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CHOLERAVibrio cholerae
Brenda Anna Kwambana
Wangeci Kagucia
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History
• Origins in India, cases reported as early as 1563• About 8 pandemics to date
– 1817-`23: First Pandemic– 1829-`50: Second Pandemic– 1852-`60: Third Pandemic* Pacini– 1863-`79: Fourth Pandemic– 1881-`96: Fifth Pandemic * Koch– 1899-`1923: Sixth Pandemic– 1961-?: Seventh Pandemic– 1992-?: Eighth Pandemic
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History
• First pandemic spreads from India to South, Central Asia, Middle East and Russia
• Second pandemic reaches England• Pandemics in 1800’s deadly• All pandemics reach Africa• First pandemic reaches Latin America in
1991
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Distribution
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Causative AgentDiscovery
• 19th Century: What is Cholera?
• Miasma Theory
• Blood Generation Theory
• Germ Theory
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Causative AgentDiscovery
• John Snow (1813-1858):
• Water borne transmission of Cholera (1855)
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Discovery
• Filippo Pacini (1812-1883)– 1854: Cholera reaches
Florence, Italy. Pacini discovers causative agent
– Publishes “Microscopical Observations and Pathological Deductions on Cholera”
– 1965: Bacterium named Vibrio cholerae Pacini 1854
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Discovery
• Robert Koch (1843-1910)
• 1884: Rediscovers Vibrio cholerae
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Vibrio choleraeMorphology
• Gram negative
• Comma shaped
• Sheathed, polar flagellum
• 1.4-2.6µm x 0.5-3µm
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Physiology
• Facultative anaerobic
• Asporogenous
• Growth stimulated by NaCl
• pH 6 - 10, Acid labile
• Temperature 18 - 37ºC
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Virulence & PathogenicityIngestion of V. cholerae
Resistant to gastric acid
Colonize small intestine
Virulence of Non-toxigenic V. cholerae O1 strain not well understood
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Toxigenic V. cholerae Pathogenicity
• Colonization factors (the TcpA pilus)
• Production of enterotoxin
• Associated outer membrane proteins on enterocytes e.g. adenylate cyclase
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Secrete enterotoxin
Enterotoxin binds to intestinal cells
Chloride channels activated
Release Large quantities of electrolytes & bicarbonates
Fluid hypersecretion
Diarrhea
Dehydration
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Transmission
• Fecal-oral route
• Entry = oral
• Discharge = fecal
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Transmission
• Humans only reservoirs
• Bacterium transmitted via contaminated water, food
• Carriers: houseflies and other insects
• Person to person transmission?
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Symptoms• 1-3 day Incubation Period
• Mild diarrhea Sudden severe diarrhea • Mucus and intestinal tissue visible in feces
• Muscle cramps
• Scaphoid abdomen
• Vomiting
• Loss of skin turgor
• Weak pulse
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Diagnosis
• Clinical symptoms
• Isolation of V. cholerae from stool– Live V. cholerae in stool (ca. 1.0 x 108 cells per ml)– Identification via dark-field microscopy
• Measurement of serum antibodies using ELISA
– Antibacterial antibodies: vibriocidal assays
– Antitoxin antibodies
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Methods of CureChemotherapeutic
• Antibiotics (tetracycline)
Immunological
• Local mucosal immune response to V. cholerae• Serological antivibrio antibodies• Antitoxin antibodies To Ease Symptoms
• Oral Rehydration• Intraveneous Rehydration
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Prevention & Control• Immunization
– Active Immunity induced by:• attenuated V. cholerae• Toxoid (not good antigen)
• Preventing contamination of food and water e.g. boiling water, covering food
• Education– Personal and domestic hygiene
• Prevention of contamination of water supplies– Improvement of sewage systems
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References
• Wachsmuth, I., Blake, P. & Olsvik. O (Eds.). Vibrio cholerae and Cholera: Molecular to Global Perspectives. Washington, DC: ASM Press (1994)
• Drasar, B., Forrest, B. (Eds). Cholera and the Ecology of Vibrio cholerae. Bury St Edmunds, Great Britain: Chapman & Hall (1996)
• Perry, J., Staley, J. & Lory, S. Microbial Life. Sunderland, MA: Sinauer Associates, Inc. (2002)
• US Food and Drug Administration. Vibrio cholerae Serogroup 01. Stable URL: “http://vm.cfsan.fda.gov/~MOW/chap7.html
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References, contd.
• Todar, K.V. cholerae and Asiatic Cholera (2002). Stable URL: http://www.bact.wisc.edu/Bact330/lecturecholera