Infections due to non-O1 Vibrio cholerae in southern Taiwan: Predominance in cirrhotic patients

Although Taiwan is not an area where cholera is endemic, from October 1988 to October 1997 30 episodes of non-O1, non-O139 Vibrio cholerae infection were noted at the National Cheng Kung University Hospital in Taiwan. Infections generally occurred in hot seasons, and two episodes were concomitant with Vibrio vulnificus infection. Three major clinical presentations were found: bacteremia with concurrent spontaneous bacterial peritonitis or invasive soft-tissue infections that occurred solely in cirrhotic patients; self-limited acute febrile gastroenteritis that occurred in patients with no underlying medical disease; and necrotizing fasciitis or cellulitis that often resulted from a wound on extremities. Other manifestations included fatal pneumonitis in a drowned man and acute pyosalpinx. The differential diagnosis of invasive infections in cirrhotic patients should include infections due to non-O1 V. cholerae or V. vulnificus, and a third-generation cephalosporin and a tetracycline analogue or a fluoroquinolone alone is recommended for treatment of severe vibrio infections.