Case report: Characterization and bioinformatics analysis of non-O1/O139 Vibrio cholerae strain isolated from a choledochoduodenal fistula patient with septicemia

The gram-negative bacterium <i>Vibrio cholerae</i> (VC) is divided into multiple serogroups, with groups O1 and O139 responsible for cholera. Conversely, <i>Vibrio cholerae</i> belonging to the non-O1/non-O139 group (NOVC) does not produce cholera-causing toxins. Insufficient understanding of the frequency of NOVC causes fear during the early detection phase. Acute gastroenteritis is often caused by NOVC, while extra gastrointestinal infections are less common. In the case described here, the patient had a postoperative choledochoduodenal fistula due to prior choledochotomy. In August 2023, he was hospitalized with fever and diarrhea. The gram-negative bacilli <i>Vibrio cholerae</i> was isolated from a blood specimen using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). The strain was identified as non-O1/O139 by serum agglutination tests. Subsequent whole-genome sequencing and database analysis revealed that the strain possessed resistance genes such as CRP, varG, almG, and QnrVC4, as well as various virulence factors such as RTX, hlyA, VAS, and T3SS. The phylogenetic tree analysis indicated that CQ23-0008VC had close relationship with <i>cholerae</i> strains isolated from aquatic environments. The patient was treated promptly and discharged after being admitted with severe symptoms. However, Bioinformatics analysis indicated that the virulence factors that were identified in the bacteria were significant; thus, these virulence factors can indicate to medical professionals that a patient could have a septicemia caused by NOVC.