Cholera

By: Kelsey Duncan

http://fieldnotes.unicefusa.org/photos/
Cholera was discovered by Filippo Pacini.

Vibrio
Cholerae

Filippo Pacini, 1854

Robert Koch, 1883

Rosenberg, Charles E. (1987). The cholera years: the United States in 1832, 1849 and 1866.
Vibrio Cholerae is the causative agent.

http://en.wikipedia.org/wiki/Cholera
Reports of cholera probably barely scratch the surface.

WHO, http://www.phac-aspc.gc.ca/tmp-pmv/info/cholera-eng.php
 Around the world,
an estimated 3-5
million cases and
over 100,000 deaths
occur each year.

WHO, 2012
 Cholera can have different hosts!

Humans (intestines)

Marine Life (shellfish, oysters)

The main connection is water.
Ingested bacteria travel to the upper
small intestine, where they replicate.
 Cholera expresses a toxin that leads to severe symptoms, and if
not treated, death.

A, B: cholera toxin
subunits

GM1: ganglioside
receptor

AC: adenylate cyclase

G: G protein

cAMP: cyclic AMP

CFTR: cystic fibrosis

transmembrane
conductance regulator

Trends Pharmacol Sci. 26, J. R. Thiagarajah and A. S. Verkman, New Drug Targets for Cholera Toxin.
Cholera toxin is
released from
bacteria in
infected
intestine
 Toxin binds
through
interaction of
the B subunit of
the toxin with
the GM1
ganglioside
receptor.

Triggers
endocytosis of
toxin
 Toxin undergoes
cleavage for A1
subunit to become
active enzyme

Inside cell: A1
fragment of toxin
subunit enters
cytosol and
activates G protein
 Action
stimulates
adenlate
cyclase to
produce cAMP
 High levels of
cAMP activate the
CFTR causing a
dramatic efflux of
ions and water
from infected
endothelial cells,
leading to watery
diarrhea
 The main symptom is rapid and
major fluid loss.

Sudden onset and

large amounts of
watery diarrhea

Major Fluid Loss

Emed, http://diarrhea.emedtv.com/cholera/cholera-symptoms.html
The most effective treatment for cholera is
oral rehydration therapy.

Mayo Clinic, 2011

 Two oral vaccines exist to
increase immunity.
Dukoral
Mutacol

Ryan, 2006, “Live Oral Cholera Vaccines”

 To prevent cholera while traveling
follow these suggestions.
 Drink only water that you have
boiled

 Make sure all vegetables are

cooked

 Avoid undercooked or raw fish

or shellfish

 Avoid foods and beverages from

street vendors

 Do not bring perishable food

back to the United States
Emed, 2012,
http://diarrhea.emedtv.com/cholera/prevention-of-cholera-p2.html
Cholera outbreak officially announced in Haiti on October 22, 2010.
Paul Farmer, PIH, 2011
 Many organizations, including
Partners in Health, are supplying aid.
Public health prevention in Haiti
and all developing countries is
crucial to eradicate cholera.
 References
 General information on vibrio cholera, cholera toxin, etc.
 www.wikipedia.org

 Cholera Toxin Pathway

 http://www.ebi.ac.uk/interpro/potm/2005_9/Page2.htm

 Effects on Health
 http://diarrhea.emedtv.com/cholera/cholera-symptoms.html

 Treatment
 WHO/CDS/CSR/ISR/2000.1 WHO Report on Global Surveillance of Epidemic-prone
Infectious Diseases-
http://www.who.int/csr/resources/publications/surveillance/en/cholera.pdf

 Incidence Reports
 WHO, 2008, http://www.who.int/topics/cholera/surveillance/en/index.html

 Prevention
 http://diarrhea.emedtv.com/cholera/prevention-of-cholera-p2.html

 Epidemiology Report: Cholera in Haiti

 Paul Farmer, Partners in Health, 2011, http://www.cdc.gov/haiticholera/haiti_cholera.htm