Cholera By: Nadia Nagy

What is Cholera? Cholera is a diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae Bhujel 2013 3-5 million cholera cases currently with ~120,000 deaths each year (WHO 2013) If left untreated can be fatal with in a few hours Fecal oral route transmission In water Sewage Food Unsanitary hygiene

Symptoms 75% of those infected do not show symptoms Symptoms include : Watery diarrhea Severe dehydration Shock Vomiting **Immunocompromised have greater risk of death

History In 1882 German bacteriologist Robert Koch, suggested that cholera was caused by a bacterium that secreted a toxin which caused rapid water loss. Reservoir found in the Ganges Delta in India In the 19th Century 1st pandemic 7 pandemics from 1817-1961

Causes Environmental: Live in costal water and travel with their host Growth is fueled by urea in sewage In Humans: Live in the intestine Pass bacteria through feces deposit Secretes toxin called CTX that increases stool flow Cholera transmission: the host, pathogen, and bacteriophage dynamic. (2009)

Pathology BOLO News 2013

Treatment Oral rehydration salts IV Fluids for severe dehydration Vaccines for preventive measures: Shanchol :long term protection Dukoral : Short term production Antibiotics also available but not common -can limit bacteria in fecal matter

Cholera In the US Rare in the U.S. Pandemic in 1834 hit Mississippi, New Orleans, and New York California, Utah, and Oregon pandemic from 1849–1855 150,000 Americans died from both pandemics believed spread from Irish immigrant ships from England, and then along the gold rush trail

Haiti On going epidemic from October 2010-present Spread quickly after 2010 earthquake As of November 2013 there has been 689,448 cholera cases and 8,448 deaths Pan American Health Organization (2013) due to inadequate sewage and water treatment

FIG 1 Genetic relationships among V FIG 1 Genetic relationships among V. cholerae isolates from Nepal and Haiti. A single maximum parsimony tree was reconstructed using 752 SNPs from 34 whole-genome sequences. SNP differences among the three most closely related Nepali groups and the Haitian group are shown. Once the cholera outbreak was confirmed following the 2010 earthquake in Haiti, rumors spread that the disease was brought to Haiti by Nepalese soldiers serving as United Nations peacekeepers. -whole-genome sequence typing (WGST), pulsed-field gel electrophoresis (PFGE), and antimicrobial susceptibility testing to characterize 24 recent Vibrio cholerae isolates from Nepal suggested epidemiological link with the Haitian outbreak. -Isolates were obtained from 10 from five different districts in Nepal. -Compared the 24 genomes to 10 previously sequenced V. cholerae isolates, including 3 from the Haitian outbreak Antimicrobial susceptibility and PFGE patterns were consistent with an epidemiological link between the isolates from Nepal and Haiti. -Results in this study are consistent with Nepal as the origin of the Haitian outbreak. Hendriksen et al. (2011)

There was a correlation in time and places between the arrival of a Nepalese soliders from an area experiencing a cholera outbreak and the appearance of the first cases in Meille a few days after.

Hendriksen et al. (2011)

References Bacterial Morphology. Microbiology. (2013). Retrieved from: http://microbiollogy.blogspot.com/2013/02/bacterial-morphology-contd_17.html Cholera: Death by Diarrhoea. Society for General Microbiology. (2011) Retrieved from: http://www.microbiologyonline.org.uk/media/transfer/doc/factfile_cholera.pdf Cholera. Mayo Clinic. (2011). Retrieved from: http://www.mayoclinic.org/diseases-conditions/cholera/basics/causes/con-20031469 Cholera outbreaks and pandemics. Wikipedia. Retrieved from: http://en.wikipedia.org/wiki/Cholera_outbreaks_and_pandemics Cholera transmission: The host, pathogen and bacteriophage dynamic. (2009). Nature Reviews Microbiology, 7(10), 693-702. doi:10.1038/nrmicro2204. Retrieved from: http://www.nature.com/nrmicro/journal/v7/n10/fig_tab/nrmicro2204_F2.html Cholera .WHO. (2014). Retrieved from: http://www.who.int/mediacentre/factsheets/fs107/en/ Frerichs, R. R., Keim, P. S., Barrais, R., & Piarroux, R. (2012). Nepalese origin of cholera epidemic in haiti. Clinical Microbiology and Infection : The Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 18(6), E158-E163. doi:10.1111/j.1469-0691.2012.03841.x. Global epidemics and impact of cholera. WHO. Retrieved from: http://www.who.int/topics/cholera/impact/en/ Goodsell, D (2014). Cholera Toxin.  RCSB Protein Data Bank. Retrieved from: http://www.rcsb.org/pdb/101/motm.do?momID=69 Hendriksen, R. S., Upadhyay, B. P., Shrestha, S. D., Adhikari, S., Shakya, G., Keim, P. S., . . . Waters, A. E. (2011). Population genetics of vibrio cholerae from nepal in 2010: Evidence on the origin of the haitian outbreak. Mbio, 2(4), e00157. doi:10.1128/mBio.00157-11 Kaper, J., Morris, J., Jr, & Levine, M. (1995). Cholera [published erratum appears in clin microbiol rev 1995 apr;8(2):316].Clinical Microbiology Reviews, 8(1), 48. Katz, L. S., Orata, F., Gladney, L. M., Stroika, S., Folster, J. P., Rowe, L., . . . Paxinos, E. E. (2013). Evolutionary dynamics of vibrio cholerae O1 following a single-source introduction to haiti. Mbio, 4(4) doi:10.1128/mBio.00398-13. Sack, D., Sack, R., Nair, G., & Siddique, A. (2004). Cholera. Lancet, 363(9404), 223-233. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/14738797