Cholera transmission: the host, pathogen and bacteriophage dynamic
Key Points Vibrio cholerae is a facultative pathogen that has an environmental reservoir in aquatic ecosystems and a pathogenic phase in the human small intestine. It produces cholera toxin in the small intestine that results in massive secretory diarrhoea containing billions of vibrios per litre. C...
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| Published in: | Nature reviews. Microbiology Vol. 7; no. 10; pp. 693 - 702 |
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| Main Authors: | , , , , |
| Format: | Journal Article |
| Language: | English |
| Published: |
London
Nature Publishing Group UK
01.10.2009
Nature Publishing Group |
| Subjects: | |
| ISSN: | 1740-1526, 1740-1534, 1740-1534 |
| Online Access: | Get full text |
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| Summary: | Key Points
Vibrio cholerae
is a facultative pathogen that has an environmental reservoir in aquatic ecosystems and a pathogenic phase in the human small intestine. It produces cholera toxin in the small intestine that results in massive secretory diarrhoea containing billions of vibrios per litre.
Cholera has two patterns of disease: endemic disease with sporadic cases and limited outbreaks, and epidemic disease with an exponential rise and fall of cases lasting several months. Transmission occurs in households through foods, water and possibly close contact, and on a larger scale through contaminated bodies of water.
The spread of cholera is dependent on numerous environmental and biological variables, including seasonal environmental drivers, host immunity, infectivity of the bacteria and lytic bacteriophages.
Acquired immunity can be long-lived. Both killed whole-cell and live attenuated vaccines have been developed, but formulations and efficacy can be improved.
The nature of hyperinfectivity of
V. cholerae
is multifactorial and transient.
Lytic bacteriophages can prey on
V. cholerae
in the intestinal tract and in the environment. Homeostasis can be achieved between prey and predator.
Mathematical models to predict the magnitude of a cholera outbreak have been developed, although they have limitations. These models should include recently discovered variables for the durability of immunity at the patient and population levels, the ratio of asymptomatic to symptomatic infections, hyperinfectivity and lytic bacteriophage predation in the host and environment.
Diarrhoeal diseases such as cholera are the second most common cause of death among children under 5 years of age globally. In this Review article, Andrew Camilli and colleagues discuss the contributions of host susceptibility,
Vibrio cholerae
virulence and lytic phage to the dynamic nature of cholera outbreaks.
Zimbabwe offers the most recent example of the tragedy that befalls a country and its people when cholera strikes. The 2008–2009 outbreak rapidly spread across every province and brought rates of mortality similar to those witnessed as a consequence of cholera infections a hundred years ago. In this Review we highlight the advances that will help to unravel how interactions between the host, the bacterial pathogen and the lytic bacteriophage might propel and quench cholera outbreaks in endemic settings and in emergent epidemic regions such as Zimbabwe. |
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| Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 14 content type line 23 ObjectType-Review-3 |
| ISSN: | 1740-1526 1740-1534 1740-1534 |
| DOI: | 10.1038/nrmicro2204 |