Cholera By: Kelsey Duncan

http://fieldnotes.unicefusa.org/photos/

Cholera was discovered by Filippo Pacini.

Robert Koch, 1883

Filippo Pacini, 1854

Vibrio Cholerae

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

Humans (intestines)

Marine Life (shellfish, oysters)

Cholera can have different hosts!

The main connection is water.

Ingested bacteria travel to the upper small intestine, where they

replicate.

Trends Pharmacol Sci. 26, J. R. Thiagarajah and A. S. Verkman, New Drug Targets for Cholera Toxin.

A, B: cholera toxin subunits

GM1: ganglioside receptor

AC: adenylate cyclase

G: G protein

cAMP: cyclic AMP

CFTR: cystic fibrosis transmembrane conductance regulator

Cholera expresses a toxin that leads to severe symptoms, and if not treated, death.

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

cookedAvoid undercooked or raw

fish or shellfishAvoid foods and beverages

from street vendorsDo not bring perishable food

back to the United StatesEmed, 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