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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 865-866
Emergence of tetracycline resistance in Vibrio cholerae O1 biotype El Tor serotype Ogawa from north India


Department of Medical Microbiology, Post Graduate Institute of Medical Education and Research, Chandigarh, Sector - 12, Punjab, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Taneja N, Samanta P, Mishra A, Sharma M. Emergence of tetracycline resistance in Vibrio cholerae O1 biotype El Tor serotype Ogawa from north India. Indian J Pathol Microbiol 2010;53:865-6

How to cite this URL:
Taneja N, Samanta P, Mishra A, Sharma M. Emergence of tetracycline resistance in Vibrio cholerae O1 biotype El Tor serotype Ogawa from north India. Indian J Pathol Microbiol [serial online] 2010 [cited 2017 Sep 23];53:865-6. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/865/72014


Sir,

Cholera continues to be a major challenge for India as this endemic infection with frequent epidemic potential is an important cause of morbidity and mortality. The use of antimicrobial agents in cholera is generally accepted as a method of reducing the duration and volume of diarrhea as well as decreasing the period of Vibrio cholerae excretion in stool. [1] Changing patterns of antibiotic sensitivity of V. cholerae is a major concern as multiple antibiotic resistant V. cholerae isolates are being reported from various parts of world. [1],[2],[3],[4] Cholera is known to be endemic in north India. This disease shows seasonal outbreaks that coincide with monsoon months. Our tertiary care referral center caters to a population of more than 4 million people in and around Chandigarh. Cases are referred from four nearby states of Punjab, Haryana, Himachal Pradesh, and Uttar Pradesh. In the past, till 2007 all (except one) V. cholerae isolates confirmed at our center, including the isolates of the outbreaks, were sensitive to tetracycline. [5] In the present correspondence, we report the appearance of tetracycline resistance in V. cholerae O1 biotype El Tor serotype Ogawa isolated in this northern region of India. The observation has epidemiological and clinical importance as tetracycline has been the mainstay of antibiotic treatment for cholera. In India, tetracycline resistance has been reported in Inaba serotypes but sparsely reported in Ogawa serotypes. [2] However, the Inaba strains that emerged in our region in 2004 were sensitive to tetracycline. [6] A serotype switch has occurred again in our region with resultant Ogawa being resistant to tetracycline. This is the first report of tetracycline resistance in Ogawa isolates from north India.

An outbreak of cholera occurred in outskirts of Chandigarh in the month of August, 2008. A total of 207 patients were admitted in a local hospital with the presentation of acute watery diarrhea with moderate to severe dehydration. Some of the patients with severe dehydration were referred to our hospital. Out of 80 stool samples, received in the laboratory for the identification of causative agent, 42 samples were found to be positive for V. cholerae O1 biotype EL Tor serotype Ogawa. Antibiotic susceptibility testing was performed by Kirby-Bauer disc diffusion method using commercial antibiotic discs (Hi Media, Mumbai) against ampicillin (10 μg), tetracycline (30 μg), trimethoprim-sulfamethoxazole (1.25/23.75 μg), chloramphenicol (30 μg), nalidixic acid (30 μg), ciprofloxacin (5 μg), cefotaxime (30 μg), gentamicin (10 μg), amikacin (30 μg), and norfloxacin (10 μg). All the isolates were resistant to nalidixic acid and trimethoprim-sulfamethoxazole and sensitive to rest of the antibiotics except tetracycline (28/42, 66.7% resistant). Additionally, minimum inhibitory concentration of tetracycline was determined by agar dilution method as per standard protocol of CLSI, 2005. [7] 16.7% (7/42) and 33.3% (14/42) of the isolates were resistant (MIC ≥ 16 μg/mL) and sensitive (MIC ≥ 4 μg/mL) to tetracycline, respectively. Rest of the isolates (50.0%, 21/42) were found to be intermediately resistant (MIC 8 μg/mL), all of which were reported as resistant by Kirby-Bauer disc diffusion method (66.7%, 28/42).

It is important to note that tetracycline-resistant V. cholerae O1 Ogawa isolates are being reported from Madagascar, Bangladesh, Tanzania, Zaire, Latin America, and Southern and Eastern regions of India. [1],[2],[3],[4] The pattern of shift in antibiotic resistance indicates an enhanced mobility in genetic elements, which confer resistance to antibiotics. Tetracycline resistance in V. cholerae is largely known to be plasmid mediated and since vibrios do not stably carry plasmids, the resistance patterns fluctuate. Recently other genetic elements, such as a class I integron and SXT constin carrying tetracycline-resistance genes, tetG and tetA genes, respectively, have also been reported to be associated with the spread of genetic determinants of resistance to antimicrobial agents. [4],[8] Tetracycline/doxycycline were being used widely in our region in the management and chemoprophylaxis to household contacts during cholera outbreak in the year 2002, 2004, and 2006. The extensive use of tetracycline/doxycycline might have lead to the rapid emergence and spread of tetracycline-resistant isolates. The molecular mechanism of tetracycline resistance and its clonal origin are under study. In the previous studies published from our center, all V. cholerae isolates (except one) were sensitive to tetracycline. [5] Thus antibiotics should be judiciously used in the management of diarrheal diseases. Even in epidemics, we should restrict the use of antibiotics. It is important to closely monitor the spread of tetracycline resistance in our region as it has immense importance in terms of the management of cholera and the role of antibiotics in cholera should be reconsidered.

 
   References Top

1.Bradley Sack R, Rahman M, Yunus M, Khan EH. Antimicrobial Resistance in organisms causing diarrheal disease. Clin Infect Dis 1997;24:102-5.  Back to cited text no. 1
    
2.Roychowdhury A, Pan A, Dutta D, Mukhopadhyay AK, Ramamurthy T, Nandy RK, et al. Emergence of tetracycline-resistant Vibrio cholerae O1 serotype Inaba, in Kolkata, India. Jpn J Infect Dis 2008;61:128-9.  Back to cited text no. 2
[PUBMED]  [FULLTEXT]  
3.Jacques-Albert D, Olivat R A, Davidra R, Migliani R, Ranjalahy J, Mauclere P. Emergence and rapid spread of tetracycline-resistant Vibrio cholerae strains, Madagascar. Emerg Infect Dis 2002;8:336-8.  Back to cited text no. 3
    
4.Iwanaga M, Toma C, Miyazato T, Insisiengmay S, Nakasone N, Ehara M. Antibiotic resistance conferred by a class I integron and SXT constin in Vibrio cholerae O1 strains isolated in Laos. Antimicrob Agents Chemother 2004;48:2364-9.  Back to cited text no. 4
[PUBMED]  [FULLTEXT]  
5.Taneja N, Mohan B, Khurana S, Sharma M. Antimicrobial resistance in selected bacterial enteropathogens in north India. Indian J Med Res 2004;120:39-43.  Back to cited text no. 5
[PUBMED]    
6.Taneja N, Biswal M, Tarai B, Sharma M. Emergence of Vibrio cholerae biotype El Tor serotype Inaba in north India. Jpn J Infect Dis 2005;58:238-40.  Back to cited text no. 6
[PUBMED]  [FULLTEXT]  
7.Clinical and Laboratory Standards Institute. Performance Standards for Antimicrobial Susceptibility Testing: Fifteenth Informational Supplement M100-S15. CLSI, Wayne, PA, USA, 2005.  Back to cited text no. 7
    
8.Ceccarelli D, Salvia A M, Sami J, Cappuccinelli P, Colombo M M. New cluster of plasmid-located class 1 integrons in Vibrio cholerae O1 and a dfrA15 cassette-containing integron in Vibrio parahaemolyticus isolated in Angola. Antimicrob Agents Chemother 2006;50:2493-9.  Back to cited text no. 8
    

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Correspondence Address:
Neelam Taneja
Associate Professor, Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, Chandigarh, Pin 160012, Punjab
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.72014

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