医学英语课件2.pptVIP

Cholera, is a Greek word, which means the gutter of the roof. It is caused by bacteria: Vibrio cholerae, which was discovered in 1883 by Robert Koch during a diarrheal outbreak in Egypt. Its antigenic structure consists of a flagellar H antigen and a somatic O antigen. It is the differentiation of the latter that allows for separation into pathogenic and nonpathogenic strains. BACKGROUND V. CHOLERAE The organism is a comma-shaped, gram-negative, aerobic bacillus whose size varies from 1-3 mm in length by 0.5-0.8 mm in diameter V. cholerae has 2 major biotypes: classical and El Tor, which was first isolated in Egypt in 1905. Currently, El Tor is the predominant cholera pathogen worldwide. PATHOGENESIS V cholerae cause clinical disease by producing an enterotoxin that promotes the secretion of fluid and electrolytes into the lumen of the gut The result is watery diarrhea with electrolyte concentrations isotonic to those of plasma The enterotoxin acts locally does not invade the intestinal wall. As a result few WBC no RBC are found in the stool. Fluid loss originates in the duodenum and upper jejunum; the ileum is less affected The colon is usually in a state of absorption because it is relatively insensitive to the toxin The large volume of fluid produced in the upper intestine, however, overwhelms the absorptive capacity of the lower bowel, which results in severe diarrhea. TRANSMISSION Cholera is transmitted by the fecal-oral route through contaminated water food Person to person infection is rare The infectious dose of bacteria required to cause clinical disease varies with the source. If ingested with water the dose is in the order of 103-106 organisms. When ingested with food, fewer organisms are required to produce disease, namely 102-104. Cholera has 2 main reservoirs, man water. Animals do not play a role in transmission of disease. V. cholerae is unable to survive in an acid medium. Therefore, any condition that reduces gastric acid production increas