A Cluster of Vibrio cholerae O1 Infections in French Travelers to Rajasthan (India), May 2006
Résumé
The index case was a female patient aged 60 years. She had a history of ischemic stroke in 2004 (no subsisting defi cit) and convulsive seizures in 2005. She was receiving long-term treatment by acetylsalicylic acid and valproate and did not receive antacids. The patient and her husband participated in a tour to Rajasthan with a group of 25 other persons (12 other couples + 1 solo traveler) in May 2006. All came from Saint-Brieuc, a city of 47,000 inhabitants in Brittany (France). The group left Saint-Brieuc on May 14, 2006, and took off from Paris the following day, arriving in Delhi, India on the evening of May 15. The patient presented the fi rst signs on May 18, on her third day in India: vomiting and fi ve to six stools per day. The stools were mixed neither with blood nor with mucus. She self-treated with loperamide and metronidazole. The group returned on May 24, 2006, by direct fl ight from Delhi to Paris. The patient had no diarrhea and no vomiting during the fl ight to Paris or the ensuing bus trip to Saint-Brieuc. The patient consulted her family physician who referred her to the emergency room at Saint-Brieuc, a secondary care hospital, on the evening of May 25. She presented very liquid stools and vomiting with no abdominal pain. Her temperature was normal. There was marked dehydration with a loss of 6 kg compared to her usual weight. Her arterial blood pressure was 105/60 mm Hg, and pulse rate was 90 bpm. Her blood chemistry showed hypokalemia (1.6 mmol/L) and dehydration (urea = 19 mmol/L, serum creatinine = 99 mol/L, blood protein = 95 g/L, and C-reactive protein <4 mg/ml). The patient was admitted to the cardiology intensive care unit on May 25 (single room) and was transferred the following day to the reanimation ward (single room). The attending physician there BRIEF COMMUNICATIONS