Vibrio Cholerae
[Link] MohaMeDaNi
JUlY,2024
VIBRIO
ØVibrio cholerae, the major pathogen in this genus, is the cause of
cholera.
ØVibrio parahaemolyticus causes diarrhea associated with eating
raw or improperly cooked seafood.
ØVibrio vulnificus causes cellulitis and sepsis.
Vibrio cholerae
Vibrio cholerae
ØEndemic in areas of poor sanitation
ØCommon in India, Sub-Saharan Africa, Southern Asia
ØVery rare in industrialized countries
Ø7 pandemics since 1817 – first 6 from Classical strains, 7th from El Tor strain.
ØIn 1992, V. cholerae serogroup O139 emerged and caused a widespread
epidemic of cholera in India and Bangladesh.
ØThe factors that predispose to epidemics are poor sanitation, malnutrition,
overcrowding, and inadequate medical services.
CAUSATIVE AGENT
DISCOVERY
The germ responsible for cholera was discovered
twice: first by the Italian physician Filippo Pacini
during an outbreak in Florence, Italy, in 1854, and then
independently by Robert Koch in India in 1883
MORPHOLOGY
§ Gram negative
§ Comma shaped
§Curved
§ polar flagellum
§ 1.4-2.6µm x 0.5-3µm
Important Properties:
V. cholerae is divided into two groups according to the
nature of its O cell wall antigen.
ØThe O1 group cause epidemic disease.
Ø Non-O1 organisms either cause sporadic disease or are
nonpathogens.
Important Properties:
ØThe O1 organisms have two biotypes, called El Tor and cholerae,
and three serotypes, called Ogawa, Inaba, and Hikojima.
Ø(Biotypes are based on differences in biochemical reactions,
whereas serotypes are based on antigenic differences.)
TRANSMISSION
vBacterium transmitted via contaminated water, food.
vHuman carriers are frequently asymptomatic and include individuals who are
in the incubation period .
vThe main animal reservoirs are marine shellfish, such as shrimp and oysters.
v Ingestion of these without adequate cooking can transmit the disease.
v Carriers: houseflies and other insects.
pathogenesis
ØThe pathogenesis of cholera is dependent on colonization of the small
intestine by the organism and secretion of enterotoxin.
ØFor colonization to occur, large numbers of bacteria must be ingested because
the organism is particularly sensitive to stomach acid.
Ø Persons with little or no stomach acid, such as those taking antacids or those
who have had gastrectomy, are much more susceptible.
ØAdherence to the cells of the brush border of the gut, which is a requirement
for colonization, is related to secretion of the bacterial enzyme mucinase,
which dissolves the protective glycoprotein coating over the intestinal cells.
Pathogenesis of diarrhea
1. Secrete enterotoxin
2. Enterotoxin binds to intestinal cells
3. Chloride channels activated
4. Release Large quantities of electrolytes.
5. Fluid hypersecretion
6. Diarrhea
7. Dehydration
Cholera
ØA major epidemic disease.
ØA life-threatening secretory diarrhea induced by enterotoxin
secreted by V. cholerae.
ØWater-borne illness caused by ingesting contaminated water/food .
ØAn enterotoxic enteropathy (a non-invasive diarrheal disease).
Cholera
The precise burden of cholera is difficult to define, as the disease is
vastly underreported.
Cholera is endemic in approximately 50 countries, mostly in Africa
and Asia, and has caused extensive epidemics throughout Africa,
Asia, the Middle East, South and Central America, and the Caribbean
Clinical features
Incubation period ranges from a few hours to 5 days Average
is 1-3 days.
Shorter incubation period :
ØHigh gastric pH (from use of antacids).
ØConsumption of high dosage of cholera.
Clinical features
Ø Diarrhea:
ØSudden, severe Watery diarrhea ( rice water)(1L/hour).
Without treatment, death in 18 hours-several days.
ØVomiting
Clinical features: Cholera Gravis
More severe symptoms Rapid loss of body fluids: 6 liters/hour.
Rapid loss of more than 10% of bodyweight.
Dehydration and shock.
Death within 12 hours or less.
Death can occur within 2-3 hours.
Consequences of Severe Dehydration
qIntravascular volume depletion
qSevere metabolic acidosis
qCardiac and renal failure
qSunken eyes, decreased skin turgor
qAlmost no urine production
1)Fluid and electrolyte loss
2)Hypokalemia—low levels of K+ in blood
a)necessary for proper nerve, muscle, heart function
b)cramping, cardiac arrest
Laboratory Diagnosis
Ø Stool culture :
A definitive diagnosis of cholera is based on isolation of the organism from
clinical samples.
Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile
salts agar (TCBS) is ideal for isolation and identification.
Laboratory Diagnosis
ØRapid tests
vAntigen detection :
Dipsticks :such as Crystal VC, which detect the presence of the O1 or O139
antigen in watery diarrheal stools, and Cholkit, which detects only the O1
antigen.
vMolecular tests :
tests that use dried fecal spots (eg, PCR), practical use of molecular tests has
been limited to epidemiologic research and surveillance.
Laboratory Diagnosis
ØDark field microscopy:
Of rice-water stools (at 400x magnification) can also be used to
evaluate for the presence of highly motile Vibrios, whose shooting
star-like motion.
Laboratory Diagnosis
The approach to laboratory diagnosis depends on the situation.
Ø Epidemic, a clinical judgment is made and there is little need for the laboratory.
Ø In endemic areas or for the detection of carriers Culture a stool sample.
Ø For diagnosis of sporadic cases a culture of the diarrhea stool .
ØBiochemical tests : The organism is oxidase-positive.
Treatment
§Aggressive volume repletion is the mainstay of treatment for cholera.
§Antibiotics such as tetracycline and doxycycline .
§ Antibiotics can:
ü Shorten the duration of diarrhea.
ü Reduce the volume of stool losses.
ü Shorten the duration of V. cholera shedding.
Prevention
qPrevention is achieved mainly by public health measures that ensure a clean water and food
supply.
qCholera vaccine, composed of killed organisms, has limited usefulness; it is only 50% effective
in preventing disease for 3 to 6 months and does not interrupt transmission.
q A live vaccine is available in certain countries .
qNeither the killed nor the live vaccine is recommended for routine use in travelers.
q The use of tetracycline for prevention is effective in close contacts but cannot prevent the
qspread of a major epidemic.
qPrompt detection of carriers is important in limiting outbreaks.
ThaNk YoU
