Hybrid Vibrio cholerae El Tor lacking SXT identified as the cause of a cholera outbreak in the Philippines.

UNLABELLED: Cholera continues to be a global threat, with high rates of morbidity and mortality. In 2011, a cholera outbreak occurred in Palawan, Philippines, affecting more than 500 people, and 20 individuals died. Vibrio cholerae O1 was confirmed as the etiological agent. Source attribution is critical in cholera outbreaks for proper management of the disease, as well as to control spread. In this study, three V. cholerae O1 isolates from a Philippines cholera outbreak were sequenced and their genomes analyzed to determine phylogenetic relatedness to V. cholerae O1 isolates from recent outbreaks of cholera elsewhere. The Philippines V. cholerae O1 isolates were determined to be V. cholerae O1 hybrid El Tor belonging to the seventh-pandemic clade. They clustered tightly, forming a monophyletic clade closely related to V. cholerae O1 hybrid El Tor from Asia and Africa. The isolates possess a unique multilocus variable-number tandem repeat analysis (MLVA) genotype (12-7-9-18-25 and 12-7-10-14-21) and lack SXT. In addition, they possess a novel 15-kb genomic island (GI-119) containing a predicted type I restriction-modification system. The CTXΦ-RS1 array of the Philippines isolates was similar to that of V. cholerae O1 MG116926, a hybrid El Tor strain isolated in Bangladesh in 1991. Overall, the data indicate that the Philippines V. cholerae O1 isolates are unique, differing from recent V. cholerae O1 isolates from Asia, Africa, and Haiti. Furthermore, the results of this study support the hypothesis that the Philippines isolates of V. cholerae O1 are indigenous and exist locally in the aquatic ecosystem of the Philippines. IMPORTANCE: Genetic characterization and phylogenomics analysis of outbreak strains have proven to be critical for probing clonal relatedness to strains isolated in different geographical regions and over time. Recently, extensive genetic analyses of V. cholerae O1 strains isolated in different countries have been done. However, genome sequences of V. cholerae O1 isolates from the Philippines have not been available for epidemiological investigation. In this study, molecular typing and phylogenetic analysis of Vibrio cholerae isolated from both clinical and environmental samples in 2011 confirmed unique genetic features of the Philippines isolates, which are helpful to understand the global epidemiology of cholera.

Desaparición tumoral tras tratamiento médico primario en la acromegalia / Tumoral disappearance after primary medical treatment in acromegaly

La acromegalia es una enfermedad de evolución insidiosa y poco común, causada por la hipersecreción crónica de somatotropina (GH). La cirugía transesfenoidal es el tratamiento de elección para la mayoría de los pacientes con acromegalia. Sin embargo, el tratamiento médico primario con análogos de la somatostatina puede ser una opción en pacientes con macroadenomas que no se puede resecar completamente y no causan síntomas compresivos. Así, varios estudios han mostrado que el tratamiento primario con análogos de la somatostatina controla las concentraciones de GH y el factor de crecimiento similar a la insulina (IGF) I y reduce el tamaño tumoral en un porcentaje de pacientes significativo. Presentamos a un paciente con acromegalia tratado de forma primaria medicamente; inicialmente no responde a un análogo de la somatostatina, pero después prácticamente desaparece el adenoma hipofisario con lanreotida autogel (AU)

Acromegaly is an insidious and uncommon disorder caused by chronic growth hormone hypersecretion. Transsphenoidal surgery is the treatment of choice in most patients with acromegaly. However, primary medical treatment with somatostatin analogs can be offered to patients with macroadenomas that cannot be completely resected and do not cause compression symptoms. Several studies have shown that primary medical therapy with somatostatin analogs controls growth hormone and insulin-like growth factor-I levels and decreases tumor volume in a significant percentage of patients. We report the case of a patient with acromegaly who received primary medical treatment with a somatostatin analog without response. The treatment was changed to lanreotide autogel, producing disappearance of the pituitary adenoma (AU)