Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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On Sep 2018




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"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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On Aug 2018




Dr. Arundhathi. S
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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


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Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
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Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
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Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
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Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2023 | Month : January | Volume : 17 | Issue : 1 | Page : DC14 - DC18 Full Version

Emergence of Multidrug Resistant Vibrio cholerae O139 in Acute Diarrhoea Patients Attending a Tertiary Care Hospital, West Bengal, India


Published: January 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/59940.17324
Nabamita Chaudhary, Tanusri Biswas, Purbasha Ghosh, Saswati Chattopadhyay, Raston Mondal

1. Assistant Professor, Department of Microbiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India. 2. Associate Professor, Department of Microbiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India. 3. Associate Professor, Department of Microbiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India. 4. Associate Professor, Department of Microbiology, Burdwan Medical College and Hospital, Burdwan, West Bengal, India. 5. Associate Professor, Department of Community Medicine, Burdwan Medical College and Hospital, Burdwan, West Bengal, India.

Correspondence Address :
Dr. Saswati Chattopadhyay,
1, Amarnath Road Uttarpara Hooghly, Kolkata, West Bengal, India.
E-mail: dr.saswatichattopadhyay@gmail.com

Abstract

Introduction: India is a developing country with many poor sanitation areas. Cholera, a water borne disease is rampant in areas of poor sanitation and is mainly due to Vibrio cholera of O1 and O139 serogroups causing acute cases of rice watery diarrhoea and high mortality. Infection due to Multidrug Resistant (MDR) Vibrio is on the rise. It is endemic in over 50 countries including India leading to a number of epidemics and pandemics. Till date, about seven pandemics have been identified due to cholera infection.

Aim: To isolate Vibrio cholerae from acute diarrhoea cases with their antibiotic susceptibility and identify MDR strains, if any.

Materials and Methods: A hospital-based, cross-sectional study was conducted in the Department of Microbiology, Burdwan Medical College, Purba Burdwan, West Bengal, India, from January 2021 to December 2021. Rectal swabs/faeces collected in Cary-Blair Transport Media were brought to the laboratory and incubated at 37°C for six hours; a loopful was inoculated in nutrient agar, MacConkey agar and selective media Thiosulphate-Citrate-Bile Salts-Sucrose agar (TCBS). Gram stain, motility, colony characteristics, oxidase test, cholera-red reaction and slide agglutination test was done. Diagnosis was confirmed; antibiotic susceptibility done and interpreted as per Clinical and Laboratory Standard Institute (CLSI) guidelines. The data was collected and entered into Microsoft Excel software and presented as frequency and percentages.

Results: Total 60 samples were collected and tested, out of which 24 (40%) were positive for Vibrio cholerae and nine in 24 (37.5%) samples were MDR strains. Twelve samples were from femlaes and 12 were from males, majority {5 (41.67%) females, 9 (75%) males} belonged to the age group of 0-5 years. Serotyping revealed that Vibrio cholerae O1 serogroup was identified in 8 (33.33%) cases and O-139 serotype in 16 (66.67%) samples. Rest were Escherichia coli (n=10, 25%), Klebsiella pneumoniae (n=5, 12.5%) and Staphylococcus aureus (n=1, 25%).

Conclusion: There is a rise of infections due to MDR strains of Vibrio O139 sero group in the community which needs early diagnosis and treatment for control. Vibrio cholerae strains were more resistant to fluoroquinolones, macrolides, tetracycline and Ampicillin.

Keywords

Antibiotic resistance, Gram negative bacteria, MacConkey agar, Selective media

Diarrhoea is defined as frequent passage of excessive watery stool for 3-7 days (1). The different aetitiological agents causing diarrhoea are viral, bacterial or parasitic (2). Among the different bacteria responsible for the condition, Vibrio cholerae is an important agent. Vibrio cholerae of the family Vibrionaceae are slender, comma shaped, water loving, motile, aerobic gram negative bacilli with polar flagella (3). The bacilli enters the body via contaminated water and unhygienic practices and being very sensitive to pH below 6, most of them are killed by the acidic pH of the stomach (4),(5). The bacilli secretes a very potent enterotoxin, the cholera toxin which binds the bacilli to the plasma membrane of the intestinal epithelial cells and leads to increase in the intracellular Cyclic Adenosine Monophosphate (cAMP). This leads to massive secretion of water and electrolytes into the intestinal lumen leading to the development of cholera (5).

Though cholera outbreaks are quite frequent in monsoons, occasional sporadic cases are also reported throughout the year in different seasons from areas with no proper sanitation (6),(7). The disease, cholera is endemic in India and the whole of the gangetic plains including the delta of the river Ganges is called ‘the homeland of Cholera’ (8),(9). Worldwide the disease has led to the development of several epidemics and since 1817, about seven pandemics has been recorded and it has become a great public health issue (7),(10),(11).

About 200 serogroups of Vibrio has been identified belonging either to the classical biotype or ElTor biotype and the two most common infectious strains being either V .cholerae O1 or O139. The disease spreads via ingestion of food and contaminated water mainly by Vibrio cholera of O1 and O139: classical or ElTor serotype and it has three sero sub types namely Ogawa, Inaba and Hikojima (12),(13). Vibrio cholerae O1 shows similar characteristics like the EI Tor serotype and showing difference from Vibrio cholerae O1 in the polysaccharide nature of its surface antigen (14),(15). The infection can become severe and the patients develops profuse watery diarrhoea with/without vomiting, muscle cramps, fever, weak pulse, loss of skin tugorsity, scaphoid abdomen and severe dehydration (3). As a result, the patient develops hypovolumic shock which if not diagnosed early, may lead to death of the patient (16),(17).

An early rapid diagnosis is required to save the patient and for this, a wet mount of the liquid watery stool is examined microscopically to find darting, motile Vibrio cholerae (18). Worldwide every year, about 1.3-4.0 million cases of cholera, occur and 21,000-143,000 deaths have been recorded by World Health Organization (WHO) (19). Prompt treatment of the condition is started with rehydration therapy-oral/parenteral (IV) with/without antibiotics. WHO recommends the use of antibiotics as they have been found to decrease the bacterial shedding, reduces the intensity and duration of the diarrhoea and hence severity of the infection (20),(21).

Tetracycline, doxycycline, furazolidone, erythromycin, trimethoprim-sulphamethoxazole, and chloramphenicol were the drugs used to treat cholera very effectively but the resistant strains were also being isolated in recent years. Improper and unrestricted use of different antibiotics has led to the development of Multidrug Resistant (MDR) strains of Vibrio cholerae which has become a source of great concern amongst all. Since no comprehensive data regarding the prevalence and antimicrobial sensitivity pattern of any prevailing MDR Vibrio cholerae in Purba Burdwan and its adjoining districts is available. Therefore, the aim of the current study was to identify the presence of the bacteria along with their antibiotic sensitivity pattern together with identification of any MDR strains.

Material and Methods

A hospital-based, cross-sectional study was conducted in the Department of Microbiology in Burdwan Medical College, Purba Burdwan, West Bengal, India, from January 2021 to December 2021 following approval by the Institutional Ethics committee (Memo No: IEC/302 dated 25/04/22)

Inclusion criteria: All the patients presenting with acute watery diarrhoea for 3-7 days were included in the study (22).

Exclusion criteria: All the patients having loose watery stool for less than 3 days or more than seven days or having dysentery (stool with mucus) were excluded from the study.

Study Procedure

A total of 60 stool samples/rectal swabs were sent to laboratory from patients suffering from acute diarrhoea in Cary-Blair Transport medium. About 2 mL of sample was inoculated in 20 mL of Alkaline Peptone Water (APW) (1:10 ratio) and incubated for six hours at 37°C for enrichment. Subculture from Enrichment media was done on MacConkey agar, nutrient agar and selective media Thiosulphate-Citrate-Bile Salts-Sucrose (TCBS) agar and checked for colony characteristics. In APW, uniform turbidity with surface pellicles was identified; in Nutrient agar, glistening, translucent colonies were seen. In MacConkey agar, pale, translucent, lactose-non fermenting colonies were seen while in TCBS, yellow button shaped sucrose fermenting colonies were identified (Table/Fig 1). Hanging drop preparation showed typical darting motility of Vibrio. Further confirmation was done by array of biochemical tests such as glucose, sucrose fermentation, indole, methyl red, oxidase test, catalase test, urease, citrate, cholera-red reaction, Lysine and Ornithine decarboxylation but not of Arginine and in triple sugar iron (23).

Serologic confirmation of Vibrio cholerae (V.cholerae) was done by slide agglutination test with specific antisera against V.cholerae O1 and O139 (Table/Fig 2). Agglutination tests for V.cholerae somatic O antigens were carried out on a clean glass slide. Few colonies were taken in an inoculating loop from MacConkey agar medium and emulsified in a small drop of normal saline and mixed thoroughly by tilting back and forth for about 30 seconds. A smooth suspension was prepared. A small drop of antiserum O1 (polyvalent O1-naba, Ogawa and Hikojima type antisera) was added to the suspension. The same process was repeated with anti-sera O-139. One drop of Normal Saline and the growth emulsion was used as a negative control to observe for auto agglutination (24).

The dehydration which developed due to acute diarrhoea due to V.cholerae was divided into mild, moderate and severe types. Patients who passed stool for maximum five times, had normal urine output, moist tongue, normal blood pressure and normal pulse and on pinching the skin it immediately recoiled back were classified as mild dehydration (25),(26). Patients who passed stool for 6-15 times, were conscious but irritable, slightly dry tongue, had sunken eyes, with normal urine output, normal blood pressure and pulse but slight tachycardia, and on pinching the skin tugorsity showed delayed recoil were classified as having moderate dehydration (25),(26). Patients who passed stool for more than 15 times, were in shock/decreased consciousness, deeply sunken eyes, no tears, very dry tongue, urine output very much reduced, hypotensive, with thread pulse and on pinching the skin showed very slow recoil were classified as having severe dehydration (25),(26).

Antibiotic Susceptibility Test

The antimicrobial susceptibility testing of V.cholerae was performed by Kirby Bauer’s disc diffusion method on Mueller Hinton agar (27). Antibiotic discs used were doxycycline (30 μg/disc), ciprofloxacin (5 μg/disc), cotrimoxazole (25 μg/disc), amikacin (30 μg/disc), ceftriaxone (30 μg/disc), cefoperazone/sulbactam (75 μg/30 μg /disc), norfloxacin (5 μg/disc), chloramphenicol (30 μg/disc), azithromycin (15 μg/disc), ampicillin (30 μg/disc) and erythromycin (10 μg/disc). The interpretation was done based on the guidelines of CLSI (28). Escherichia Coli (E.coli) ATCC®25922 and Staphylococcus aureus ATCC®29213 were the controls used by us antibiotic susceptibility tests (29).

Detection of Multidrug Resistant (MDR) strains

The isolates which were resistant to at least one anti-microbial drug in three or more antimicrobial categories were considered as MDR strain. (30) The groups of drugs tested were: Penicillin (ampicillin), cephalosporins (ceftriaxone), aminoglycosides (amikacin), macrolides (erythromycin, azithromycin), fluoroquinolones (ciprofloxacin, norfloxacin), β-lactam/β-lactam inhibitors (cefoperazone-sulbactam) (31).

All the patients were followed up till their discharge from the hospital and all necessary information regarding age sex, symptomatology was collected from the admission files of the patients. Most of the patients having acute diarrhoea were not admitted and were treated in the Outpatient Department (OPD) of the health centres. Only the very severe ones with/ without complications were admitted in the hospital.

Statistical Analysis

The data collected from the above test was analysed by the Microsoft Excel software and presented as frequency and percentages for all the variables like age, symptoms, history of hospitalisation, outcome, laboratory results and death, if any.

Results

Out of total 60 stool/rectal swab samples received in the laboratory during the study period, 24 samples showed growth of Vibrio cholerae. An age-sex proportion of cholera cases were drawn up. The highest proportion of cholera was observed in the paediatric age group (O-5 years) and maximum number of cases was in males (n=9, 75%) followed by in females (n=5, 41.67%) (Table/Fig 3).

Of the 60 stool/rectal swab samples, 40 (66.67%) samples showed growth of pathogenic organisms. Vibrio cholerae was isolated in 24 stool samples. Serotyping, however, showed that V.cholerae O1 serogroup was identified in eight (33.33%) cases and V.cholerae O-139 serotype in 16 (66.67%) samples. Rest were E.coli (n=10, 25%), KLebsiella pneumoniae (n=5, 12.5%) and Staphylococcus aureus (n=1, 2.5%) (Table/Fig 4).

Vibrio cholerae induced infections are very rampant in the monsoon seasons. We found an intriguing seasonal variation in our study, though 18 (75%) cases were reported during monsoons, 12.5% were found during summer and 12.5% in the winter. The highest number of cholera cases was obtained during months of June, July and August with sharp decline in December and January (Table/Fig 5).

High frequency of passage of stool in first 24 hours was noted in 24 patients with positive V.cholerae culture; most of the cases (13 cases; 54.16%) passed stool 6-10 times while 14 (58.33%) patients presented with moderate dehydration (Table/Fig 6).

The isolates were least susceptible to ampicillin (3-12.5%), ciprofloxacin (3-12.5%) and erythromycin (5-20.83%). they showed moderate susceptibility to doxycycline (10-41.67%), cotrimoxazole (12-50%), amikacin (15-62.5%), norfloxacin (15-62.5%) and azithromycin (16-66.67%). The isolates were most susceptible to cefoperazone/sulbactam (23-96%), chloramphenicol (22-91.67%) and ceftriaxone (20-83.33%) (Table/Fig 7).

Out of 24 V.cholerae isolates, nine (37.5%) samples were found to be MDR with all of these strains showing maximum resistance (66.66%) to Ampicillin, Cefoperazone/Sulbactam, Amikacin and Ciprofloxacin (Table/Fig 8).

Discussion

Cholera is a major public health problem in most of the developing countries of the world including India. In India, it is endemic and has led to a number of epidemics and pandemics. Of the 60 rectal swabs/faeces samples from the clinically suspected patients of acute diarrhoeal diseases, 24 (66.67%) of total samples, revealed the growth of 0-139 serotype of Vibrio cholera. This was unlike with different studies where Vibrio cholera O1 is the predominant strains being isolated. For example, Parvin I et al., in Bangladesh, an endemic region like India, conducted a study on diarrhoea stools from 2000-2018. They found that there was a gradual fall of Vibrio cholera O1 cases from 2006. In 2016, the number of cases due to it was only 6% but thereafter, there was an increase in the number of cases reaching 12% in 2018 (32). A study conducted by Kumar A and Oberoi A in Punjab in 2013 on 1063 acute diarrhoea stool found 41 Vibrio cholera positive cases and all were Vibrio cholera O1 (33). Another study conducted by Maharjan S et al., in Nepal from June 2014 to December 2014, found that of 650 stool samples, 50 showed growth of enteric bacterial pathogens; of these, 21 (3%) were V.cholerae serogroup O1 and rest were Shigella (27).

Cholera being a water-borne disease, contamination of water due to heavy rains and floods in the monsoons is one of the main reasons for its spread. In the present study, 62.5% cases occurred during monsoons from April peaking during the monsoons similar to a study conducted by Kumar A and Oberoi A who found 39/41 ( 95%) Vibrio cholera O1 cases during the monsoons. The cases were observed by Kumar A and Oberoi A to occur from May to June till August (23). A prevalence study conducted by Sharma A et al., in Assam from 2003-2013, Vibrio cholera O1 was isolated in 70 out of 1779 stools. Out of the 1779 stools, 733 stool samples were received in the monsoons (July-October) and Vibrio cholera O1 was in 50/733 (6.8%) stools in the monsoons (9). Thakur NH et al., found that diarrhoea due to Vibrio species was present uniformly throughout the year with slight peaks in rainy, winter and summer seasons (3).

In this study, children below five years of age (41.67% in females and 75% in male children) were most susceptible to the infection like Sharma A et al., study in Assam. They observed that Vibrio cholerae was maximum cases in children between 0-10 years age group with 11.5% cases in 0-05 years age group (9). Similar observations were found by Thakur NH et al., who also reported that children below 5yrs of age were the most vulnerable age group to Vibrio infection (3). Garbern SC et al., however found that the infection due to Vibrio cholerae was more common in older children and adults in urban Bangladesh (4).

In the present study, authors found that majority of V.cholerae cases (22, 91.67%) presented with moderate and mild dehydration. Thida Oo NA et al., like present study found 02/35 (5.7%) patients presented with no/mild dehydration, some dehydration in 20/34 (57.2%) patients and severe dehydration in 13/34 (37.1%) patients (33). This was unlike the study conducted in Yangon, Myanmar who found that out of the 24 Vibrio cholera O1 isolates, 16 patients presented with severe dehydration (34). Garbern SC et al., also found that 76 (12.2%) patients had no/mild dehydration, 226 (36.3%) had some dehydration while 318 (51%) had severe dehydration (4).

Regarding the frequency of stool, in our study, we found 13 (54.16%) passed stool 6-10 times in 24 hours which was similar to the study by Thida Oo NA et al., who reported that most of the cases 22/35 cases (62.9%) had stool frequency for 6-10 times (33). Current study showed that the isolated strains were very much susceptible to combination drug-Cefoperazone/sulbactam-23, and to Chloramphenicol-22 and Ceftriaxone-20. This was in concordance with study by Kumar A and Oberoi A who found that all the 41 isolated Vibrio cholera O1 isolates all were susceptible to Chloramphenicol and Ceftriaxone (23).

Increasing resistance to Ciprofloxacin was also noted in our study-only 03 strains were sensitive to it (03/24; 12.5%) while the rest were resistant. Emergence of Ciprofloxacin resistance was also observed by Sharma A et al., from 2008-2012 which ranged from 15.3% to 40% in 2012 (9). Kumar A and Oberoi A however, reported that only 01/41 (2.4%) strain was resistant to Ciprofloxacin (23). In this study, nine Vibrio cholerae MDR strains were detected, which is similar to the study conducted by Afum T et al., in patients from Ghana complaining of acute diarrhoea. They isolated 28 Vibrio species, of these there was 4/28 (14.28%) were MDR-being resistant to fluoroquinolones, cephalosporins and aminoglycosides (10).

Antibiotics with rehydration therapy was found to be better in relieving the symptoms faster than rehydration treatment alone similar to the findings of Kitaoka M et al., (35). But with the emergence of MDR strains of Vibrio cholerae rational use of these antibiotics is required. To decrease the incidence of infections due to Vibrio cholerae, potable drinking water along with proper hygienic practices-WaSH issues (drinking Water, Sanitation, Hygiene) along with periodic quality check of different water sources should be implemented (8).

Limitation(s)

Molecular characterisation of isolates was not studied and the sample size was small. The study sample size was small because it consisted of the occasional outbreak samples sent by the Chief Medical officer of Health of Purba Burdwan and adjoining districts and thus is a representative sample of the general population.

Conclusion

A resistance pattern was observed, wherein the Vibrio cholerae strains were more resistant to fluoroquinolones, macrolides, tetracycline and ampicillin as against the pattern in the past decade where the highest sensitivity was reported to ampicillin followed by furazolidone, tetracycline and ciprofloxacin. Together with this, we have observed the emergence of multidrug resistance strains of V.cholera.

Acknowledgement

Authors are grateful to the Principal, Dean and Medical Superintendent of Burdwan Medical College for allowing to conduct the study. Also, authors are thankful to all the staff of Microbiology laboratory for cooperating to carry out the study. Lastly, authors are very much grateful to all the participants of this study for their full hearted support and cooperations.

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DOI and Others

DOI: 10.7860/JCDR/2023/59940.17324

Date of Submission: Sep 04, 2022
Date of Peer Review: Oct 17, 2022
Date of Acceptance: Nov 23, 2022
Date of Publishing: Jan 01, 2023

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. NA

PLAGIARISM CHECKING METHODS:
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• iThenticate Software: Nov 21, 2022 (9%)

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