera (1); however, patients. In addition, most of the agar (Eiken Chemical Company, during the 6-year period, we observed population in developing countries Tokyo, Japan). The specimens were the emergence of tetracycline cannot afford the newer and more plated directly onto thiosulfate citrate resistance among V. cholerae O1 expensive drugs. Our fi ndings bile salt sucrose agar. They were then isolates and a sudden upsurge in such emphasize the need for continued Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 3, March 2011 O1 serotype Ogawa isolated in Manhica strains. In this article, we describe susceptibility patterns of V. cholerae. District Hospital, southern Mozambique. a case of N. meningitidis infection J Antimicrob Chemother. 2007;60:662–4. DOI: 10.1093/jac/dkm257 antimicrobial drug susceptibility to 7. Roychowdhury A, Pan A, Dutta D, Muk- hopadhyay AK, Ramamurthy T, Nandy the genotype characteristics of this resistant Vibrio cholerae O1 serotype Inaba, in Kolkata, India. Jpn J Infect Dis. Koel Bhattacharya,
8. Garg P, Chakraborty S, Basu I, Datta S, hospital in Beijing in May 2009. The Suman Kanungo, Dipika Sur,
Banwari Lal Sarkar,
panding multiple antibiotic resistance among clinical strains of fever (39°C). N. meningitidis infection Byomkesh Manna,
isolated from 1992–7 in Calcutta, India. was confi rmed on the basis of the Anna Lena Lopez,1
Epidemiol Infect. 2000;124:393–9. DOI: clinical signs and results of laboratory Manjira Bhattacharya,
Suman Nandy,
9. Garg P, Sinha S, Chakraborty R, Bhat- tacharya SK, Nair GB, Ramamurthy T, neck stiffness developed, and the and Swapan Kumar Niyogi
sistant strains of Vibrio cholerae O1 bio- type El Tor among hospitalised patients sign and negative Brudzinski sign. India (K. Bhattacharya, S. Kanungo, D. Sur, crob Agents Chemother. 2001;45:1605–6. S. Nandy, S.K. Niyogi); and International Vaccine Institute, Seoul, South Korea (A.L. Address for correspondence: Suman Kanungo, National Institute of Cholera and Enteric system (bioMérieux, Marcy-Etoile, Diseases, P-33, CIT Rd, PO-Beliaghata, France) showed that the isolate was Kolkata 700010, India; email: kanungosuman@ N. meningitidis. However, this strain References
1. World Health Organization. The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revision. WHO/CDD/SER/80.2. Geneva: The Or-ganization; 2005. 2. Bauer AW, Kirby WM, Sherris JC, Turck M. Antibiotic susceptibility testing by a groupable N. meningitidis strain by emergence of El Tor Vibrio cholerae resis- tant to antimicrobial agents during the fi rst six months of fourth cholera epidemic in Serogroup, China (PFGE), and subtyping of the variable To the Editor:
regions of the genes (porA, porB, and meningitidis is a major public health fetA) encoding the outer membrane erae strains, Madagascar. Emerg In- serogroups, and most meningococcal number 482. The allele numbers for disease is caused by strains that abcZ, adk, fumC, gdh, pdhC, and pgm were 222, 3, 58, 386, 18, and 77, Emergence of multiply antibiotic-resistant express 1 of the 5 types of capsular respectively. This strain was assigned Vibrio cholerae in Bangladesh. J Infect W135). In the natural reservoir of a new sequence type number, ST7962.
6. Mandomando I, Espasa M, Vallès X, the human nasopharynx, strains of N. Sacarlal J, Sigaúque B, Ruiz J, et al. An- meningitidis that do not fi t into 1 of the 13 serogroups and are presumably ST7962 was most similar to the 1Current affi liation: Pfi zer Inc., Hong Kong unencapsulated are common. By ST4821 complex with 3 identical Special Administrative Region, People’s contrast, rare meningococcal diseases loci. The PFGE pattern of this Republic of China. are caused by these nonserogroupable strain was compared with the PFGE Emerging Infectious Diseases • www.cdc.gov/eid • Vol. 17, No. 3, March 2011

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