Intensive care management of a patient with necrotizing fasciitis due to non-O1/O139 Vibrio cholerae after traveling to Taiwan: a case report

Case report: Detection of non-O1/non-O139 Vibrio cholerae in a patient with hepatic space-occupying lesions using metagenomic next-generation sequencing

Introduction/background

Vibrio cholerae is the causative agent of the human intestinal infectious disease cholera, which includes a variety of serogroups. However, there have been very few cases of hepatic space-occupying lesions associated with this infection. Currently, there are various methods for detecting this pathogen, including metagenomic sequencing, which enables quicker and more accurate identification. In this study, metagenomic sequencing is employed to accurately identify non-O1/O139 Vibrio cholerae infections by analyzing the genetic material present in clinical samples.

Presentation of case

A 75-year-old man presented with diarrhea and fever after consuming crabs. The initial treatment improved the diarrhea, but a liver abscess developed later. Magnetic resonance imaging (MRI) of the liver revealed a hepatic space-occupying lesion. Upon further investigation, a Gram-negative, rod-shaped bacterium was cultured from the patient's liver puncture fluid, and Vibrio cholerae was detected in the same fluid using metagenomic next-generation sequencing (mNGS). The pathogen was confirmed to be non-O1/non-O139 Vibrio cholerae (NOVC) using polymerase chain reaction (PCR). Following treatment with piperacillin/tazobactam sodium and moxifloxacin, the patient's body temperature returned to normal, the liver abscess improved significantly, and he was subsequently discharged from the hospital.

Discussion

This case study describes an elderly male patient with a hepatic space-occupying lesion. Multiple cultures of specimens failed to identify the underlying cause; however, advanced techniques such as mNGS and PCR confirmed an NOVC infection. This indicates that mNGS can serve as a valuable tool in diagnosing cases of unexplained liver infections.

Conclusion

The use of mNGS is significant for detecting and clinically diagnosing infectious pathogens in patients with unexplained space-occupying lesions.

Vibrio cholerae-Associated Necrotizing Fasciitis in an Immunocompromised Individual: Trivial Exposure Leading to a Life-Threatening Illness

Vibrio cholerae primarily causes gastrointestinal infections. However, in immunocompromised patients, the presentation can be atypical in the form of extraintestinal manifestation and more invasive disease. We report a patient with human immunodeficiency virus (HIV), who had necrotizing fasciitis in the left leg following exposure to stagnant rainwater. These immunocompromised patients should be educated about the possibility of such life-threatening infection following such a minor exposure.

Whole Genome Analysis of a Non-O1, Non-O139 Vibrio cholerae Detected from Human Blood in China

Non-O1, non-O139 Vibrio cholerae (NOVC) can cause cholera-like diarrhea, but it rarely causes extraintestinal infection, so it is easily overlooked. In this report, we present a case of NOVC detected through blood culture in a 58-year-old male patient with cirrhosis, resulting in severe infection. The patient had been diagnosed with cirrhosis seven years prior and was admitted to the hospital due to abdominal distension and gastrointestinal bleeding. Gram-negative bacilli were isolated from blood cultures and identified as V. cholerae using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and average nucleotide identity (ANI). Moreover, the serum agglutination test showed that the strain was non-O1/non-O139. Further whole genome sequencing and analysis of the strain showed that the strain mainly carried virulence genes tox R, RTX, hly A, T3SS/T6SS, but no resistant genes such as sulII, dfrA1, strB were detected. It provides information for the study of the pathogenic mechanism and drug resistance mechanism of V. cholerae. The patient had severe symptoms and a poor prognosis, indicating that although the NOVC strain infected in this patient had few virulence genes, it was not weak in pathogenicity. It may be caused by the effect of some virulence genes, which should be paid attention to.

[Atypical bacterial Infections of the Hand]

Atypical infections of the hand are rare and often misdiagnosed. Delay of treatment can lead to irreversible damage, even life-threatening sepsis. The article provides a survey of some of the most frequent atypical infections and their appearance on the hand (Mykobakteria, Vibriones, Francisella, Actinomycetoma), illustrated by two case reports. Knowing the pathogenesis of the most frequent atypical infections allows considering them in the daily practice for differential diagnosis, initiate specific testing, and administer an adequate therapy at an early stage.