Cholera el tor Increased cAMP

• Asiatic Cholera / Epidemic Cholera  activates a secretory mechanism which:

o blocks Na+ absorption
Vibrio cholerae has 2 biotypes (on the basis of o promotes excretion of water and
several phenotypic characteristics) chlorides.
a. Classic  This mechanism is the prototype for all
b. El tor biotype toxigenic diarrheas.
 The toxin acts through an intact epithelium
Cholera vibrios are: on the vasculature of the bowel, with
 facultative anaerobes. resultant outpouring of intestinal fluids.
 The optimum growth temp is 37oC
 growth is arrested below 14oC and above Cholera red test / Nitroso – indole rxn:
42oC.
 grow rapidly on alkaline media at pH 6 – 9 .
In peptone  Releases
Test to differentiate the two biotypes: medium with tryptophanase indole group
tryptophan  Reduces
1. Direct Hemagglutination test NO3
Classic (-) ; El tor (+) agglutinates sheep RBC
chicken red cells
nitrosoreductase
2. Sensitivity to Polymyxin B
Classic (+) sensitive; El tor (-) resistant
cholera red • NO2
3. Hemolysis test Upon addition
Classic (-) ; El tor (+) hemolytic/hemolysis on  red color of
nitrosoindole of H2SO4
blood agar
is visible
4. Sensitivity to Cholera Phage IV (Murkerjee)
Classic (+) sensitive; El tor (-) resistant
Oxidase test:
5. Voges Proskauer  dark purple color on the paper within 10 sec
Classic (-) ; El tor : purple & pink color
Mucoid test / String test:
Serotypes due to minor difference in “O”  Suspend an 18 to 24 hr growth from:
antigen o MEA (Meat Extract Agar)
1. Inaba or original type : antigen A, C o GA (Gelatin Agar); or
2. Ogawa or variant type: antigen A, B o TTGA (Taurocholate Tellurite
3. Hikojima or middle type: antigen A, B,C Gelatin Agar); or
o Kleiger’s Iron Agar slant
The 1st two are distinct from one another and the
last is related to both types.  .. in a drop of 0.5% aq. soln. of sodium
desoxycholate on a slide.
Infective dose: 102 – 103
If positive (+)
Pathogenicity: 1. the suspension immediately loses turbidity
 enterotoxin – choleragen: binds to a 2. becomes mucoid (as with all vibrios)
receptor and a surface of cell & activates 3. A mucoid “string” forms when the loop is
intracellular adenylate cyclase to convert drawn slowly away from the suspension.
ATP into cyclic adenosine monophosphate
(cAMP) Cause of Death (COD):
 hypovolemic shock
 uncompensated metabolic acidosis
 renal failure
Clinical symptoms in cholera:
1. aphonia Vibrio cholerae can be detected directly by
a. voice is high pitched and inaudible • Dark field microscopy
2. sunken eyes • on a wet mount of a fresh stool
3. wrinkled skin • its serotype can be discerned by
4. muscle cramps immobilization with Inaba or Ogawa
5. metabolic acidosis specific anti-serum
a. which starts from:
i. diarrhea - rice watery stool rich • Best selective medium: TCBS agar
in H2O, HCO3 & glucose. • Organism grows as a typical opaque
rice watery stools contains 109vibrios/mL yellow colonies.

acidosis – results due to loss of large volumes of
bicarbonate rich stools.
hypokalemia - due to continuous potassium loss
muscle cramps mostly located in the
fingers, toes & lower extremities.
If a delay in sample processing is expected:
• Carey – Blair transport medium; and/or
• alkaline-peptone-water-enrichment medium
o should be inoculated as well.

Stool smears stained by fuchsin solution when

All signs, symptoms & metabolic derangements examined microscopically occur in groups similar to
in cholera result from the.. “shoals of fish”.
 loss of isotonic, watery stools rich in
electrolytes such as Na+,Cl-,HCO3 & K+ Adequacy of hydration is confirmed by frequent
from the gut. clinical evaluation:
These losses result from the a. Pulse rate and strength
 hypersecretion of the isotonic electrolyte b. Skin turgor
solution by an intact small bowel mucosa. c. Urine output
It is caused by
 a heat labile enterotoxin known as Over-hydration:
choleragen. • observation of neck veins
• auscultation of lungs

dehydration: Ideal bed for patients with cholera el tor –

 signs of severe dehydration occur rapidly “cholera cot”
such as
o sunken fontanel (in infants) and
eyeballs (in adults) Cholera Vaccine:
o loss of turgor and elasticity of the • a sterile suspension of killed Vibrio cholerae
skin of the Inaba and Ogawa strains in NSS or
o (+) skin fold sign with wrinkling of the suitable diluent.
fingertips – washerwoman’s hands, • It contains about 8 billion cholera vibrios per
o cold clammy sweat mL killed and preserved by the addition of
o decrease blood pressure 0.5% phenol.
o scaphoid abdomen Remarks: Immunity lasts for 6 months or less.
Protection depends largely on booster
 vomiting doses.
 increased exhaustion
 oliguria; and even
Acceptable Composition:
 anuria
Glucose 20 g/L
Uremia – accumulation of waste products like urea NaCl 4 g/L
NaHCO3 4 g/L
in the blood to toxic limits.
KChloride 1 g/L
- due to tubular necrosis.