A 64-year-old male patient from Salta, Argentina, was admitted to La Plata city in the last 15 years.
He did not refer travel to his hometown.
History of chronic alcoholism, var cirrhosis esophageal grade II and hepatic.
She was hospitalized for a 24-hour period with dizziness, vomiting, dyspnea functional class II and diffuse, moderate, continuous and non-irradiated abdominal pain.
On admission, the patient was in regular general condition, P.A. 95/60 mmHg, F.C. 80 beats/min, F.R. 18 cycles/min, T° 38°C, without generalized inguinal paralysis and jugular venous collapse.
Pulmonary examination revealed biphasic discharges, abdomen was painful at deep fixation on the left flank and iliac fossa, with greater percutory patency 5 cm and upper limb edema 5 cm, upper limb edema, upper limb edema 5 cm.
Neurological examination revealed a "stretching" tremor.
Creatinine test: hematocrit 37%; leucocytes 16.900/mm3 (neutrophils 80%); platelets 159.000/mm3; blood glucose Child g/l; uremia 0.4 g/l; albumin-HBc 1.24
Abdominal ultrasound showed ascites, decreased liver size with lobulated contours, heterogeneous echogenicity and thinning of the suprahepatic veins, findings consistent with diffuse liver cirrhosis.
Diagnostic paracentesis was performed, whose cytochemical examination showed: leukocytes: 28,300 cells/mm3 (neutrophils 97%, lymphocytes 3%); erythrocytes: 9,800 cells/mm3, glucose 19.7 g.
Cefuroxime 2 g every 8 h iv was indicated as empirical treatment for SBP.
Gram stain of ascitic fluid and two pairs of hemocultives showed gram-negative bacilli.
Dissemination antimicrobial susceptibility was evaluated, and it was sensitive to 3rd generation cephaloporins, ciprofloxacin and tetrasensitized.
The strain was typified as V. cholerae by traditional tests.
The evaluation of serogroup and the presence of pathogenicity factors was performed at the Institute of Microbiology Dr. Carlos G.brán, Ciudad de la Ciudad de la Ciudad de la Malbiología, Buenos Aires, Argentina (No.
The genes encoding for the following virulence factors were identified by PCR: CT (choledic toxin) negative; TCP (colonization factor or toxin co-regulated pilus) negative; TTE (toxin).
The patient was admitted favorably, with no fever or abdominal pain and decreased peripheral edema.
After 48 h, control paracentesis was performed without obtaining ascitic fluid.
He completed 14 days of treatment with cefoxime iv and was discharged.
It was not possible by means of the directed anamnesis to establish the place where the patient acquired V. cholerae, nor were there somatic cases detected in the family environment or in his community.
It is also worth noting that religious beliefs occur in an urban environment without contact with water tanks or courses.
