Zusammenfassung
Vibrio cholerae non-O1/non-O139 können weltweit verbreitet sowohl im Süßwasser als auch im Brackwasser angetroffen werden. Besonders in der warmen Jahreszeit können sie sich zu Konzentrationen vermehren, die für das Zustandekommen von Infektionen relevant sind. In den Jahren 2000 bis 2005 wurden in Österreich 13 Infektionen mit non-O1/non-O139 Vibrio cholerae dokumentiert. Zwölf Patienten (im Alter von 8 bis 65 Jahren; 7 männlich) erkrankten manifest: Durchfall × 5, Otitis × 6, Sepsis × 1. Alle 5 Patienten, deren Infektionen auf Auslandsaufenthalte zurückgeführt werden konnten, hatten Diarrhoe. Die 8 Personen ohne Auslandsanamnese hatten Otitis media (n = 4), Otitis externa (n = 2), Sepsis (n = 1) und einmal einen asymptomatischen Verlauf. Die tödlich verlaufende Sepsis betraf einen Fischer vom Neusiedler See eine Woche nach Abschluss einer Chemotherapie (Plasmozytom). Detaillierte Reiseanamnesen innerhalb Österreichs waren für 5 der 8 Personen erhältlich: für alle Fünf waren Aufenthalte am Neusiedler See belegbar. Warum sich die im Inland erworbenen Infektionen vorwiegend als Otitis und nicht als Diarrhoe manifestieren ist unklar. Wir nehmen an, dass Durchfallerkrankungen durch non-O1/non-O139 Vibrio cholerae in Österreich aufgrund der Vorgehensweisen in mikrobiologischen Laboren nicht erkannt werden. Eine bakteriologische Untersuchung auf Vibrio cholerae erfolgt in Regelfall nur bei entsprechender Auslandsanamnese.
Summary
From 2000 to 2005, 13 infections due to non-O1/non-O139 Vibrio cholerae were documented in Austria. Twelve patients (8 years to 65 years old; 7 male) had symptomatic infections: diarrhea × 5, otitis × 6, septicemia once. All 5 patients who acquired their infections abroad, suffered from diarrhea. The 8 persons without travel history outside of Austria had otitis media (n = 4) or otitis externa (n = 2); the lethal case of septicemia affected a fisherman with underlying malignancy. One isolate was from an asymptomatic child. Detailed data on travel history inside Austria was available for 5 of these 8 patients: all 5 had visited or lived near Austria's largest lake. The concentration of salt in this westernmost steppe lake in Europe is approximately one-twentieth of that of sea water. Why otitis and not diarrhea is the dominating manifestation of non-O1/non-O139 infection acquired in Austria remains to be elucidated. We hypothesize that diarrhea due to Vibrio cholerae serogroups other than O1 and O139 acquired in Austria may simply be unrecognized by the standard operating procedures employed in clinical microbiology laboratories. Testing for Vibrio cholerae is not considered necessary for domestically acquired diarrhea. Only in patients who acquired diarrhea abroad, do physicians sometimes consider cholera as a differential diagnosis, thereby prompting the laboratory to use thiosulfate citrate bile salt sucrose (TCBS) agar plates.
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Huhulescu, S., Indra, A., Feierl, G. et al. Occurrence of Vibrio cholerae serogroups other than O1 and O139 in Austria. Wien Klin Wochenschr 119, 235–241 (2007). https://doi.org/10.1007/s00508-006-0747-2
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DOI: https://doi.org/10.1007/s00508-006-0747-2