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Value of the syndromic approach for the diagnosis of an imported case of cholera.

A 70-year-old woman with no relevant medical history presented banal clinical signs of infectious gastroenteritis on her return from a trip to the Republic of the Union of Myanmar. The appearance of her stools and clinical findings were not suggestive of a typical case of cholera, but Vibrio cholerae was nevertheless isolated from her stools in the laboratory. The National reference center (NRC) for vibrios and cholera identified a Vibrio cholerae serogroup O1 (serotype Inaba) strain. The health authorities were notified of an imported case of cholera, identified on the basis of clinical, biological and epidemiological data. The diagnostic strategy used in the laboratory was based on a two-step algorithm involving molecular biological screening followed by culture on selective media for species identification. It was this approach, benefiting from the complementarity of the different techniques, that made it possible to reach a reliable rapid biological diagnosis of this atypical, but frequent form of the disease. The diagnosis of imported cases is of the utmost importance, because the mandatory signaling and notification of cases trigger investigations to check for additional cases among other exposed individuals or contacts of the patient, even though the risk of secondary transmission appears to be low in France. It also supplies data to international surveillance networks for cholera, which remains a serious disease and a major problem globally. This case highlights the importance of interactions between the various biological personnel and clinicians.