CHOLERA

• Cholera is acute diarrheal disease

caused by vibrio cholera and is a toxin
mediated.
The vibrio cholera is a gram positive
comma shaped bacteria. The disease
was first seen in the valley of Ganges in
India and Bangladesh .
The vibrio dose not invade the epithelium but
secrete endotoxin which is similar to that of E.
coli. This endotoxin is composed of 5 binding
peptide B and a catalytic peptide A. The B
peptide binds with GM1 GANGLIOSIDE on
the epith, surface of the small intestine and
through intracellular chain reactions which
ends in persistence activation of adenylate
cyclase, high level of cAMP and massive
secretion of sodium, chlorine and water.
• The reabsorptive function of the colon is
overwhelmed and liter of dilute (rise water)
diarrhea containing flecks of mucosa but few
WBC is produced.
• Because the overall absorption of the gut
remains intact the oral formula can replace
the massive loss of sodium, chlorine and
bicarbonate and fluid losses and can reduce
mortality rate from 50% to 1%.
• V. cholera does not invade the mucosa
and consequently cause minor
histological changes that underestimate
the physiological damage caused by the
endotoxin. These changes are:
congestion of mucosal lamina propria,
moderate mononuclear infiltrate and
hyperplasia of the Payer’s patches.