Cholera

Cholera
‫ہیضہ‬
Prof. Dr. Sehar

Afshan Naz
M.Phil., PhD
Cholera
• Cholera is an infectious disease

caused by eating food or drinking
water contaminated with a bacterium
called Vibrio cholerae.
• This organism secrete an enterotoxin

which causes severe watery diarrhea,
which can lead to dehydration and
even death if untreated.
• Cholera outbreaks are still a serious
problem in some parts of the world.
• The disease is most common in

places with poor sanitation,
crowding, war, and famine. Common
locations include parts of Africa,
south Asia, and Latin America.
• The World Health Organization

reports that there are 1.3 million to 4
million cases each year.
• Vibrio cholerae, the bacterium that
causes cholera, is usually found in
food or water contaminated by feces
from a person with the infection.
Common sources include:
• Municipal water supplies
• Ice made from municipal water
• Foods and drinks sold by street
vendors
• Vegetables grown with water
containing human wastes
• Raw or undercooked fish and seafood
caught in waters polluted with
Etiology
• Vibrio cholerae is the major causative
agent of Cholera
• Gram-negative
• Curved or comma-shaped rods
• Highly motile with a single polar
flagellum.
• Non-sporing
• Non-capsulated
• Vibrio cholerae was first isolated in pure
culture by Robert Koch in 1883.
• Other species of genus Vibrio includes
• V. parahemolyticus and
Growth Characteristics
• Characteristically grow well at very high
pH (8.5- 9.5) and rapidly kills by acids
• Killed at 55℃ for 10 minutes
• Sensitive to chemicals
• Sensitive to dessication
• Survive for 4-7 days over surfaces of vegetables
and fruits
•
• Grows well on simple media such as
Nutrient agar and produce smooth
round translucent colonies.
On Blood agar it gives beta hemolysis
• On selective media such as
MacConkey`s agar or EMB agar it
produces non lactose fermenter
colourless colonies
• Another selective media, Thiosulfate Citrate
Bile Salt Sucrose agar (TCBS) having pH 8.6-
9.5, is used widely for its selective isolation
from stool specimen.
• On this media it produces sucrose
fermenter yellow colonies.
Antigenic Structures
• Heat-labile flagellar H antigen.
• Somatic O antigen –lipopolysaccharides
antigen. Because of this
lipopolysaccharide it has 140 serogroups.
• Serogroup O-1 and O-139- cause classic
cholera.
• Others cause cholera like diseases.
• Antibodies against O antigen gives
protection against infection.
Virulence Factors
1- Vibrio cholerae toxin-
coregulated pili (TCP) are Type IV pili
that self-aggregate, bringing the
bacteria together in microcolonies that
protect them from host defenses and
concentrate their secreted cholera
toxin.
TCP is important for colonization of the host
gut mucosal layer
2- Enzyme
3- Toxins:
V.cholerae serotype 0-1
produces two type of toxins
• Endotoxin
• Exotoxin
Endotoxin
• Lipopolysaccharide present in
cell wall
• Released upon lysis of cell
• Pyrogenic (fever producing)
Exotoxin
Enterotoxin or Choleragen
• V.cholerae serotype 01 during its growth
produces an exotoxin known as enterotoxin
or Choleragen which is responsible for the
loss of fluid in Cholera
• This is AB toxin, consisting of two subunits
• Sub unit B also known as Choleragenoid
binds to mucosal receptors and promotes
entry of sub unit A into the cell.
• A subunit is the main toxic part responsible
for biological activity of choleragen
Pathogenesis
• Transmission is usually through the fecal-
oral route of contaminated food or water
caused by poor sanitation.
• High infectious dose i.e. 108-109 is
required to initiate the infection because
this bacilli is susceptible to gastric acids
• About 100 million bacteria must typically
be ingested to cause cholera in a normal
healthy adult
• Cholera is not an invasive infection.
• The organism do not reach blood stream
but only remain within the intestinal tract.
• The organisms survived from gastric acids
enters the intestine and attach to microvilli
of the brush borders of epithelial cells.
• The Vibrio bacilli infects the host using two
major virulence factors: the toxin-co-
regulated pilus (TCP) and cholera toxin
(CT). TCP is important for colonization of
the host gut mucosal layer where CT is
released and passes through the gastro
endothelial wall..
• In addition to Cholera toxin
(Choleragen), the Vibrio also
liberates mucinases ( which can
dissolve the protective
glycoprotein coatings over the
intestinal cells) and endotoxins
• This Cholera toxin elevates the
production of cyclic AMP which
produces massive secretion of
fluids into the lumen of the intestine
Clinical picture
• Symptoms begin with sudden onset of watery
diarrhea, which may be followed by vomiting.
Fever is typically absent.
• The diarrhea has fishy odor in the beginning
but became less smelly & like “rice water” in
few hours due to presence of mucus,
epithelial cells and large number of vibrio
bacilli.
• Sunken eyes and hollow cheeks
• In severe cases stool volume exceeds 250
ml /kg leading to severe dehydration, shock &
death if untreated.
• Patient if survive, recovers slowly.
Classical cases of Cholera
Laboratory Diagnosis
Collection of Specimen:
• Stool sample
• Rectal swab
• Vomitus
Direct Microscopy:
The Presence of many curved-
shaped bacilli in Gram stained
smear of stool sample
indicates the probability of
Vibrios.
Dark Field microscopy may
demonstrate the motility of
• Primary Isolation:
• Alkaline Peptone water is used for the
enrichment of Vibrio in stool sample.
• After incubation, the clinical specimens can
be streaked on different appropriate media
for primary isolation
Blood agar
MacConkey`s Agar
Thiosulfate Citrate Bile Salts Sucrose agar
(TCBS)
• Grows well on simple media such as
Nutrient agar and produce smooth
round translucent colonies.
On Blood agar it gives beta hemolysis
• On selective media such as
MacConkey`s agar or EMB agar it
produces non lactose fermenter
colourless colonies
• Another selective media, Thiosulfate Citrate
Bile Salt Sucrose agar (TCBS) having pH 8.6-
9.5, is used widely for its selective isolation
from stool specimen.
• On this media it produces sucrose
fermenter yellow colonies.
Bio chemical Identification
• The isolates are identified on the basis

of following tests
• Catalase test: Positive
• Oxidase Test positive ( other
enterobacteriacae are mostly negative)
• TSI reaction: Acidic Butt, Acidic Slant
with Gas
• Sugar Fermentation; Ferments sucrose
• Indole positive
• Methyl Red Test Negative
• Voges Praskeur Positive
Serodiagnosis
Vibrio Cholerae can be classified by
slide agglutination tests by using anti
O group O-1 and O-139 antibodies.
Treatment
• Water and electrolyte replacement
by giving ORS to cure severe
dehydration
*ORS (Oral rehydration Salts contain
NaCl,
KCl, glucose etc)
• Oral Tetracycline is drug of choice
• Erythromycin or Chloromphenicol
can be uses in case of tetracycline
resistance.
Prevention
• Improve Sanitation
• Public health
awareness
• Prophylaxis:
• A killed vaccine is
available which is
effective in
stimulating partial
protection of short
duration (6
months).

Cholera

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Cholera

Prof. Dr. Sehar

• Cholera is an infectious disease

• This organism secrete an enterotoxin

• The disease is most common in

• The World Health Organization

• The isolates are identified on the basis

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