CHOLERA

Cholera is a gastro intestinal disease or infection. it is an acute infection by Vibrio

cholera an enteric pthogen.

Cholera, sometimes known as Asiatic or epidemic cholera, is an infectious

gastroenteritis caused by enterotoxin-producing strains of the bacterium Vibrio
cholera. Transmission to humans occurs through eating food or drinking water
contaminated with cholera vibrios.

• Vibrio cholerae is a Gram-negative bacterium which is comma shaped.

• V. cholerae produces cholera toxin, an enterotoxin, whose action on the
mucosal epithelium lining of the small intestine is responsible for the
disease's infamous characteristic, exhaustive diarrhea.
• In its most severe forms, cholera is one of the most rapidly fatal illnesses
known, and a healthy person's blood pressure may drop to hypotensive levels
within an hour of the onset of symptoms.
• infected patients may die within three hours if medical treatment is not
provided. In a common scenario, the disease progresses from the first liquid
stool to shock in 4 to 12 hours, with death following in 18 hours to several
days, unless oral rehydration therapy is provide.
• Rice grain like structures are seen in the stools of the patient which are the
bacteria.

Symptoms:

• Symptoms include profuse and painless watery diarrhea, effortless vomiting

which causes loff of electrolytic equilibrium of the body.
• Loss of electrolytes causes death due to Hypovolomic shock.
• If the patient has a severe cholera it causes massive water loss from the
body.
• In acute cholera there are a few complications like Muscle cramps, Renal failure,
pulmonary edema due to heavy water loss.

Pathogenecity:

• The pathogen enters the body through the contaminated food and water.
• Vibrio are very sensitive pathogens so when they enter stomach the acidic
juices of the stomach kill most of the vibrio.
• If a person drinks soda water and then eats or drinks the contaminated food
or waterthe vibrio have better chances of survival because the acidic nature
of the stomach is highly reduced due to the soda which is a base.
• The pathogen passes through the mucosa layer of the intestine and then
enters the epithelium tissue.
• Heamagglutinin protease is the enzyme which helps the vibrio ti split th
mucosa layer.
• Throughout the infection the pathogen is attached to the epithelial cells of
intestine without causing any damage to the tissue.
• They multiply and produce various toxins like CHOLEROGEN and CHOLERA
TOXIN.
 • Cholera toxin is highly antigenic in nature. This toxin is a protein and it is a
gene product but the gene which synthesizes this ptn is not possessed by
vibrio.
• The gene is present in the bacteriophage of v. cholera where it acts as
Vlasmid and can replicate.
• Choleratoxin has a molecular weight of 84000. It has 1A and 5B subunits.
• B sub-unit is attached to the G.M.
• A sub-unit is transported into the enterocyte(cells of enteron) where it breaks
down into A1 and A2.
• The A2 fragment links the A1 fragment to the B sub-unit.
• The A1 fragment causes the activity of ADENYLATE CYCLASE which causes
cyclic AMP.
• Over Production of cyclic AMP causes loss of fluids and electrolytes.

Susceptibility

Recent epidemiologic research suggests that an individual's susceptibility to cholera

(and other diarrheal infections) is affected by their blood type: Those with type O
blood are the most susceptible,[18][19] while those with type AB are the most
resistant. Between these two extremes are the A and B blood types, with type A
being more resistant than type B.[citation needed]

About one million V. cholerae bacteria must typically be ingested to cause cholera in
normally healthy adults, although increased susceptibility may be observed in those
with a weakened immune system, individuals with decreased gastric acidity (as
from the use of antacids), or those who are malnourished.

It has also been hypothesized that the cystic fibrosis genetic mutation has been
maintained in humans due to a selective advantage: heterozygous carriers of the
mutation (who are thus not affected by cystic fibrosis) are more resistant to V.
cholerae infections.[20] In this model, the genetic deficiency in the cystic fibrosis
transmembrane conductance regulator channel proteins interferes with bacteria
binding to the gastrointestinal epithelium, thus reducing the effects of an infection.

Epidemiology:

• Sporadic, endemic, epidemic and pandemic have all been caused due to
Vibrio cholerae.
• In India its homeland is Ganga and Bhramaputra rivers.
• In early 18th centuary the disease was only confined to India. But during
1817-1923 cholera spread from Bengal.
• Bengal caused 6 pandemics. The variant which was spreading was the ELTOR
strain.
• 1n 1991 the pandemic occurred in peru.
• Infection can occur to humans either from the patients or the carriers.

Lab Diagnosis:

• The stools are collected and examined before the administering of the
antibiotics.
• Isolation of the bacteria is easy due to excess of cells.
 • A lubricated Catheter is inserted into the rectum and the rectal swabs are
collected.
• Transport media include VR medium or on Carry blair medium, alkaline peptone
water is used in the media for optimum growth of the pathogen.
• Either MAC agar or TC(Theosulphate citric), BS(Bile salt) agar is used. The
media should be fresh and not 3-4 days old.
• Incubation is at 37*c for 24 hours. Once the colonies are obtained after
incubation the colonies are picked up with a straight wire.
• Agglutination with O antigen is done.
• Generally V. phage typing is done to identify the Bacterio phage.

Treatment:

In all cases as soon as the symptoms are observed the first line treatment is to
provide Oral rehydration therapy. This is effective to treat the infection. But in many
rare cases antibiotics are also used but they are of secondary importance. Oral Tetra
Cyclin is an effective drug against V.cholerae.

Immunity:

• For any gastro intestinal infection the immunity is not available for lifelong
period, it is only for a period of 6 months.
• Copro antibodies are formed which provide Local immunity they are mainly
IgM, IgG, and IgA.
• When it comes to Vaccines the conc. Of Vibrio in Vaccine is usually 8000
mn/ml.
• For the first time live vibrios were used by Ferran. These live vibrios are killed
by the body and thus immunity is obtained. Usually it is administered in
Intramuscular region.
• This vaccine containes OGAVA and INABA serotypes.
• Oral vaccines have also been developed but they Failed.