Cholera is a prototype of toxigenic diarrhea. The epidemiology of cholera took a dramatic turn in the later months of 1992, V. cholerae 0139 strain emerged in Madras (Chennai), which then spread far and wide(1). The present study was conduced to elucidate the type of cholera organism prevalent and its antibiotic sensitivity pattern in east Delhi.

Study period was July 2001 -Nov 2002, in pediatric emergency of G.T.B. hospital and University College of Medical Sciences, Delhi. All the patients satisfying the criteria were studied.

Inclusion criteria: All pediatric patients admitted with acute onset, profuse, rice water like diarrhea of less than 24 hrs duration(2).

Exclusion criteria: Dysentery, mucoid diarrhea and history of receiving any antibiotic drug 48 hours prior to admission. Stool samples were immediately transported in bile alkaline peptone water and processed. Hanging drop/dark ground microscopy was done to look for the motility. The stool samples were cultured using macConkey agar, Deoxycholate citrate agar (DCA), and Thiosulphate citrate bile salt sucrose agar. Plates were incubated at 37ºC for 24 hours.

Information about age, sex, caste, place of residence, socio economic status and source of water supply was taken from parents/guardians of all patients. Susceptibility pattern of all the isolates were tested for the following antibiotics: chloramphenicol, gentamicin, cotrimoxazole, cefotaxime, furazolidine and ciprofloxacin(3).

Out of total 1324 stool samples, 133 children (10%) grew Vibrio cholerae. Out of these 133,70 were boys and 63 girls; 125 (94%) grew 01 Ogawa, one grew 0139 (0.8%) and 7(5.2%) were non 01-non 0139. Hanging drop was positive in 59 cases only. Maximum number of cases were from the local areas, during June to October months i.e., 15, 30, 20, 16 and 12 children respectively. Distribution of parents were in <1, 1-5, 5-10 and 10-12 years of age i.e., 13, 66, 37 and 17 respectively. 01 Ogawa was sensitive to chloramphenicol, gentamicin, cefotaxime and ciprofloxacin, but showed resistance to cotrimoxozole and furazolidine. Non 01- Non 0139 were also sensitive to the above anti-biotics except furazolidine and cotrimoxazole (moderately). Furazolidine and cotrimoxazole resistance in V. cholerae was seen in this study. This report addresses the fact that proper monitoring of usage of antibiotics is essential. Similar finding of growing antibiotic resistance was found by Avasthi, et al.(5).

The sudden emergence of V. cholerae 0139 on late 1992 and its quick dissemination in many countries was initially considered as the beginning of 8th pandemic of cholera. It was also thought that it might replace V. cholerae 01 Eltor, as the latter had replaced V. cholerae 01 classical in, 1960s. However, V. cholerae 01 biotype remained firmly established in Delhi during and after the emergency of V. cholerae 0139 strain(4). Why V. cholerae 0139 has not been able to replace V. cholerae 01 biotype, or has it lost its epidemic potential is still not clear.

Shalu Gupta,
M.M.A. Faridi,
Department of Pediatrics,
G.T.B. Hospital, New Delhi, India.
Correspondence to:
Dr. Shalu Gupta,
42,Maitri Apartments,
Plot No. 5, Mayur Vihar,
New Delhi 110 091, India.

1. Nair GB, Bhattacharya SK, Deb BC Vibrio cholerae 0139 Bengal: The eighth pandemic strain of cholera. Indian J Pub Health, 1994: 38: 33:36.

2. Task force on Diarrheal Disease. Guidelines for management of diarrhea in children. Indian Academic of Pediatrics, New Delhi, 2000.

3. Bauer AW, Kirby WMM. Antibiotic suscep-tibility testing by a standardized. Single method Am J Clin Path, 1996; 45: 493-496.

4. Singh J, Sachdeva V, Bhatia R. Endemic cholera in Delhi, 1995. Analysis of data from a sentinel centre. J Diarrheal Dis Res 1996; 15: 105-107.

5. Chinna RS, Kaushal V, Ram S, Awasthi G. Profile, clinical features and sensitivity pattern of cholera in Ludhiana (Punjab). J Indian Acad of Clin Med 1999; 1: l-5.