Cholera, Non-Vibrio Cholera, and Stomach Acid

Nalin, DavidR.; Levine, M. M.; Bergquist, Eric; Libonati, Joe; Levine, RichardJ.; Hoover, David L.; McLaughlin, James C.; Alam, Jainul; Hornick, R. B.

doi:10.1016/s0140-6736(78)91568-4

Cited by 90 publications

(35 citation statements)

References 6 publications

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“…In volunteer challenge studies a total purge of >5.0 liters of diarrheal stool is used as the definition of severe cholera and indicates a degree of purging that if not promptly and properly treated with aggressive rehydration would lead to cholera gravis, manifested by severe dehydration and hypovolemic shock. Another host risk factor for development of severe cholera is hypochlorhydria, with evidence deriving from clinical observations [39], epidemiologic studies, and volunteer challenge studies [40, 41]. …”

Section: Host Factorsmentioning

confidence: 99%

Factors That Explain Excretion of Enteric Pathogens by Persons Without Diarrhea

Levine

Robins-Browne

2012

Clinical Infectious Diseases

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Excretion of enteropathogens by subjects without diarrhea influences our appreciation of the role of these pathogens as etiologic agents. Characteristics of the pathogens and host and environmental factors help explain asymptomatic excretion of diarrheal pathogens by persons without diarrhea. After causing acute diarrhea followed by clinical recovery, some enteropathogens are excreted asymptomatically for many weeks. Thus, in a prevalence survey of persons without diarrhea, some may be excreting pathogens from diarrheal episodes experienced many weeks earlier. Volunteer challenges with Vibrio cholerae O1, enterotoxigenic Escherichia coli (ETEC), enteropathogenic E. coli, Campylobacter jejuni, and Giardia lamblia document heterogeneity among enteropathogen strains, with some inexplicably not eliciting diarrhea. The immune host may not manifest diarrhea following ingestion of a pathogen but may nevertheless asymptomatically excrete. Some human genotypes render them less susceptible to symptomatic or severe diarrheal infection with certain pathogens such as Vibrio cholerae O1 and norovirus. Pathogens in stools of individuals without diarrhea may reflect recent ingestion of inocula too small to cause disease in otherwise susceptible hosts or of animal pathogens (eg, bovine or porcine ETEC) that do not cause human illness.

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Section: Host Factorsmentioning

confidence: 99%

Factors That Explain Excretion of Enteric Pathogens by Persons Without Diarrhea

Levine

Robins-Browne

2012

Clinical Infectious Diseases

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“…A very high‐risk setting for developing TD is seen with persons living in industrialized regions but travelling to a developing region to visit friends and relatives living under less hygienic conditions 76 . A separate group where chemoprophylaxis may be indicated include those having experienced TD before, suggesting genetic susceptibility to the disease, 77, 78 or those with reduced levels of gastric acid from drugs or prior surgery 79–81 . One authority in travel medicine furthermore suggested that prophylaxis be provided to persons requesting use of a preventive drug for future travel if they are not in one of the other categories 75 .…”

Section: Current Recommendation For Chemoprophylaxismentioning

confidence: 99%

Systematic review: prevention of travellers’ diarrhoea

DuPont

2008

Aliment Pharmacol Ther

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“…We found no published reports of blood group distribution in Haiti. Other risk factors related to development of symptomatic cholera are low gastric acidity,17,18 retinol deficiency,12 and, potentially, iron deficiency 19…”

Section: Introductionmentioning

confidence: 99%

Seroepidemiologic Survey of Epidemic Cholera in Haiti to Assess Spectrum of Illness and Risk Factors for Severe Disease

Jackson¹,

Talkington²,

Pruckler³

et al. 2013

The American Society of Tropical Medicine and Hygiene

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To assess the spectrum of illness from toxigenic Vibrio cholerae O1 and risk factors for severe cholera in Haiti, we conducted a cross-sectional survey in a rural commune with more than 21,000 residents. During March 22–April 6, 2011, we interviewed 2,622 residents ≥ 2 years of age and tested serum specimens from 2,527 (96%) participants for vibriocidal and antibodies against cholera toxin; 18% of participants reported a cholera diagnosis, 39% had vibriocidal titers ≥ 320, and 64% had vibriocidal titers ≥ 80, suggesting widespread infection. Among seropositive participants (vibriocidal titers ≥ 320), 74.5% reported no diarrhea and 9.0% had severe cholera (reported receiving intravenous fluids and overnight hospitalization). This high burden of severe cholera is likely explained by the lack of pre-existing immunity in this population, although the virulence of the atypical El Tor strain causing the epidemic and other factors might also play a role.

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Cholera, Non-Vibrio Cholera, and Stomach Acid

Cited by 90 publications

References 6 publications

Factors That Explain Excretion of Enteric Pathogens by Persons Without Diarrhea

Factors That Explain Excretion of Enteric Pathogens by Persons Without Diarrhea

Systematic review: prevention of travellers’ diarrhoea

Seroepidemiologic Survey of Epidemic Cholera in Haiti to Assess Spectrum of Illness and Risk Factors for Severe Disease

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