VIBRIO CHOLERAE

By: Shareef Mohamed Jason Schwartz

Introduction

Familia: Vibrionaceae Genus: Vibrio Species: V. cholerae Gram-negative bacteria with a single, polar flagellum for movement Vibrio cholera is curved rod ,comma shaped 1-2 um It is actively motile and has typical darting motility On prolonged incubation the vibrios tend to become straight rods. Intestinal infection noninvasive, affecting the small intestine through secretion of an enterotoxin

Transmission

Transmitted by fecal-oral route

contaminated water, food (fish, shellfish), swimming feces of asymptomatic and sick human carriers. no person-to-person transmission

May persist in shellfish or plankton Endemic in areas of poor sanitation (India and Bangladesh ) 7 pandemics since 1817 first 6 from Classical strains, 7 th from El Tor 1993: Cholera in Bengal caused by O139 may be cause of 8 th pandemic

http://www.herbalgranny.com/2009/08/06/herbal-treatment-forcholera/

Haiti

About 727 people were killed by cholera After the earthquake 10 months ago in Haiti, it left the country without proper water filtration and sanitary food and water supply. Cholera has now spread to six of 10 regions in Haiti Most of the residents are not properly educated about the disease and the common ways to treat bacteria. Video on Haiti

http://www.bbc.co.uk/news/world-latin-america-11614639

Infection

Infectious dose ranges from 106-1011 colonizing units The high level is necessary as the bacteria must survive the gastric acid barrier as the bacterium is sensitive to acidic conditions Vibrio's are sensitive to low pH and die rapidly in solutions below pH 6; however, they are quite tolerant of alkaline conditions.

Incubation period
Ranging from a few hours to 5 days

Most cases presenting within 1-3 days As likely for organisms passing through the gastric barrier, the incubation period is shortest when:

highest dose of ingested organism High gastric pH

Process of Infection

V. cholerae must penetrate the mucus lining the coats the intestinal epithelium, the bacterium adheres to and colonizes the epithelial cells of the small intestine. Inactivates GTPase function of G-protein coupled receptors in intestinal cells G proteins stuck in On position 100 fold increase in cAMP Activation of ion channels Ions flow out and water follows

Symptoms

Diarrhea may be sudden or gradual Rapid onset of water associated with stool Vomiting, frequently watery, is common and may begin before or after diarrhea.

Mortality

In untreated patients, mortality can reach 5070% Risk much higher in children

10x greater than adults 50% risk of fetal death in 3rd trimester

As well as pregnant women

Patients can die within 2-3 hours of first sign of illness also seen from 10 hours- several days

How common is it?

The bacteria is native to the Ganges delta, which is in India and extends into Bangladesh. There is an ongoing global pandemic in Asia, Africa, and Latin America that has lasted more than four decades. Since 1995, over 80 percent of reported cases have occurred in Africa. In the United States, there are zero to five cases per year.

Treatment

Untreated: 60% fatality Treated: <1% fatality Rehydration & supportive therapy

Oral Potassium chloride (1.5 g/L) Rice flour (30-80g/L) Trisodium citrate (2.9 g/L) Intravenous (IV)

Sodium chloride (3.5 g/L)

Doxycycline or tetracycline (Tet resistance may be developing) of secondary value

Two Vaccines

Dukoral (manufactured by SBL Vaccines ShanChol (manufactured by Shantha Biotec in India),

Vaccines

Two types of cholera vaccines are currently approved for use in humans:
Dukoral

(manufactured by SBL Vaccines ShanChol (manufactured by Shantha Biotec in India),

Killed-whole-cell formulation: killed bacterial cells from both biovars of serovar 01 and purified B subunit of the cholera toxin.

Provides immunity to only 50% of adult victims and to less than 25% of child victims.

Live-attenuated vaccine, genetically engineered

Provides >90% protection against classical biovar and 65-80% agaisnt E1Tor biovar.

Laboratory Diagnosis

Diagnosis are made through isolation of bacteria from extra- intestinal environment or stool samples Specimens are collected:

Gram Stain show sheets of curved Gram negative rods Untreated patients have 106 to 108 organisms / ml

Cholera is confirmed through culture of a stool specimen or rectal swab. Cary Blair media is ideal for transport, and the selective thiosulfatecitratebile salts agar (TCBS) is ideal for isolation and identification.

References

Bbb - vibrio cholerae serogroup o1. (2009, May 04). Retrieved from http://www.fda.gov/Food/FoodSafety/FoodborneIllness/FoodborneIllnessFoodbornePathogensNaturalToxins/ BadBugBook/ucm070071.htm Cholera. (2010). Centers for diease control and preventation . Retrieved November 23, 2010, from http://www.cdc.gov/cholera/ Cholera. (2010). World health organization. Retrieved November 23, 2010, from http://www.who.int/topics/cholera/en/ Cholera in Haiti. (2010). World health organziation . Retrieved November 23, 2010, from http://www.who.int/csr/don/2010_10_26/en/index.html Handa, Sajeev. (2010). Cholera. Emedicine, Retrieved from http://emedicine.medscape.com/article/214911overview Leinwand, Donna. (2010). Haiti's cascading crises come down to h0. USA TODAY, Retrieved from http://web.ebscohost.com/ehost/detail?vid=8&hid=106&sid=ecaf75f6-1139-45c6-82062b75a950b422%40sessionmgr115&bdata=JnNpdGU9ZWhvc3QtbGl2ZQ%3d %3d#db=f5h&AN=J0E145805781310 Todar, Kenneth. (2009). Vibrio cholerae and asiatic cholera. Retrieved from http://www.textbookofbacteriology.net/cholera.html