Vibrio cholerae Infection

Excerpt

Toxigenic strains of Vibrio cholerae are a major cause of acute, severe, dehydrating diarrhea in low- and middle-income countries with unsatisfactory hygienic conditions and those affected by natural disasters and humanitarian crises. V cholerae is a gram-negative, comma-shaped bacterium that causes acute, large-volume, watery diarrhea that can result in rapid dehydration and hypovolemia. Cholera is a rapidly progressing illness and is associated with high mortality rates if not treated promptly. The case fatality ratio can exceed 50% without appropriate treatment but decreases to less than 1% when prompt rehydration and antibiotics are administered. V cholerae is transmitted through the fecal-oral route by contaminated water or food. Risk factors for acquiring V cholera include poverty, inadequate sanitation, contaminated water, and food.

Cases of cholera are commonly underreported for many reasons, including a lack of appropriate surveillance and resources. The World Health Organization (WHO) estimates that annually there are 1.4 to 4.0 million cases and 21,000 to 143,000 deaths worldwide from cholera. Historically, cholera has been endemic in the Asian subcontinent, but it has also established itself in other regions and is now endemic in Latin and Central America and sub-Saharan Africa.

Over the past 2 centuries, V cholerae has caused 7 pandemics. The seventh pandemic, which is still ongoing, was first reported in 1961 in Sulawesi, an island governed by Indonesia, in 1971 in Africa, and in 1991 in the Americas. V cholerae is constantly evolving, with new genotypes and phenotypes emerging, most likely due to antibiotic pressure.

Cholera continues to be a significant public health threat for many reasons: its endemicity is expanding, outbreaks are unpredictable, it has high morbidity and mortality, it is underdetected and underreported, antimicrobial resistance is increasing, and resources for treatment are inadequate. The WHO's Global Task Force for Cholera Control (GTFCC), a global network of partners coordinated by the WHO, established an initiative with a goal to reduce cholera globally by 90% and eradicate the disease in at least 20 countries by 2030.

Appropriate oral and intravenous rehydration therapy and administering antibiotics and electrolytes are the cornerstones for treating cholera. Oral cholera vaccines are a significant component of the treatment and control strategies implemented in endemic zones or during an outbreak. These vaccines have been shown to be effective in preventing and managing cholera. Water, sanitation, and hygiene (WASH) practices are also crucial in preventing the transmission of V cholera.