Epidemiologic Notes and Reports Non-O1 Vibrio cholerae Gastroenteritis--New Hampshire

In September 1981, an isolated case of non-O1 Vibrio cholerae gastroenteritis occurred in a Laconia, New Hampshire, resident following consumption of raw clams harvested from New England coastal waters. The patient was a previously healthy 40-year-old woman; her recent travel and personal-contact histories were unremarkable. Within 26 hours after eating the clams, she developed acute abdominal cramps, followed by fever and bloody diarrhea. She was treated symptomatically with rest and oral hydration and recovered without sequelae. Her stool culture grew V. cholerae (Smith serotype 361) and no other enteric pathogens. Studies for production of heat-labile and heat-stable toxins were negative. The asymptomatic family members had also eaten the clams; their stool cultures grew only normal flora. Subsequent cultures of shellfish harvested from the same coastal area were negative for vibrio organisms.

The market where the clams were purchased provided names of eight restaurants it routinely supplies, none of which reported any recent gastrointestinal illness among customers or employees. A retrospective review of hospital emergency-room records identified 36 other patients who had presented with gastrointestinal symptoms during the week the index case occurred. Only one had had a stool culture, which grew Campylobacter jejuni. All patients were sent food-history questionnaires; none of the 14 respondents reported eating raw shellfish before onset of symptoms or eating at any of the restaurants supplied by the market. After the index case was reported, prospective surveillance was initiated for patients presenting with diarrheal disease at the local emergency room and at a regional medical clinic. Stool cultures were obtained from these patients and screened on thiosulfate-citrate bile salts sucrose (TCBS) agar, a selective medium for vibrio species. No further cases were identified.

This represents the first reported case of non-O1 V. cholerae gastroenteritis apparently caused by shellfish from New England waters. Reported by S MacRae, Dept of Microbiology, T Clements, Dept of Infection Control, Lakes Region General Hospital, J Cournoyer, New Hampshire State Dept of Health and Welfare; Field Svcs Div, Epidemiology Program Office, CDC.

Editorial Note

Editorial Note: Isolated cases of non-O1 V. cholerae gastroenteritis have been reported previously in the United States (1,2), and outbreaks of intestinal illness caused by this organism have occurred elsewhere (3-5). Investigations of recent isolated cases in the United States have demonstrated a statistically significant association between eating raw shellfish and development of disease (1,2). Most of these cases have been associated with Gulf Coast oysters.

Environmental studies have demonstrated that the organisms can be found in brackish surface waters and are more numerous during warmer summer months (1). A Food and Drug Administration study of 790 samples of randomly selected oysters collected between June 1979 and May 1980 revealed non-O1 V. cholerae in 111 samples (14%) (6). Some investigators have demonstrated an association between fecal contamination of water and presence of the organism (1), but non-O1 V. cholerae has been found in waters free of fecal contamination and thus may be a constituent of normal marine flora (7).

Although no outbreaks of illness due to this organism have been reported in the United States, it is possible that common-source exposures have occurred in which milder cases have gone undetected and unreported. Non-O1 V. cholerae should be included in the differential diagnosis of acute gastroenteritis following ingestion of raw seafood. Diagnosis can be facilitated by culture of stool specimens on TCBS medium.

References

1. Wilson R, Lieb S, Roberts A, et al. Non-O group 1 Vibrio cholerae gastroenteritis associated with eating raw oysters. Am J Epidemiol 1981;114:293-8.

2. Morris JG Jr, Wilson R, Davis BR, et al. Non-O group 1 Vibrio cholerae gastroenteritis in the United States: clinical, epidemiologic, and laboratory characteristics of sporadic cases. Ann Intern Med 1981;94:656-8.

3. Aldova E, Laznickova K, Stepankova E, Leitava J. Isolation of nonagglutinable vibrios from an enteritis outbreak in Czechoslovakia. J Infect Dis 1968;118:25-31.

4. Dakin WP, Howell DJ, Sutton RG, O'Keefe MF, Thomas P. Gastroenteritis due to non-agglutinable (non-cholera) vibrios. Med J Aust 1974;2:487-90.

5. CDC. Outbreak of Vibrio cholerae non O-1 gastroenteritis--Italy. MMWR 1981;30:374-5.

6. Twedt RM, Madden JM, Hunt JM, et al. Characterization of Vibrio cholerae isolated from oysters. Appl Environ Microbiol 1981;41:1475-8.

7. Colwell RR, Kaper J, Joseph SW. Vibrio cholerae, Vibrio parahaemolyticus, and other vibrios: occurrence and distribution in Chesapeake Bay. Science 1977;198:394-6.

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