Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

Abstract

Abstract. Mortality and morbidity associated with cholera acquired in a modern endemic setting have not been well defined. In Dhaka, Bangladesh from 1986 to 1996, we found that causative agents of cholera shifted over time, varying by serogroup, biotype, and serotype. At the International Centre for Diarrhoeal Disease Research (ICDDR,B: Centre for Health and Population Research) in 1996, 19,100 cholera patients were treated, 887 (4.6%) were admitted, and 33 died (mortality rate ϭ 3.7% of cholera inpatients, 0.14% of all cholera patients). When cholera inpatients who were discharged improved were compared with those who died, bacteremia (odds ratio [OR] ϭ 10.5, 95% confidence interval [CI] ϭ 2.9-37.9), radiographic evidence of pneumonia (OR ϭ 3.1, 95% CI ϭ 1.2-7.7), and acidosis as estimated by the serum bicarbonate value (OR ϭ 0.893, 95% CI ϭ 0.825-0.963) were independently associated with death by multivariate analysis. Pneumonia was the leading cause of death and accounted for two-thirds of all deaths among individuals with cholera in this study. Death in hospitalized patients with cholera acquired in a modern endemic setting is, therefore, extremely rare, and most frequently due to concomitant infection, especially pneumonia.

Cholera — the new strike of an old foe

“…Death can occur within hours as a result of circulatory collapse. Because of the accumulation of fluid in the intestines, diarrhoea -the typical symptom of cholera -is absent [8].…”

Secretory IgA-mediated protection againstV. choleraeand heat-labile enterotoxin-producing enterotoxigenicEscherichia coliby rice-based vaccine

“…cholera toxin B subunit | mucosal vaccine | oral vaccine | plant-made vaccine | MucoRice C holera is an acute diarrheal disease leading to death by severe dehydration without appropriate treatment, especially in developing countries (1). Cholera toxin (CT), produced by Vibrio cholerae, consists of a B-subunit pentamer (i.e., CTB) and a single A subunit (i.e., CTA) (2).…”

The Mannose-Sensitive Hemagglutinin ofVibrio choleraePromotes Adherence to Zooplankton

“…Despite the fact that O1 strains of the El Tor biotype were not associated with epidemic cholera until the beginning of the seventh pandemic in 1961, they have displaced classical biotype strains during the past 15 years to become the most prevalent epidemic strains at the present time (4,7,59,61). During this time, there was also a transient outbreak caused by strains of the previously unrecognized O139 serogroup (14,49,59).…”

“…During this time, there was also a transient outbreak caused by strains of the previously unrecognized O139 serogroup (14,49,59). Strains of the O139 serogroup share many characteristics with O1 El Tor strains and are thought to be derived from O1 El Tor (18,36,55,71).…”

“…(i) To what degree do different plankton attachment factors contribute to persistence, growth, and survival of the various epidemiological strains in the natural aquatic environment? (ii) Does the possession of the MSHA pilus in addition to at least one additional attachment factor by the O1 El Tor strain have a role in its worldwide replacement of the classical strain in the seventh pandemic and its present epidemiological predominance over O139 in Bangladesh and India (4,7,11,59,61)? (iii) Are particular attachment factors specialized for different types of planktonic surfaces?…”