# One Swallow Does Not Make a Summer: A Confirmed Case of Imported Vibrio cholerae After Clostridioides difficile Diagnosis in Brescia, Northern Italy

## TL;DR

A man returning to Italy from Africa was diagnosed with both Clostridioides difficile and Vibrio cholerae, highlighting the need to consider cholera in travelers with severe diarrhea.

## Contribution

This case emphasizes the importance of considering cholera in travelers with diarrheal illness, even when another pathogen is initially identified.

## Key findings

- A 49-year-old Nigerian man had Vibrio cholerae and Clostridioides difficile coinfection after returning from Africa.
- The patient developed acute kidney injury and required ICU care with fluid resuscitation and antibiotics.
- No additional cholera cases were found in surveillance of the patient and contacts.

## Abstract

Vibrio cholerae, the aetiological agent of cholera, is predominantly an imported pathogen in high‐income countries. We report a case of a 49‐year‐old Nigerian male returning from Africa with abdominal pain and watery diarrhea, who rapidly developed acute kidney injury. The initial diagnosis was Clostridioides difficile enteritis, based on GDH antigen and toxin detection in stool samples. Microbiological cultures subsequently revealed concomitant growth of Vibrio cholerae. The patient required intensive care unit management, including aggressive fluid resuscitation and antimicrobial treatment with doxycycline and vancomycin. Surveillance cultures were performed on both patients and patients’ contacts; no additional cholera cases were detected during follow‐up. This case highlights the importance of considering cholera in patients presenting with diarrheal syndromes after returning from endemic regions, even when another, more common pathogen in high‐income countries has already been identified. Coinfection may worsen clinical outcomes and has significant implications for both therapeutic decisions and infection control measures.