VIBRIO, CAMPYLOBACTER AND HELICOBACTER

Gehan J. Panagoda

Cholera

An acute diarrhoeal disease

IP 6 hrs to 3 days Faces/vomitus/carrier state are sources of infection death may occur in 24 hrs effortless vomiting profuse rice water stool quick dehydration hypovolaemic shock - due to fluid loss metabolic acidosis - due to fluid loss anuria 15 -20 liters of fluid will be lost in a day

Cholera

Endemic - localized situation /poor sanitary conditions Epidemic - a geographic region / due to migration of people Pandemic- over most of the world , there have been 7 pandemics In Sri Lanka it is mainly a endemic disease In 1999 - 112 patients Colombo > Puttalam > Moneragala

Carrier state Convalescent carrier - can survive in the gall bladder and secrete for about 4 to 5 weeks
Chronic carrier state In the gall bladder, observed only with ElTors

Vibrio
Short Rigid Gram -ve Single flagellum

Comma ( ) shape - called Comma vibrio

Halophilic vibrios

V. parahaemolyticus V. alginolyticus V. vulnificus V. mimicus

Non-halophilic vibrios

V. cholerae 01 - classical - El Tor biotype non 01 V. cholerae (NCV or NAG)

Flagella - H antigens - common to many vibrios O antigens present on the cell wall is different in strains

O gives the smoothness

VIBRIOS Gp A Common H Different O O subgroup I (V. cholerae 01) Gp B Unrelated to Cholera vibrios

Serologically
O subgroups II-VI (NAG vibrios or V. cholerae non-01[NCV])

Non-haemolytic cholerae vibrios (Classical type) Voges-Proskauer -ve (VP) Based on minor differences in 01

Haemolytic El Tor vibrios

Voges-Proskauer +ve (VP) Based on minor differences in 01

Ogawa Inaba

Hikogima

Ogawa Inaba

Hikogima

Virulent factors

Toxins and enzymes - heat stable endotoxin - enterotoxin (exotoxin [cholera toxin CT]) - CT is antigenically and pharmacologically identical in all sero and bio types

SCAN FIGURE

Vascular permiability factor (VPF) CT increases capillary permeability factor Mucinase Extreme cellular desquamation Resistance Susceptible to heat, drying, autoclaving temp, high pH, saltycan survive in linen for 1-3 days. ElTor survive longer periods than the classical type

Initially ElTor has been isolated from Haj pilgrims ElTor has been responsible for endemic and pandemic outbreaks Differentiation of ElTor from classical types Chick red cell agglutination test loopful of culture + saline (on a slide) + 2.5% chick erythrocytes clumping in a minute in ElTor Sensitivity to polymyxin B Classical +ve

Voges-proskauer test (VP) ElTor +ve Phage typing

SCAN Table 35.4 and 35.5

Laboratory diagnosis Specimens From patients - watery stools and mucous flakes From contacts and carriers - rectal swabs Transport - Venkataraman-Ramakrishnan (VR) Vibrios do not multiply - Bile peptone

Direct microscopy Not a reliable method Wet preparation in saline/dark field

Darting movement

Movements stop on adding antisera Culture Stools can be directly cultured If transport media used, sub on a enrichment medium before culturing on a solid medium Available media - MacConkey ( Vibrio - NLF) - Monsurs medium - black centre with turbid halo

Biochemical tests Main tests to be performed VP Haemolysis Polymyxin B Phage typing

Agglutination test 1st test for V. cholerae 01 with its antiserum If +ve use monospecific sera of Ogawa and Inaba IF the 1st colony becomes negative, repeat at least for further five colonies because V. cholerae 01and non-01 V. Cholerae may coexist together If test become -ve with antisera of V. Cholerae 01, test for 02-0139 O types

As a precautionary measure
Carriers can be detected Water and sewage can be tested for Vibrios Immunity Antibodies can be detected after an infection However, there is only a limited protection, repeat attacks are not common for 6-12 months

Prophylaxis General measures Increased sanitation and purification of water Isolation of patiensts Specific measures Parenteral -A killed whole cell vaccine is available (Equal number of Inaba and Ogawa)

Oral - B. subunit-whole cell vaccine (BS-WC)

CT B subunit Heat killed classical vibrio -ogawa Heat killed classical vibrio -Inaba Formalin killed ElTor -Ogawa Formalin killed ElTor - Inaba

Overall protection 85% for one year 60% for two years Live vaccine Recombinant vaccine is available Gene of V. Cholerae 01 has been inserted to Salmonella typhi Ty21a

Treatment Need to replace the lost water and electrolytes Sodium chloride 3.5g Potassium chloride 1.5g Sodium citrate 2.9g Glucose 20.0g ALL IN A LITERE OF CLEAN DRINKING WATER Antibiotic treatment Secondary importance/Tetracycline can be given to reduce the stool output