Fnt

Active adenyl cyclase

ATP cAMP

Nester-Anderson-Roberts: I IV. Infectious Diseases I 24. Alimentary System I I © The McGraw-Hill

Microbiology, A Human Infections Companies, 2003

Perspective, Fourth Edition

24.5 Bacterial Diseases of the Lower Alimentary System 613

Table 24.5 Cholera

(T) Vibrio cholerae, the causative bacterium, enters the mouth with fecally contaminated food or drink

(2) The bacteria attach to epithelial cells of the small intestine

® V. cholerae toxin enters the cells and prevents them from down-regulating secretion of water and electrolytes

@ The epithelial cells pump water and electrolytes from the blood into the intestinal lumen, causing watery diarrhea

© Shock and death occur because of fluid loss from the circulatory system, unless the fluid can be replaced

© The bacteria exit the body with feces

Symptoms

Incubation period Causative agent

Pathogenesis Epidemiology

Prevention and treatment

Abrupt onset of massive diarrhea, vomiting, muscle cramps

Short, generally 12 to 48 hours

Vibrio cholerae, a curved, alkali and salt tolerant, Gram-negative rod bacterium

Heat-labile exotoxin causes excessive secretion of water and electrolytes by the intestinal epithelium; leads to dehydration and shock

Ingestion of fecally contaminated food or water; sometimes natural sources associated with marine crustaceans

Purification of water, careful handwashing; vaccination.Treatment: Rehydration with a solution of electrolytes and glucose, given intravenously in severe cases; or similar electrolyte solution containing a glucose source given by mouth in milder cases available in a number of countries outside the United States. One consists of a living, genetically altered strain of V. cholerae, and another, killed V. cholerae in combination with the purified recombinant B subunit of cholera toxoid. Treatment of cholera depends on the rapid replacement of electrolytes and water before irreversible damage to vital organs can occur. The prompt administration of intravenous or oral rehydration fluid decreases the mortality of cholera to less than 1%.

The main features of cholera are summarized in table

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