Background Culturing is generally considered to be the gold standard for detecting Vibrio cholerae in stool, though it is not always feasible in resource-limited settings. The Crystal VC dipstick test allows for rapid stool testing for the diagnosis of cholera in the field. However, previous studies have found low specificities (49%–79%) associated with direct testing of stool for cholera using this kit when compared to culturing. Methods In the present study conducted in Dhaka, Bangladesh in 2013, we compare direct testing using the Crystal VC dipstick test and testing after enrichment for 6-hours in Alkaline Peptone Water (APW) to bacterial culture as the gold standard. Samples positive by dipstick but negative by culture were also tested using PCR. Results Stool was collected from 125 patients. The overall specificities of the direct testing and testing after 6-hour enrichment in APW compared to bacterial culture were 91.8% and 98.4% (p=0.125) respectively, and the sensitivities were 65.6% and 75.0% (p=0.07), respectively. Conclusion The increase in the sensitivity of the Crystal VC kit with the use of the 6 hour enrichment step in APW compared to direct testing was marginally significant. The Crystal VC dipstick was found to have a much higher specificity than previously reported (91–98%). Therefore this method provides a promising screening tool for cholera outbreak surveillance in resource limited settings where elimination of false positive results is critical.

Recurrent cholera causes significant morbidity and mortality among the growing population of Dhaka, the capital city of Bangladesh. Previous studies have demonstrated that household contacts of cholera patients are at >100 times higher risk of cholera during the week after the presentation of the index patient. Our prospective study investigated the mode of transmission of Vibrio cholerae, the cause of cholera, in the households of cholera patients in Dhaka city. Out of the total 420 rectal swab samples analyzed from 84 household contacts and 330 water samples collected from 33 households, V. cholerae was isolated from 20%(17/84) of household contacts, 18%(6/33) of stored drinking water, and 27%(9/33) of source water samples. Phenotypic and molecular analyses results confirmed the V. cholerae isolates to be toxigenic and belonging to serogroup O1 biotype El Tor (ET) possessing cholera toxin of classical biotype (altered ET). Phylogenetic analysis by pulsed-field gel electrophoresis (PFGE) showed the V. cholerae isolates to be clonally linked, as >95% similarity was confirmed by sub-clustering patterns in the PFGE (NotI)-based dendrogram. Mapping results showed cholera patients to be widely distributed across 25 police stations. The data suggesting the transmission of infectious V. cholerae within the household contacts of cholera patients through drinking water underscores the need for safe water to prevent spread of cholera and related deaths in Dhaka city.

Helicobacter pylori infection is the main cause of gastric cancer. Vacuolating cytotoxin A (VacA) is a H. pylori pore-forming toxin and a key determinant of gastric cancer risk. VacA is secreted as an 88-kDa polypeptide (p88) that upon interaction with host cells induces cytotoxic effects, including cell vacuolation and mitochondrial dysfunction. These effects are currently believed to be due to VacA p88 accumulating inside host cells and forming oligomeric anion-specific channels in membranes of intracellular compartments. However, the molecular nature of intracellular VacA channels in host cells remains undefined. Here we show that VacA within endosomes is rapidly processed into smaller p31/p28 and p37 products that coincide with vacuolating activities. VacA processing requires endosomal acidification and concerted cleavage by multiple endo-lysosomal proteases including cathepsins. In situ structural mapping reveals that upon processing, the toxins central hydrophilic linker and globular C-terminus are excised, whereas oligomerization determinants are retained. Congruently, the processed products are constituents of a high-molecular-weight complex inside the host cell, which we propose is the intracellular, mature and active VacA pore. These findings suggest that VacA exploits human endosomal machinery for proteolytic processing and intracellular activation.