Non-O1, Non-O139 Vibrio cholerae Bacteremic Skin Infection with Multiple Skin Necrosis: Case Report

Non-O1, non-O139 <i>Vibrio cholerae</i> (NOVC) extraintestinal infections are rare, but recently, several clinical incidents have been reported worldwide. Toxigenic <i>V. cholerae</i> is a well-known etiological agent of cholera, responsible for acute dehydrating watery diarrhea. Outbreaks occur in an epidemic seasonal pattern, particularly in countries with poverty and poor sanitation. Strains of NOVC are usually not involved in causing the epidemic or pandemic outbreaks seen with potential strains of <i>V. cholerae</i> serogroup O1 and O139. However, they can still cause severe sporadic cases of intestinal as well as extraintestinal infections. In this study, we investigated a case of extraintestinal infections associated with the NOVC serogroup isolated from a deep closed wound abscess. The isolate was screened for the presence of three major virulence genes, <i>tox</i>R, <i>ctx</i>A, and <i>tcp</i>A. The strain tested positive for the <i>tox</i>R gene encoding the regulatory protein and cholera toxin (<i>ctx</i>) gene and tested negative for the toxin-coregulated pilus (TCP) gene, which is essential for the colonization of the human intestine, causing the severe diarrheal disease cholera. To the best of our knowledge, this is the first case of extraintestinal infection caused by toxigenic <i>Vibrio cholerae</i> non-O1/non-O139 in a hospitalized patient in Saudi Arabia.