Vibrio cholerae

Wewedru I.
.

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Introduction

• Family affiliation – Vibrionaceae

• Other species:
oV.alginolyticus,
oV.mimicus,
oV.parahaemolyticus,
o V.vulnificus,etc.

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Microscopy

• Curved gram negative bacilli (coma shaped).

• Highly motile with single polar flagellum.

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Diagnosis

1. Specimens: Severe watery diarrhoea and rectal

swab.

2. Wet mount examination:

o Characteristic darting motility
o Motility is stopped by addition of specific anti-
somatic antibody

3. Gram stain – Curved gram –ve bacilli.

4
Diagnosis…

4. Culture:
o TCBS (selective medium) : Yellow colonies (V.-
parahaemolyticus – green colonies) after 24 hr
incubation.
o Alkaline peptone water (pH 8.6) – an enrichment
medium.

5. Fluorescent Ab test

6. PCR

5
Diagnosis…

7. Identification:
• Gram stain
• Oxidase test (+ve, do not pick colonies from
TCBS).
• Serotyping:
o Poly O1 and 0139
o Mono – Inaba, Ogawa and Hikojima.

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Differential characters

Biotype El Tor Classical

Serotypes Ogawa Inaba Hikojima Ogawa Inaba Hikojima

Antigens A,B A,C A,B,C A,B A,C A,B,C

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Viability

• Tolerate alkaline

• Sensitive to acid

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Clinical manifestation

• Cholera is a potentially epidemic and life threaten-

ing secretory diarrhoea.

• Characterised by mucous, voluminous watery diar-

rhoea/stools, often accompanied by vomiting result -
ing in hypovolemic shock and acidosis.

• Mild infections can be caused.

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Pathogenesis

• Cholera transmission is by the faecal oral route.

• Sensitive to acid and most die on the stomach.

• Organisms adhere to and colonize the small bowel.

• Secrete potent enterotoxin (CT , also called cholera-

gen).

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Pathogenesis…

• Toxin binds to the plasma membrane of the intesti-

nal cells and release an enzymatically active subunit
that causes a rise in cyclic adenosine – 5-
monophosphate (cAMP) production.

• High level of intracellular cAMP causes massive se-

cretion of electrolytes and water into the intestinal
lumen.

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Host defenses

• Non – specific defenses: gastric acid, mucous scre-

tions and intestinal motility.

• Breast feeding protects infants in endemic areas

from the diseases.

• IgA and IgG antibodies production against Vibrios’

somatic Ag, outer membrane protein and/or the en-
terotoxin and other products.

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Epidemiology

• Endemic or epidemic in areas with poor sanitation.

• Sporadic or limited outbreaks in developed coun-
tries.
• In coastal regions, it may persist in shellfish and
planktons.
• Long term convalescent carriers are rare.
• Entiritis due to the halophile V.parahaemolyticus is
associated with raw or improperly cooked seafoods.

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Antibiotics/Control

• Sanitation effective but not feasible in endemic ar-

eas.

• No effective vaccine.

• Health education
• Antimicrobial agents: TE, COT, NA, Cip, E and
Cephalosporins.

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