title: Molecular evidence of cholera outbreak caused by a toxigenic Vibrio cholerae O1 El tor variant strain in Kelantan, Malaysia.
abstract: A total of 20 Vibrio cholerae isolates were recovered for investigation from a cholera outbreak in Kelantan, Malaysia, that occurred between November and December 2009. All isolates were biochemically characterized as V. cholerae serogroup O1 Ogawa of the El Tor biotype. They were found to be resistant to multiple antibiotics, including tetracycline, erythromycin, sulfamethoxazole-trimethoprim, streptomycin, penicillin G, and polymyxin B, with 35% of the isolates being resistant to ampicillin. All isolates were sensitive to ciprofloxacin, norfloxacin, chloramphenicol, gentamicin, and kanamycin. Multiplex PCR analysis confirmed the biochemical identification and revealed the presence of virulence genes, viz., ace, zot, and ctxA, in all of the isolates. Interestingly, the sequencing of the ctxB gene showed that the outbreak strain harbored the classical cholera toxin gene and therefore belongs to the newly assigned El Tor variant biotype. Clonal analysis by pulsed-field gel electrophoresis demonstrated that a single clone of a V. cholerae strain was responsible for this outbreak. Thus, we present the first molecular evidence that the toxigenic V. cholerae O1 El Tor variant has invaded Malaysia, highlighting the need for continuous monitoring to facilitate early interventions against any potential epidemic by this biotype.
authors.affiliation: Department of Medical Microbiology and Parasitology, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu 16150, Malaysia. yeancyn@yahoo.com
authors.forename: Geik Yong
authors.initials: GY
authors.lastname: Ang
authors.forename: Choo Yee
authors.initials: CY
authors.lastname: Yu
authors.forename: Kamarudin
authors.initials: K
authors.lastname: Balqis
authors.forename: Husni Tan
authors.initials: HT
authors.lastname: Elina
authors.forename: Hussin
authors.initials: H
authors.lastname: Azura
authors.forename: Mat Hussin
authors.initials: MH
authors.lastname: Hani
authors.forename: Chan Yean
authors.initials: CY
authors.lastname: Yean
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D015373:Bacterial Typing Techniques; D002771:Cholera / Q000453:epidemiology / Q000382:microbiology*; D002772:Cholera Toxin / Q000096:biosynthesis* / Q000235:genetics; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D006801:Humans; D008296:Malaysia / Q000453:epidemiology; D008826:Microbial Sensitivity Tests; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D041241:Vibrio cholerae O1 / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification / Q000472:pathogenicity*; D037521:Virulence Factors / Q000096:biosynthesis / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D037521:Virulence Factors; D002772:Cholera Toxin
references.citation: J Clin Microbiol. 1993 Sep;31(9):2474-82
references.pmid: 7691876
references.citation: J Clin Microbiol. 2003 Oct;41(10):4502-11
references.pmid: 14532174
references.citation: Clin Microbiol Rev. 1992 Oct;5(4):387-99
references.pmid: 1423217
references.citation: Trop Biomed. 2009 Dec;26(3):320-5
references.pmid: 20237446
references.citation: Microbiol Immunol. 2008 Jun;52(6):314-7
references.pmid: 18577166
references.citation: J Clin Microbiol. 1994 Dec;32(12):2975-9
references.pmid: 7883885
references.citation: Epidemiol Infect. 2000 Feb;124(1):25-30
references.pmid: 10722126
references.citation: Bull World Health Organ. 1967;36(6):871-83
references.pmid: 4865453
references.citation: J Clin Microbiol. 2001 Jul;39(7):2594-7
references.pmid: 11427575
references.citation: Bull World Health Organ. 1980;58(5):747-51
references.pmid: 6975183
references.citation: Epidemiol Infect. 1991 Aug;107(1):225-33
references.pmid: 1879486
references.citation: Proc Natl Acad Sci U S A. 1993 Jun 1;90(11):5267-71
references.pmid: 8389476
references.citation: Acta Trop. 2002 Aug;83(2):169-76
references.pmid: 12088858
references.citation: J Clin Microbiol. 2006 Nov;44(11):4211-3
references.pmid: 16957040
references.citation: Am J Clin Pathol. 1966 Apr;45(4):493-6
references.pmid: 5325707
references.citation: Proc Natl Acad Sci U S A. 2003 Feb 4;100(3):1304-9
references.pmid: 12538850
references.citation: J Clin Microbiol. 2002 Sep;40(9):3296-9
references.pmid: 12202569
references.citation: Microbiol Mol Biol Rev. 1998 Dec;62(4):1301-14
references.pmid: 9841673
references.citation: Lancet. 2004 Jan 17;363(9404):223-33
references.pmid: 14738797
references.citation: J Clin Microbiol. 1996 Oct;34(10):2537-43
references.pmid: 8880516
references.citation: J Microbiol Methods. 2008 Sep;75(1):142-4
references.pmid: 18579241
references.citation: Lancet. 1993 Mar 13;341(8846):704
references.pmid: 8095621
references.citation: J Clin Microbiol. 1997 Sep;35(9):2299-306
references.pmid: 9276406
references.citation: J Clin Microbiol. 1991 May;29(5):1058-9
references.pmid: 1676035
references.citation: Clin Microbiol Rev. 1995 Jan;8(1):48-86
references.pmid: 7704895
references.citation: Lancet. 1993 Aug 14;342(8868):382-3
references.pmid: 8101894
references.citation: Microbiol Rev. 1983 Dec;47(4):510-50
references.pmid: 6363898
references.citation: Emerg Infect Dis. 2008 Jun;14(6):987-8
references.pmid: 18507925
references.citation: Clin Microbiol Infect. 2007 Oct;13 Suppl 3:1-46
references.pmid: 17716294
references.citation: Med J Malaysia. 2000 Mar;55(1):143-5
references.pmid: 11072502
references.citation: Lancet. 1993 Jun 26;341(8861):1661
references.pmid: 8100020
references.citation: J Med Microbiol. 2002 Mar;51(3):264-268
references.pmid: 11871621
references.citation: J Clin Microbiol. 1993 Jan;31(1):22-5
references.pmid: 7678018
references.citation: J Clin Microbiol. 1985 Sep;22(3):405-8
references.pmid: 2995438
references.citation: J Clin Microbiol. 1995 Sep;33(9):2233-9
references.pmid: 7494007
references.citation: Emerg Infect Dis. 2004 Nov;10(11):2057-9
references.pmid: 16010751
references.citation: J Med Microbiol. 2006 Nov;55(Pt 11):1563-1569
references.pmid: 17030917
references.citation: Indian J Med Res. 2008 Dec;128(6):695-8
references.pmid: 19246791
references.citation: J Clin Microbiol. 1994 Jul;32(7):1685-90
references.pmid: 7929758
references.citation: Emerg Infect Dis. 2009 Jan;15(1):131-2
references.pmid: 19116078
references.citation: J Bacteriol. 2002 Aug;184(15):4259-69
references.pmid: 12107144
references.citation: Proc Natl Acad Sci U S A. 2002 Feb 5;99(3):1556-61
references.pmid: 11818571