powerpoint presentation - · pdf filechapter-x cholera vibrio cholerae r.kavitha, m.pharm,...
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CHAPTER-XCHOLERAVIBRIO CHOLERAE
R.KAVITHA, M.PHARM,LECTURER, DEPARTMENT OF PHARMACEUTICS,SRM COLLEGE OF PHARMACY,SRM UNIVERSITY, KATTANKULATHUR.
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HISTORY
Origins in India, cases reported as early as 1563About 8 pandemics to date
1817-`23: First Pandemic1829-`50: Second Pandemic1852-`60: Third Pandemic* Pacini1863-`79: Fourth Pandemic1881-`96: Fifth Pandemic * Koch1899-`1923: Sixth Pandemic1961-?: Seventh Pandemic1992-?: Eighth Pandemic
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HISTORY
First pandemic spreads from India to South, Central Asia, Middle East and RussiaSecond pandemic reaches EnglandPandemics in 1800’s deadlyAll pandemics reach AfricaFirst pandemic reaches Latin America in 1991
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DISTRIBUTION
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CAUSATIVE AGENTDISCOVERY
19th Century: What is Cholera?
Miasma Theory
Blood Generation Theory
Germ Theory
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CAUSATIVE AGENTDISCOVERY
John Snow (1813-1858):
Water borne transmission of Cholera (1855)
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DISCOVERY
Filippo Pacini (1812-1883)
1854: Cholera reaches Florence, Italy. Pacini discovers causative agentPublishes “Microscopical Observations and Pathological Deductions on Cholera”1965: Bacterium named Vibrio cholerae Pacini 1854
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DISCOVERY
Robert Koch (1843-1910)
1884: Rediscovers Vibrio cholerae
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VIBRIO CHOLERAEMORPHOLOGY
Gram negative
Comma shaped
Sheathed, polar flagellum
1.4-2.6µm x 0.5-3µm
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PHYSIOLOGY
Facultative anaerobic
Asporogenous
Growth stimulated by NaCl
pH 6 - 10, Acid labile
Temperature 18 - 37ºC
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VIRULENCE & PATHOGENICITYIngestion of V. cholerae
Resistant to gastric acid
Colonize small intestine
Virulence of Non-toxigenic V. cholerae O1 strain not well understood
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Toxigenic V. cholerae Pathogenicity
Colonization factors (the TcpA pilus)
Production of enterotoxin
Associated outer membrane proteins on enterocytes e.g. adenylate cyclase
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Secrete enterotoxin
Enterotoxin binds to intestinal cells
Chloride channels activated
Release Large quantities of electrolytes & bicarbonates
Fluid hypersecretion
Diarrhea
Dehydration
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TRANSMISSION
Fecal-oral route
Entry = oral
Discharge = fecal
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TRANSMISSION
Humans only reservoirs
Bacterium transmitted via contaminated water, food
Carriers: houseflies and other insects
Person to person transmission?
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SYMPTOMS1-3 day Incubation Period
Mild diarrhea Sudden severe diarrhea
Mucus and intestinal tissue visible in feces
Muscle cramps
Scaphoid abdomen
Vomiting
Loss of skin turgor
Weak pulse
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DIAGNOSIS
Clinical symptoms
Isolation of V. cholerae from stoolLive V. cholerae in stool (ca. 1.0 x 108 cells per ml)Identification via dark-field microscopy
Measurement of serum antibodies using ELISAAntibacterial antibodies: vibriocidal assaysAntitoxin antibodies
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METHODS OF CUREChemotherapeutic
Antibiotics (tetracycline)
Immunological
Local mucosal immune response to V. choleraeSerological antivibrio antibodiesAntitoxin antibodies
To Ease Symptoms
Oral RehydrationIntraveneous Rehydration
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PREVENTION & CONTROLImmunization
Active Immunity induced by:attenuated V. choleraeToxoid (not good antigen)
Preventing contamination of food and water e.g. boiling water, covering foodEducation
Personal and domestic hygienePrevention of contamination of water supplies
Improvement of sewage systems