LONDON Patients who have had Roux-en-Y gastric
bypass may be at higher risk for developing cholera when exposed to the
disease, according to a case report presented here.
The presence of gastric acid is a natural defense
against ingested infectious organisms, but the presence of gastric acid is low
in patients who have had Roux-en-Y gastric bypass, Tiffany Bias,
PharmD, of the Brooklyn Hospital Center told Infectious Disease
News. Previous studies have explored hypochlorhydria as a
predisposing factor to the acquisition of cholera.
The case study included a 34-year-old woman who had
previously had Roux-en-Y gastric bypass. She was admitted to the hospital for
abdominal pain and multiple episodes of diarrhea and emesis after recent travel
to Port-au-Prince, Haiti, for 4 days, according to the study abstract. The
patient also presented with dehydration, acute renal failure and electrolyte
imbalances. The electrolyte imbalances worsened during the hospital stay.
Metronidazole treatment was initiated, with no
improvement after 4 days. A stool white blood cell test was positive, and a
stool culture revealed Vibrio cholerae and Aeromonas hydrophila.
Blood cultures also revealed Escherichia coli and A. hydrophila.
These were successfully treated with ceftriaxone. Serotyping confirmed V.
cholerae serotype O1, which was treated with doxycycline. Treatment led to
a reduction in bowel movements, improvement of hydration and normalization of
electrolytes within 24 hours.
Normal fasting baseline gastric pH has been
reported as 0.3 to 0.9, Bias said. This patient had a confirmed
diagnosis of achlorhydria, as her baseline gastric pH was almost 6. We suspect
that overall reduction of gastric pH and intrinsic properties of the V.
cholerae isolate such as induction of [acid tolerance response] and
adaptability in mild acidic conditions may have increased survival of the
organism in our patient.
- Bias T. #P1590. Presented at: 22nd European Congress of Clinical
Microbiology and Infectious Diseases; March 31-April 3, 2012; London.
- Dr. Bias reports no relevant financial disclosures.