An outbreak of acute diarrhoea occurred in the Belgundi area (population 3896) of Belgaum Taluka (population 815 581) in Karnataka, South India, in June 2010. An estimated 16.22 % of people were affected and 0.16 % deaths were reported. Vibrio cholerae O1 El Tor was isolated from 18 of the 147 stool samples cultured. Seven out of eight drinking water samples collected from different sources were found to be grossly contaminated with faecal coliforms. All isolates were multidrug resistant, with some showing resistance to quinolones, gentamicin and cephalosporins in addition to co-trimoxazole and tetracycline, the drugs that were being used by the state health authorities for empirical treatment. Two serotypes and at least eight genotypes of V. cholerae were observed among the isolates. Cholera was confirmed as one, if not the only, cause of the outbreak, which, to our belief, is the first report of cholera from this region. It might have occurred due to a ‘flare up’ in the number of endemic strains triggered by shortage of portable water, onset of monsoon rains and breakdown of sanitation systems, rather than being a de novo outbreak arising out of new exogenous infectious sources. A change in the empirical treatment, coupled with chlorination, improvement in sanitation measures and extensive Information Education Communication activities, resulted in decline of the outbreak and prevention of further deaths.
AkondM. A., AlamS., HasanS. M. R., UddinS. N., ShirinM.2008; Antibiotic resistance of Vibrio cholerae from poultry sources of Dhaka, Bangladesh. Advan Biol Res 2:60–67
BauerA. W., KirbyW. M., SherrisJ. C., TurckM.1966; Antibiotic susceptibility testing by a standardized single disk method. Am J Clin Pathol 45:493–496[PubMed]
BhattacharyaD., BhattacharjeeH., RamanathanT., SudharmaS. D., SinghaniaM., SugunanA. P., RoyS.2011; Third-generation cephalosporin resistance in clinical isolate of Shigella sonnei in Andaman & Nicobar Islands, India. J Infect Dev Ctries 5:674–676[PubMed]
BhattacharyaD., SayiD. S., ThamizhmaniR., BhattacharjeeH., BharadwajA. P., RoyA., SugunanA. P.2012; Emergence of multidrug-resistant Vibrio cholerae O1 Biotype El Tor in Port Blair, India. Am J Trop Med Hyg 86:1015–1017 [View Article][PubMed]
CLSI2007Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard M2-A10 Wayne, PA: Clinical and Laboratory Standards Institute;
ColwellR. R., HuqA., ChowdhuryM. A. R., BraytonP. R., XuB.1995; Serogroup conversion of Vibrio cholerae. Can J Microbiol 41:946–950 [View Article][PubMed]
FieldsP. I., PopovicT., WachsmuthK., OlsvikO.1992; Use of polymerase chain reaction for detection of toxigenic Vibrio cholerae O1 strains from the Latin American cholera epidemic. J Clin Microbiol 30:2118–2121[PubMed]
GargP., NandyR. K., ChaudhuryP., ChowdhuryN. R., DeK., RamamurthyT., YamasakiS., BhattacharyaS. K., TakedaY., NairG. B.2000; Emergence of Vibrio cholerae O1 biotype El Tor serotype Inaba from the prevailing O1 Ogawa serotype strains in India. J Clin Microbiol 38:4249–4253[PubMed]
GoelA. K., JainM., KumarP., SargunaP., BaiM., GhoshN., GopalanN.2011; Molecular characterization reveals involvement of altered El Tor biotype Vibrio cholerae O1 strains in cholera outbreak at Hyderabad, India. J Microbiol 49:280–284 [View Article][PubMed]
HoshinoK., YamasakiS., MukhopadhyayA. K., ChakrabortyS., BasuA., BhattacharyaS. K., NairG. B., ShimadaT., TakedaY.1998; Development and evaluation of a multiplex PCR assay for rapid detection of toxigenic Vibrio cholerae O1 and O139. FEMS Immunol Med Microbiol 20:201–207 [View Article][PubMed]
JainM., GoelA. K., BhattacharyaP., GhatoleM., KambojD. V.2011; Multidrug resistant Vibrio cholerae O1 El Tor carrying classical ctxB allele involved in a cholera outbreak in South Western India. Acta Trop 117:152–156 [View Article][PubMed]
KanungoS., SahB. K., LopezA. L., SungJ. S., PaisleyA. M., SurD., ClemensJ. D., NairG. B.2010; Cholera in India: an analysis of reports, 1997-2006. Bull World Health Organ 88:185–191 [View Article][PubMed]
ManningP. A., StroeherU. H., MoronaR.1994; Molecular basis for O-antigen biosynthesis in Vibrio cholerae O1: Ogawa-Inaba switching. In Vibrio cholerae and Cholera: Molecular to Global Perspectives pp. 77–94 Edited by WachsmuthK., BlakeP. A., OlsvikO. Washington, DC: American Society for Microbiology;
MishraM., MohammedF., AkulwarS. L., KatkarV. J., TankhiwaleN. S., PowarR. M.2004; Re-emergence of El Tor vibrio in outbreak of cholera in & around Nagpur. Indian J Med Res 120:478–480[PubMed]
OrlandiP. P., MagalhãesG. F., MatosN. B., SilvaT., PenattiM., NogueiraP. A., SilvaL. H.2006; Etiology of diarrheal infections in children of Porto Velho (Rondonia, Western Amazon region, Brazil). Braz J Med Biol Res 39:507–517 [View Article][PubMed]
RoyS., DuttaB., GhoshA. R., SugunanA. P., NandyR. K., BhattacharyaS. K., SehgalS. C.2005; Molecular tracking of the lineage of strains of Vibrio cholerae O1 biotype El Tor associated with a cholera outbreak in Andaman and Nicobar Islands, India. Trop Med Int Health 10:604–611 [View Article][PubMed]
SugunanA. P., RoyS., MurhekarM. V., NaikT. N., SehgalS. C.2007; Outbreak of rotaviral diarrhoea in a relief camp for tsunami victims at Car Nicobar Island, India. J Public Health (Oxf) 29:449–450 [View Article][PubMed]
SunL., KleinE. Y., LaxminarayanR.2012; Seasonality and temporal correlation between community antibiotic use and resistance in the United States. Clin Infect Dis 55:687–694 [View Article][PubMed]