Vibrio cholerae (Cholera)

Foundational Sciences Microbiology Bacteriology Gram negative bacteria Comma-shaped rods

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Vibrio cholerae (Cholera)

Bacteriology

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Introduction to bacteria
 Bacterial structure and functions

Gram positive bacteria

High Yield Notes 6 pages

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Vibrio Cholera Characteristics

Picmonic

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 Vibrio Cholera Disease

Picmonic

Vibrio

Sketchy Medical

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First Aid 2023 2022 2021 2020 2019 2018 2017 2016

cAMP (cyclic adenosine monophosphate)

Vibrio cholerae p. , 144

Diarrhea
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Vibrio cholerae p. , 144
 Rice-water diarrhea
Vibrio cholerae p. , 144

Vibrio cholerae p. , 144

exotoxin production p. 130
Gram-negative algorithm p. 139
watery diarrhea p. 176

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Wikipedia

Transcript

Content Reviewers
Yifan Xiao, MD

Contributors
Evan Debevec-McKenney

Cholera is a contagious infection caused by the bacteria Vibrio cholerae, which can in turn
cause severe gastroenteritis and excessive watery diarrhea for several days.

Rapid dehydration and electrolyte imbalances can be fatal as suspected in the deaths of
James K. Polk, the 11th President of the United States; and Charles the Tenth, King of France.
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V. cholerae is a gram-negative, curved bacteria which looks like little red or pink comma-
shapes on a gram stain.
This protein in turn leads to an overproduction of the intracellular secondary messenger
protein, cyclic adenosine monophosphate, or simply cAMP.

Increase in cAMP causes chloride channels on the cells to increase the secretion of chloride
into the lumen while inhibiting the channels that let sodium and chloride back into the cell.

So, the abnormally high levels of luminal sodium and chloride disrupt the osmotic balance
between the intestines and surrounding tissue; and water, bicarbonate, and potassium rush
into the lumen of the intestines as a result.

This can cause symptoms like vomiting and voluminous amounts of watery diarrhea
containing extremely high concentrations of sodium, potassium, chloride, bicarbonate; as
well as high levels of live V. cholerae ready to infect another individual.

There could also be flecks of the mucous layer of the intestine which looks similar to rice in
water.

Typically, there is no fever, pain or cramping.

And while the incubation time for V. cholerae can take hours, to 2-3 days; severe dehydration
and depletion of electrolytes can happen within 4 to 12 hours of the first bout of diarrhea or
vomiting.

These imbalances can lead to symptoms like disorientation, dry mouth, swollen tongue,
sunken eyes, cold clammy skin, or shriveled and dry hands and feet.

Other, even more severe, fatal complications can come from depleted electrolytes and water
in the blood.

Like low levels of bicarbonate can cause metabolic acidosis with deep and labored breathing
called Kussmaul breathing.

Or low levels of potassium can cause muscle dysfunction including leg cramps, weakness
and abnormal heart rhythms.

And low chloride and sodium can cause headaches, poor balance, disorientation, seizures
and coma.

Finally, severe dehydration can cause hypovolemic shock with a significant decrease in blood
pressure.

Diagnosis is typically made by a stool sample growing V. cholerae on a thiosulfate-citrate-

bile salts-sucrose agar. 2
But even before a definitive diagnosis can typically be made, the first line of treatment is to
rapidly replace the lost water and electrolytes with rehydration salts either orally or
intravenously.

In cases of mild to moderate diarrhea, this type of supportive therapy is enough of a

treatment course and the diarrhea may resolve on its own in about 3 to 7 days.

But more extreme cases may require antibiotics. In this case, the stool culture can be helpful
in deciding which antibiotics would be most effective against the infecting strain, and may
include tetracyclines, ciprofloxacin, ofloxacin, furazolidone, or trimethoprim-
sulfamethoxazole.

Summary
So, to recap: Cholera is a contagious, severe gastroenteritis caused by the gram-negative
Vibrio cholerae bacteria.

It’s route of transmission is fecal to oral through consumption of contaminated sources like
water and shellfish.

Some strains produce cholera enterotoxin at the surface of intestinal epithelial cells which
leads to the over-activation of cAMP by permanently activating Gs alpha.

Patients most often present with voluminous “rice-water” diarrhea that quickly leads to
dehydration and electrolyte imbalances that can be fatal if not rapidly treated with
rehydration salts.

Summary

Vibrio cholerae is a bacterium that causes cholera, a severe and contagious diarrheal disease.
Cholera is transmitted through contaminated water or food and is most common in areas
with poor sanitation and limited access to clean drinking water.

Some strains produce cholera enterotoxin, which acts on the intestinal epithelial cells in the
small intestine, causing over-activation of the enzyme adenylate cyclase. This leads to an
increase in the intracellular levels of cyclic AMP (cAMP) in the intestinal cells, which in turn
leads to the secretion of large amounts of water and electrolytes into the intestinal lumen,
resulting in the characteristic watery diarrhea of cholera.

Patients most often present with voluminous, profuse, watery diarrhea, vomiting, and
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dehydration, all of which lead to fatal dehydration and electrolyte imbalances. Treatment
involves rehydration therapy to replace all the fluids and electrolytes that are lost through
 diarrhea. In severe cases, antibiotics such as tetracyclines, ciprofloxacin, or trimethoprim-
sulfamethoxazole may be necessary.

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