Case Study (indicate your references used)

A 25-year-old man went to a long tour in India. After a 5-day period of severe diarrhea and
treatment, he gradually recovers and slowly returns to work. He is married 3 years later but after
a few years of trying to conceive a child, semen analysis reveals that his sperm are few in
number and malformed, and blood tests show a high titer of antibodies against sperm antigens.

1. What is the diagnosis of the patient? Indicate the causative agent and describe its
pathogenesis.

- The patient may have cholera, a water-borne infectious disease and is also known as
“blue death”. This is caused by intestinal infection with Vibrio cholerae, a gram-
negative bacterium and its causative agent. These bacteria can be acquired from
drinking or eating contaminated water and food and they are also commonly found in
the tropics particularly Africa, Asia, Latin America, Middle East, and India. Living in
or travelling to places where cholera is present only raises the risk of getting it. These
bacteria also produce toxin that causes higher amount of water to be released from
cells that line the intestines and then results to massive fluid loss via vomiting and
excessive diarrhea.

2. What cells are affected in the body by this agent?

- The target cells of this agent’s toxins are the Sertoli cells. These are supporting or
“nurse cells” of the testicles that play a role in the process of spermatogenesis or the
production of sperm and extend from basal lamina to the free surface of the
epithelium. Epithelial cells in the intestine can also be affected by interfering with the
cells signalling pathway resulting to the overactivation of the signalling pathway.s

3. Explain what causes formation of antibodies against sperm antigens.

- The antibodies that fight against sperm antigens are called antisperm antibodies.
Testicles normally keep the sperms away from the immune system and and the rest of
the body. These sperm antibodies can be made by man when there’s a contact
between his sperm and his immune system. This can occur when the testicles are
injured or even after a surgery such as vasectomy. The immune system mistakenly
targets the sperms in the semen as invaders and damages or kills them. And if there’s
too much of sperm antibodies come into contact with the sperm, it will be hard to the
sperm to fertilize an egg.
References:

Ana A. Weil, Jason B. Harris, in Molecular Medical Microbiology (Second Edition), 2015

Bronson R, Cooper G, Rosenfeld D. Sperm antibodies: Their role in infertility. Fertility and
Sterility 1984; 42 (2): 171-183

Matthew K. Waldor, Edward T. Ryan, in Mandell, Douglas, and Bennet’s Principles and
Practicce of Infectious Diseases (Eight Edition), 2015

S. Mandal, M. Mandal, Encyclopedia of Food Microbiology (Second Edtion), 2014