Cholera: a great global concern

Abstract

Cholera, caused by the infection of toxigenic Vibrio cholerae (V. cholerae) to humans, is a life threatening diarrheal disease with epidemic and pandemic potential. The V. cholerae, both O1 and O139 serogroups, produce a potent enterotoxin (cholera toxin) responsible for the lethal symptoms of the disease. The O1 serogroup has two biotypes (phenotypes), classical and El Tor; each of which has two major serotypes (based on antigenic responses), Ogawa and Inaba and the extremely rare Hikojima. V. cholerae O1 strains interconvert and switch between the Ogawa and Inaba serotypes. Fluid and electrolyte replacement is the mainstay of treatment of cholera patients; the severe cases require antibiotic treatment to reduce the duration of illness and replacement of fluid intake. The antibiotic therapy currently has faced difficulties due to the rapid emergence and spread of multidrug resistant V. cholerae causing several outbreaks in the globe. Currently, cholera has been becoming endemic in an increasing number of geographical areas, reflecting a failure in implementation of control measures. However, the current safe oral vaccines lower the number of resistant infections and could thus represent an effective intervention measure to control antibiotic resistance in cholera. Overall, the priorities for cholera control remain public health interventions through improved drinking water, sanitation, surveillance and access to health care facilities, and further development of safe, effective and appropriate vaccines. Thus, this review describes the facts and phenomena related to the disease cholera, which is still a great threat mainly to the developing countries, and hence a grave global concern too.

Edible ice in Jakarta, Indonesia, is contaminated with multidrug-resistant Vibrio cholerae with virulence potential

“…It threatens mortality in many developing countries and remains an important public-health problem (Fazil & Singh, 2011;Mandal et al, 2011). According to a recent survey on the incidence of cholera, Kolkata (India) leads, followed by Beira (Mozambique) and Jakarta (Indonesia) (Deen et al, 2008).…”

“…V. cholerae O1 strains that are resistant to cefotaxime, nalidixic acid, streptomycin, tetracycline and trimethoprim have been isolated from south India (Jagadeeshan et al Cholera has been categorized as one of the emerging and reemerging diseases that cause severe diarrhoea. It threatens mortality in many developing countries and remains an important public-health problem (Fazil & Singh, 2011;Mandal et al, 2011). According to a recent survey on the incidence of cholera, Kolkata (India) leads, followed by Beira (Mozambique) and Jakarta (Indonesia) (Deen et al, 2008).…”

Rethinking cholera pathogenesis- No longer all in the same “camp”

“…Further, in the face of emerging antibiotic resistance, limiting therapeutic options for severe disease, new appro-aches to the treatment of cholera beyond supportive rehydration will likely be needed. 7 In this regard, the work presented highlights possible targets, such as EP and TLR4 receptors, as well as NF-kB activation, that might profitably be explored in clinical trials if the current results can be extrapolated to human patients.…”

“…V. cholerae O1 El Tor variant (EL) is a major epidemic strain to which several recent large outbreaks of severe diarrheal illness have been attributed. [7][8][9] Compared to classical (CL) and El Tor (ET) biotypes of V. cholerae serotype O1, infection with the mixed biotype EL results in more severe diarrhea and dehydration, an effect that had previously been attributed to its much higher production of cholera toxin. [10][11][12][13] Using a mouse model, Satitsri and colleagues set out to examine whether the increased severity of EL-associated disease additionally reflected an inflammatory component that might damage epithelial integrity.…”

“…[15][16][17] Thus, particularly in the setting of infection with El Tor variants of V. cholerae, which in fact have become predominant causes of modern epidemics, we must entertain a more nuanced understanding of the mechanisms that result in life-threatening disease. 7,18,19 These more complex mechanisms, moreover, may be overlaid on host-specific factors, such as variations in innate immune reactivity and perhaps also the influence of the highly variable resident microbiota, which is known to modulate epithelial function. 16,20 This could account for heterogeneity in the clinical presentation of cholera, even in populations similarly exposed to pathogenic strains.…”