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Organism
- Low tolerance for acid, grows under alkaline conditions
- Distinguished by LPS, O Ag, and production of Cholera toxin
- O1=eltor, O139 cause cholera
- Toxin coregulated pilus, expression regulated with CT
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Toxin
- ADP-R toxin
- B=GM1-ganglioside receptor
- Binds Gs, keeps it activated
- Increases cAMP -> hypersecretion of chloride
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Epidemiology
- Contaminated water
- Endemic in India, Africa
- Human carriage brief, incubation =1-2 days
- Inadequately cooked shellfish
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Pathogenesis
- Colonizes jejenum to colon
- Surface pili adhesion factors
- Cholera toxin
- Outpourin of fluid, electrolytes greatest in Small Intestine
- Same sodium content, 2-5x K and HCO3 content
- Dehydration, hypokalemia
- Not altered mucosa
- Transmembrane protein ToxR regulates TCP and CT responds to environment changes
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Manifestations
- Rapdi onset
- Fullness, discomfort, loose stools
- Watery, volumness, odorless, rice water stools
- No pus or blood, afebrile
- Dehydration, hypotension, death
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Diagnosis
- Isolation from stool
- Selective media
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Treatment
- Supportive
- Rehydration
- Doxycycline shortens duration
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