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Vibrio cholerae and Asiatic Cholera (page 1)
(This chapter has 4 pages)
© Kenneth Todar, PhD
Introduction
The genus Vibrio consists of Gram-negative straight
or
curved rods, motile by means of a single polar flagellum. Vibrios are
capable
of both respiratory and fermentative metabolism. O2 is a
universal
electron acceptor; they do not denitrify. Most species are
oxidase-positive.
In most ways vibrios are related to enteric bacteria, but they share
some
properties with pseudomonads a well. The Family Vibrionaceae is
found in the "Facultatively Anaerobic Gram-negative Rods" in Bergey's
Manual
(1986), on the level with the Family Enterobacteriaceae. In the
revisionist taxonomy of 2001 (Bergey's Manual), based on phylogenetic
analysis,
Vibrionaceae, Pseudomonadaceae and Enterobacteriaceae
are all landed in the Gammaproteobacteria. Vibrios are
distinguished
from enterics by being oxidase-positive and motile by means of polar
flagella.
Vibrios are distinguished from pseudomonads by being fermentative as
well
as oxidative in their metabolism. Of the vibrios that are clinically
significant
to humans, Vibrio cholerae,the agent of cholera, is the most
important.
Most vibrios have relatively simple growth factor requirements and
will
grow in synthetic media with glucose as a sole source of carbon and
energy.
However, since vibrios are typically marine organisms, most species
require
2-3% NaCl or a sea water base for optimal growth. Vibrios vary in their
nutritional versatility, but some species will grow on more than 150
different
organic compounds as carbon and energy sources, occupying the same
level
of metabolic versatility as Pseudomonas. In liquid media
vibrios
are motile by polar flagella that are enclosed in a sheath continuous
with
the outer membrane of the cell wall. On solid media they may synthesize
numerous lateral flagella which are not sheathed.
Vibrios are one of the most common organisms in surface waters of
the
world. They occur in both marine and freshwater habitats and in
associations
with aquatic animals. Some species are bioluminescent and live in
mutualistic
associations with fish and other marine life. Other species are
pathogenic
for fish, eels, and frogs, as well as other vertebrates and
invertebrates.
V. cholerae and V. parahaemolyticus are pathogens of
humans.
Both produce diarrhea, but in ways that are entirely different. V.
parahaemolyticus
is an invasive organism affecting primarily the colon; V. cholerae
is noninvasive, affecting the small intestine through secretion of an
enterotoxin.
Vibrio vulnificus is an emerging pathogen of humans. This
organism
causes wound infections, gastroenteritis, or a syndrome known as
"primary
septicemia."
Campylobacter jejuni (formerly Vibrio fetus), is now
moved
to the class Epsilonproteobacteria in the the family Campylobacteraceae.
Campylobacter
jejuni has been associated with dysentery-like gastroenteritis, as
well as with other types of infection, including bacteremic and central
nervous system infections in humans. Another vibrio-like organism, Helicobacter
pylori causes duodenal and gastric ulcers and gastric
cancer.
It is also reclassified into the class Epsilonproteobacteria
family
Helicobacteraceae.
Vibrio cholerae
Cholera
Cholera (frequently called Asiatic cholera or epidemic
cholera) is a severe diarrheal disease caused by the bacterium Vibrio
cholerae. Transmission to humans is by water or food. The
natural
reservoir of the organism is not known. It was long assumed to be
humans,
but some evidence suggests that it is the aquatic environment.
V. cholerae produces cholera toxin, the model for
enterotoxins,
whose action on the mucosal epithelium is responsible for the
characteristic
diarrhea of the disease cholera. In its extreme manifestation, cholera
is one of the most rapidly fatal illnesses known. A healthy person may
become hypotensive within an hour of the onset of symptoms and may die
within 2-3 hours if no treatment is provided. More commonly, the
disease
progresses from the first liquid stool to shock in 4-12 hours, with
death
following in 18 hours to several days.
The clinical description of cholera begins with sudden
onset
of massive diarrhea. The patient may lose gallons of protein-free fluid
and associated electrolytes, bicarbonates and ions within a day or two.
This results from the activity of the cholera enterotoxin which
activates
the adenylate cyclase enzyme in the intestinal cells, converting them
into
pumps which extract water and electrolytes from blood and tissues and
pump
it into the lumen of the intestine. This loss of fluid leads to
dehydration,
anuria, acidosis and shock. The watery diarrhea is speckled with flakes
of mucus and epithelial cells ("rice-water stool") and contains
enormous
numbers of vibrios. The loss of potassium ions may result in cardiac
complications
and circulatory failure. Untreated cholera frequently results in high
(50-60%)
mortality rates.
Treatment of cholera involves the rapid intravenous
replacement
of the lost fluid and ions. Following this replacement, administration
of isotonic maintenance solution should continue until the diarrhea
ceases.
If glucose is added to the maintenance solution it may be administered
orally, thereby eliminating the need for sterility and iv.
administration.
By this simple treatment regimen, patients on the brink of death seem
to
be miraculously cured and the mortality rate of cholera can be reduced
more than ten-fold. Most antibiotics and chemotherapeutic agents have
no
value in cholera therapy, although a few (e.g. tetracyclines) may
shorten
the duration of diarrhea and reduce fluid loss.
chapter continued
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