Biology

(16 - 18)

Cholera
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 What is Cholera?
Cholera is an acute intestinal infection caused by the bacterium
Vibrio cholerae.

Despite being an avoidable and

treatable condition, cholera kills
over 100,000 individuals each year.
The main source of infection is
contaminated water and food, with
most cases occurring in developing
countries.
The incubation period for cholera is
short (less than one to five days). The
bacteria multiply in the intestine where
they release a powerful enterotoxin
that produces severe inflammation of
the intestine, causing a copious, watery
diarrhoea to be produced.
 Cholera – Source of Infection
The main source of cholera
infection is water contaminated
by the faeces of sufferers and
carriers; the bacterium is also
spread by contaminated food.
Cholera is most prevalent in
countries where access to safe
water and sanitation measures
are inadequate.
 Cholera Statistics (1)
The data below displays the cholera cases and deaths notified to the
World Health Organisation (WHO) in 2003.

Number of Log Number

Country/Area Deaths
Cholera Cases of Cases
Africa 108 067 5.03 1884

Americas 33 1.52 0

Asia 3 463 3.54 10

Europe 12 1.08 0

Display the data as a bar chart; comment on the world

distribution of cholera and the number
of reported deaths for the disease’.
Oceania data was not reported in 2003
 Cholera Statistics (3)
The data below displays the cholera cases and deaths notified to the
World Health Organisation (WHO) in 2003.

Number of Log Number

Country/Area Deaths
Cholera Cases of Cases
Africa 108 067 5.03 1884

Americas 33 1.52 0

Asia 3 463 3.54 10

Europe 12 1.08 0

12 cases of cholera were reported in Europe where access to safe water

and sanitation provision is good. How can you account for these cases?
 Cholera Statistics (4)
The data below displays the cholera cases and deaths notified to the
World Health Organisation (WHO) in 2003.

Number of Log Number

Country/Area Deaths
Cholera Cases of Cases
Africa 108 067 5.03 1884

Americas 33 1.52 0

Asia 3 463 3.54 10

Europe 12 1.08 0

All 12 cases occurring in Europe were imported.

 Cholera Statistics - Plotting Log Values

Click here to view the

animated chart
 The Cholera Bacterium - Vibrio cholerae (1)
Haemagglutinin
Accessory
colonisation factors

Comma-shaped
bacterium (vibrio) Flagellum
Pili

Flagellar motility and chemotaxis allow the bacteria

to colonise the small intestine; bacteria swim into the
intestinal mucosal layer.

The haemagglutinins, accessory factors and pili are required for adherence
to and successful colonisation of intestinal epithelial cells.

Enterotoxin release disturbs normal gut homeostasis.

 The Cholera Bacterium - Vibrio cholerae (2)

Transmission electron microscope image of Vibrio cholerae that has

false digital colour. This is a wild type strain, clearly showing the pili
as 7nm fibres that form bundles.
 How Vibrio cholerae Affects the Intestines (1)
Intestinal Lumen of
Blood epithelial cells intestine
Normal Gut Homeostasis
Within the human intestine,
normal movement of ions
involves the uptake of sodium
ions from food into the
bloodstream. There is no net
movement of chloride ions from
the blood into the lumen of
the intestine.

Na+ from food

When Vibrio cholerae colonise the
intestine, normal ion movements
are disrupted.
 How Vibrio cholerae Affects the Intestines (2)
Intestinal Lumen of
Blood epithelial cells intestine Vibrio cholerae bind to intestinal
epithelial cells releasing their
Binding of enterotoxins. The toxin binds to
enterotoxin sugar groups projecting from the
epithelial cells.

Vibrio cholerae Cholera toxin activates epithelial

Cholera toxin adenyl cyclase. This enzyme
catalyses the conversion of ATP
Adenyl cyclase to cyclic AMP (cAMP) within the
ATP cAMP cells.
The increased cAMP levels block
+
X Na the transport of Na+ into the
epithelial cells and bring about
Cl- the active secretion of chloride
ions into the lumen.
Explain how the action of the
enterotoxin leads to copious,
watery diarrhoea.
 How Vibrio cholerae Affects the Intestines (3)
Intestinal Lumen of
Blood epithelial cells intestine Vibrio cholerae bind to intestinal
epithelial cells releasing their
Binding of enterotoxins. The toxin binds to
enterotoxin sugar groups projecting from the
epithelial cells.

Vibrio cholerae Cholera toxin activates epithelial

Cholera toxin adenyl cyclase. This enzyme
catalyses the conversion of ATP
Adenyl cyclase to cyclic AMP (cAMP) within the
ATP cAMP cells.
The increased cAMP levels block
+
X Na the transport of Na+ into the
epithelial cells and bring about
Cl- the active secretion of chloride
ions into the lumen.
The change in ion concentrations across the
epithelial cells disrupts the osmotic balance.
The large concentration of ions in the intestinal
H2O lumen leads to the osmotic movement of large
amounts of water into the lumen
 Oral Rehydration Therapy (1)

Photo credit: CDC

Cholera-induced dehydration is rapid and can quickly lead to death; this patient is
being given oral rehydration therapy (a solution of glucose and salts) to counteract
the severe dehydration.
 Oral Rehydration Therapy (2)

Photo credit: CDC

During a cholera epidemic in Peru, some of the very ill patients are being treated
by intravenous drip to counteract their severe dehydration.
 Prevention of Cholera (1)
The principle issues that need to be addressed to prevent
outbreaks of cholera are:

▪ Improvements in water supply

▪ Improvements in sanitation and sewage disposal
▪ Food safety
▪ Community awareness of preventative measures
▪ Political commitment

Oral cholera vaccines have recently become available for

use by individuals; the use of vaccines as a preventative
measure is still being researched and reviewed.
Use a variety of resources to research the
current status of oral cholera vaccines.
 Cholera – A Global Threat

“Cholera remains a global threat and one of the

key indicators of social development. While the
disease no longer poses a threat to countries
with minimum standards of hygiene, it remains
a challenge to countries where access to safe
drinking-water and adequate sanitation cannot
be guaranteed for all. Almost every developing
country is facing either a cholera outbreak or
the threat of a cholera epidemic.”

World Health Organisation

 Acknowledgements:
Various disease images
Courtesy of Public Health Image Library
Department of Health and Human Services
Centres for Disease Control and Prevention, USA

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