VIBRIO CHOLERAE

A. Morphology
V. cholerae is a Gram negative, curved or comma-shaped rod, non-
sporing, non-capsulated, about 1.5 µm x 0.2-0.4 µm in size. Because of
its typical comma shaped appearance, it is also named Vibrio comma.
S shaped or spiral forms may be seen due to end to end attachment
of two or more cells.

B. Pathogenesis
V. cholerae causes an acute diarrhoeal disease known as cholera and it
occurs only in man. The human infection occurs by ingestion of
contaminated food and drinks. The ingested organisms pass through
the acid barrier of the stomach and multiply in the alkaline medium
of the small intestine. The vibrio’s do not penetrate deep into the gut
and there is no bacteraemia. Vibrios become adherent to the
epithelium by special fimbria such as the toxin co-regulated pilus
(TCP). Once epithelial cell attachment occurs, V. cholerae produces
enterotoxin and the disease.The massive loss of water and
electrolytes (sodium and bicarbonates) by action of enterotoxin,
leads to :

• dehydration causing haemoconcentration, anuria and hypovolaemic

shock
• base-deficit acidosis and

• muscle cramps due to hypokalaemia.

In untreated cases the mortality rate is 60- 70% due to renal failure.
Both the biotypes of V. cholerae O 1 produce equally severe
disease but in El Tor strains, the incidence of mild and asymptomatic
infections is more frequent.

C. Carrier State
• Convalescent Carrier -After treatment, few cases may continue to
excrete vibrios for 4 to 5 weeks due to survival of the bacilli in
gall bladder. These are known as convalescent carriers.

• Chronic Carrier -It is found in endemic areas and the vibrios are
excreted in faeces intermittently from the gall bladder. Chronic
carriers have been found in ElTor cholera and serve to
perpetuate inter-epidemic infections.

D. Culture
Cholerae is strongly aerobic, growth being scanty and slow
anaerobically. It grows within a temperature range of 16°-40°C but
optimum temperature is 37°C. It grows best in alkaline media, the
optimum pH being 8.2 (pH range 7.4-9 .6). The organism is extremely
sensitive to an acidic pH which kills it. V. cholerae is a non-halophilic
 vibrio, therefore, cannot grow in media with a concentration of sodium
chloride more than 7%. However it can grow in media without sodium
chloride.

• Ordinary Media

• Nutrient agar

• MacConkey's agar

• Blood agar

• Peptone water

• Gelatin stab culture

• Special Media-The special media are classified as follows:

• Transport or holding media

• Enrichment media

• Plating media

E. Toxins
Besides heat stable endotoxin, V cholerae also produces exotoxin
(enterotoxin). The enterotoxin is also named as cholera toxin (CT),
choleragen or cholera enterotoxin.

• Enterotoxin-It is a heat labile, protein in nature. It has a

molecular weight of 90,000. It has two fractions: one A (active)
subunit and five B (binding) subunits. The cholera toxin (CT)
resembles heat-labile toxin (LT) of Esch. coli chemically,
antigenically and in its mode of action. CT is more potent than
LT of Esch. coli.
 ESCHERICHIA COLI

The genus is named after Escherich who first isolated the bacillus under the
name Bacterium coli commune (1885). Esch.coli is the type species of the
genus Escherichia. Which is a parasite inhabiting only in the human or
animal intestine.

A. Morphology
Esch.coli is a gram negative bacillus measuring 1-3µm x 0.4-0.7µm. Most
strains are motile by peritrichate
flagella. It is non-sporing and non-capsulated.

B. Culture
It is an aerobe and facultative anaerobe and grows on ordinary culture
medium at optimum temperature of 37°C (temperature range 10--40°C) in
18- 24 hours. Colonies of some strains show beta haemolysis on blood agar.
On MacConkey's medium, colonies are pink due to lactose fermentation (LF
or lactose fermenter colonies).
In general, colonies are circular, moist, smooth with entire margin and non-
mucoid. In liquid medium, growth occurs as uniform turbidity.

C.Pathogenesis
Esch.coli forms a part of normal intestinal flora of man and animal. There
are four major types of clinical syndromes which are caused by Esch.coli:
• Urinary Tract Infection
• Pyogenic Infections
• Septicaemia.

• Urinary Tract Infection

Esch. coli is the commonest organism responsible for urinary tract infection
(UTI). Esch. coli that causes UTI often originates in the intestine of the
patient. Route of infection to reach urinary tract is either the ascending
route or the haematogenous route. The ascending route is through faecal
flora spreading to the perineum and from there they ascend into the
bladder.

• Pyogenic Infections
Esch. coli may cause wound infection, peritonitis, cholecystitis and neonatal
meningitis. It is an important cause of neonatal meningitis

• Septicaemia
Esch. coli is a very common cause of septicemia in many hospitals and leads
to fever, hypotension and disseminated intravascular coagulation
(endotoxic shock). This condition usually occurs in debilitated patients and
mortality is very high.

D.Toxins
Some strains of Esch. Coli produce enterotoxins, haemolysin and
Verocytotoxin.

• Enterotoxins
Enterotoxigenic strains of Esch. coli (ETEC) produce one or both of
two enterotoxins, a heat-labile toxin (LT) and a heat-stable toxin
(ST). Production of both LT and ST is plasmid (ent plasmid)
mediated.

• Haemolysin
Some strains of Esch. coli produce a haemolysin which can lyse
erythrocytes of some species. A larger proportion of Esch. coli
 recovered from extra-intestinal lesions of man are haemolytic than
those isolated from faeces.

• Verocytotoxin(VT)
It is also called Shiga like toxin (SLT). Biological, physical and
antigenic properties of VT are similar to Shiga toxin produced by
Sh.dysentriae type1.