CYP27A1 and infection: However, the strain harbored the El-Tor variant of hlyA, vscV2, vspD, and rtxA. Although the expression levels of the virulence genes were not quantified, these factors may contribute to the strain’s ability to cause invasive disease even in the absence of ctx. This case supports emerging evidence that the pathogenicity of NOVC strains can be mediated by a diverse repertoire of virulence determinants and emphasizes the need for further genomic and functional studies to better understand the mechanisms underlying severe infections caused by these strains.