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Vibrio cholerae Dr. Jyotsna Agarwal Dept. Microbiology Cholera: Introduction Transmitted to humans via contaminated food and water Part of normal flora of brackish water and estuaries Epidemiology of Vibrio cholerae Cholera recognized for more than two millennia with sporadic disease and epidemics Endemic in communities with poor sanitation Seven pandemics (possible beginning of 8th) since 1817 Human carriers and environmental reservoirs Historical Perspective: 1817-1820 First Pandemic spread out of India to Europe spread from India -> Middle East (reaching Turkey & Persia) -> Far East (Singapore, Japan, Philippines) 1829-1851 Second pandemic Entered US through NY and New Orleans -> proceeded through entire country Historical Perspective: Identification 1854 - Filippo Pacini identified curved or comma shaped bacterium associated with this disease, which he called Vibrio cholerae 1883- Rober Koch isolated the bacteria Historical Perspective: 1854- John Snow hypothesized water as primary reservoir for transmission – Broad Street pump incident – 56 deaths in 2 days Recent Cholera Pandemics 7th pandemic: V. cholerae O1 biotype El Tor Began in Asia in 1961 8th pandemic (??) V. cholerae O139 Bengal Began in India in 1992 and spread to Asia, Europe and U.S. Cholera affected countries General Characteristics of Vibrio Similarities to Enterobacteriaceae Gram-negative Facultative anaerobes Fermentative bacilli Differences from Enterobacteriaceae Polar flagella Oxidase positive Vibrio spp. (Family Vibrionaceae) Associated with Human Disease General Characteristics of Vibrio Comma-shaped bacilli pH range for growth on media pH 7.0 - 9.0 V. cholerae grow without salt, Most other vibrios are halophilic Taxonomy of Vibrio cholerae >200 serogroups based on somatic O-antigen O1 and O139 serogroups are responsible for epidemic cholera O1 serogroup subdivided into Two biotypes: El Tor and classical Three serotypes: ogawa, inaba, hikojima Non-cholera vibrio (NCV) or nonagglutinating vibrios (NAG) or non-O1 vibrio cholerae) Difference between El Tor & classical Vibrio cholerae Pathogenesis of V.cholerae Incubation period: 2-3 days High infectious dose Abrupt onset of life-threatening watery diarrhea Rice-water stools: Colorless Odorless Speckled with mucus Pathogenesis of V. cholerae Cholera toxin leads to profuse loss of fluids and electrolytes (Na, K HCO3) A-B type of toxin, receptor GM1, increase intracellular cAMP Death attributable to: Hypovolemic shock Metabolic acidosis Laboratory Identification of Vibrios Transport medium or holding medium - Cary-Blair - Venkatraman Ramakrishnan medium- liquid Enrichment medium - alkaline peptone broth Yellow colonies on TCBS Selective/differential culture medium TCBS agar – V. cholerae grow as yellow colonies – Gram stain – Biochemical and serological tests – Motility- Darting motility on hanging drop preparation Treatment & Prevention of cholera Untreated: 60% fatality Treated: <1% fatality Rehydration & supportive therapy Oral Intravenous Doxycycline or tetracycline Water purification, sanitation & sewage treatment Vaccines Summary General characters of vibrio, history Vibrio cholerae Cholera: mode of spread, clinical features Laboratory diagnosis Treatment/prevention