Perineal arterial compression has been demonstrated in long distance cyclists; 5 our patient was a frequent bike rider. However, the relationship between bike riding and FG has not been established as a risk factor, so far. We speculate that repeated trauma to the perineum with an HIV-positive immu- nocompromised status could have been factors provoking a local trauma that led to a fatal infection. Conflict of interest: No conflict of interest to declare. References 1. Roca B, Cunat E, Simon E. HIV infection presenting with Fournier’s gangrene. Neth J Med 1998;53:168—71. 2. Ayumba BR, Magoha GA. Epidemiological aspects of Fournier’s gangrene at Kenyatta National Hospital. Nairobi East Afr Med J 1998;75:586—9. 3. Yeniyol CO, Suelozgen T, Arslan M, Ayder AR. Fournier’s gangrene: experience with 25 patients and use of Fournier’s gangrene severity index score. Urology 2004;64:218—22. 4. Elem B, Ranjan P. Impact of immunodeficiency virus (HIV) on Fournier’s gangrene: observations in Zambia. Ann R Coll Surg Engl 1995;77:283—6. 5. Sommer F, Konig D, Graft C, Schwarzer U, Bertram C, Klotz T, et al. Impotence and genital numbness in cyclists. Int J Sports Med 2001;22:410—3. B. Chazan* ,a,b Y. Chen a R. Raz a a Infectious Disease Unit, Ha’Emek Medical Center, Afula, Israel b Family Medicine Department, Northern Branch of Ben-Gurion University, Ha’Emek Medical Center, Afula, Israel D. Kopelman Surgery B Ward, Ha’Emek Medical Center, Afula, Israel Z. Katz Urology Ward, Ha’Emek Medical Center, Afula, Israel D. Kniznik Intensive Care Unit, Ha’Emek Medical Center, Afula, Israel R. Colodner Microbiologic Laboratory, Ha’Emek Medical Center, Afula, Israel R. Raz Rappapot School of Medicine, Technion, Haifa, Israel *Corresponding author. Tel.: +972 4 6494259; fax: +972 4 6494470 E-mail address: chazan_b@clalit.org.il (B. Chazan) Corresponding Editor: Salim S. Abdool Karim, Durban, South Africa 27 October 2005 doi:10.1016/j.ijid.2006.02.007 The first outbreak of acute diarrhea due to a pandemic strain of Vibrio parahaemolyticus O3:K6 in Kolkata, India Since 1996, infections caused by Vibrio parahaemolyticus have increased globally. Outbreak and/or sporadic cases of diarrhea caused by V. parahaemolyticus have been reported from India, Indonesia, Japan, Taiwan, the USA, Laos, Korea, Chile, Ban- gladesh, Russia, Thailand, Spain, France, and Vietnam. This increase in incidence appears to be related to the emergence of a new clone belonging to the O3:K6 serovar, which has pandemic potential. Due to its spread in many countries with identical phenotypic and genotypic features, the recently emerged V. parahaemolyticus has now been termed a ‘pan- demic strain’, which can be identified by group-specific GS- PCR based on the sequence variation in the toxRS gene. 1 In addition, the pandemic strains have a novel open reading frame orf8, which corresponds to a filamentous phage f237. 2 On September 14, 2003, an outbreak of diarrhea occurred near Dumdum in Kolkata, India. About 200 people had diar- rhea after consumption of rice with meat served at the blood donation camp. Twenty-one patients were admitted to the Infectious Diseases Hospital (IDH), Kolkata from this out- break-affected area. Stool specimens were collected from all the patients and screened for common enteric pathogens within two hours of collection, using standard methods. 3 In addition, 3—5 Escherichia coli colonies grown in MacConkey agar from each stool specimen were screened for diarrhea- genic E. coli (DEC) by PCR. 4 In this assay, all the tested E. coli isolates were negative for common DEC such as enterotoxi- genic E. coli, enteropathogenic E. coli, and enteroaggrega- tive E. coli. V. parahaemolyticus was isolated from five patients (24%) and no other pathogens were detected in the other 16 patients. All the patients had acute diarrhea with watery stool and showed moderate-to-severe dehydration. The five V. parahaemolyticus strains were serotyped as O3:K6 using commercial antisera (Denka Seiken Corp., Tokyo, Japan). A PCR assay was performed to determine the species- specific toxR of V. parahaemolyticus 5 and tdh and trh viru- lence genes. 6 The GS and orf8 PCRs were also performed using published methods 1,2 in an automated thermocycler (Model 9700, Applied Biosystems, CA, USA). All five V. para- haemolyticus strains were positive in toxR, tdh, orf8, and GS- PCR assays. To confirm the clonal relationship, V. parahaemolyticus O3:K6 strains isolated before 1996 (AQ4037), during 1996 (KXV224), and in 2003 before the Kolkata outbreak (SC84 and SC179) were included in the pulsed-field gel electrophoresis (PFGE) along with the outbreak strains following the methods described previously. 7 NotI (Takara Shuzo, Tokyo, Japan) Letters to the Editor 185