Pathologic findings from intestinal biopsy specimens in human cholera

Asakura, Hitoshi; Morita, Akira; Morishita, Tetsuo; Tsuchiya, Masaharu; Fukumi, Hideo; Ohashi, Makoto; Uylangco, C.; Castro, A.

doi:10.1007/bf01070987

Cited by 20 publications

(3 citation statements)

References 10 publications

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“…V. cholerae non-0-1 clinical isolates have been reported to cause the destruction of intestinal villi (22,31). Villous denudation was also noted in intestinal biopsies from humans with cholera by Asakura et al (1); according to these authors, Virchow had already described the phenomenon in intestinal lesions caused by cholera in 1879. However, the denudation concept seems controversial, other authors (E. J. Gangarosa, A. Takeuchi, and H. Sprinz, Am.…”

Section: Discussionmentioning

confidence: 96%

In vivo adherence and colonization of Vibrio cholerae strains that differ in hemagglutinating activity and motility

Teppema¹,

Guiñée²,

Ibrahim³

et al. 1987

Infect Immun

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A scanning electron microscopic study was carried out to compare the in vivo pathogenicity of two strains of Vibrio cholerae in an adult rabbit ligated-gut test model. V. cholerae C5 (serotype Ogawa, biotype El Tor), a motile strain possessing hemagglutinating activity in vitro, and C21 (serotype Ogawa, classical biotype), a nonmotile strain possessing no hemagglutinating activity, were tested. Tissue samples from small intestinal loops were examined 3, 6, 9, and 12 h postinoculation. Contradictory to most published data, neither hemagglutinating activity nor motility appeared to be essential prerequisites for the pathogenesis of cholera in the experimental animal model used: nonmotile hemagglutinin-negative strain C21 adhered to and colonized the small intestine at least to the same extent as did motile hemagglutinin-positive strain C5. Maximum colonization was seen at 9 h postinoculation for both strains. C5 and C21 vibrios caused comparable damage to the villi of the small intestine. The villous epithelium showed only mild changes during the first 9 h postinoculation. However, after 12 h the epithelium was seriously damaged concomitant with a decrease in the number of vibrios. Many villi showed partial or total denudation, owing to repelled epithelium, leaving a bare basal lamina with only some to moderate numbers of vibrios attached. Since similar changes were induced by pure cholera enterotoxin, these changes were likely the result of excessive fluid accumulation. From this study it is concluded that, at least in the animal model used, factors other than hemagglutinating activity and motility may also play a role in the association of V. cholerae with the small intestinal surface.

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Section: Discussionmentioning

confidence: 96%

In vivo adherence and colonization of Vibrio cholerae strains that differ in hemagglutinating activity and motility

Teppema¹,

Guiñée²,

Ibrahim³

et al. 1987

Infect Immun

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“…The clinical diagnosis was confirmed bacteriologically in each case, and the cultures of rectal swabs were all positive for Vibrio cholerae. The identity of isolates was reported in detail in our previous report (Asakura et al, 1973 illness when biopsy was carried out are summarized in the table. Patients had diarrhoea at the time of biopsy but they were not in shock because they were receiving replacement therapy of fluids and electrolytes.…”

Section: Methodsmentioning

confidence: 99%

“…A light microscopic study reported by us on the jejunal mucosa in human cholera showed that there were villi associated with pathological desquamation and necrosis of epithelial cells between villi with intact structures (Asakura, Morita, Morishita, Tsuchiya, Fukumi, Ohashi, Uylangco, and Castro, 1973). Rice watery stool was supposed to be due in part to multiple pathological desquamation and necrosis of the intestinal epithelium, as well as to hypersecretion of epithelial cells and excessive production of mucus in the crypts.…”

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confidence: 98%

Electron microscopic study on the jejunal mucosa in human cholera

Asakura¹,

Tsuchiya²,

Watanabe³

et al. 1974

Gut

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SUMMARY Small intestinal mucosa obtained from six fasting patientswith cholera byaperoral biopsy technique was studied with the electron microscope. The cultures of their rectal swabs were all positive for Vibrio cholerae. In the absorptive cells, large pseudopod-like cytoplasmic processes with deformed microvilli or without microvilli (blebs) projected into the intestinal lumen from the apical cell surface, interrupting the microvillous border. In the crypts some of the undifferentiated crypt cells possessed pseudopod-like cytoplasmic projections which extended into the crypt lumen. The swelling of mitochondria, the disappearance of their cristae, an increase in the number of vesicles of the Golgi apparatus, and the dilatation and vesiculation of endoplasmic reticulum were observed in the epithelial cells. The apical portion of the cells became oedematous in some of the epithelial cells. Cytoplasmic fragments enclosed by a plasma membrane, desquamated epithelial cells, cytoplasmic organelles, and secretory granules were lying free in the intestinal lumen.Marked irregular widening of the interepithelial spaces in the jejunal mucoa was observed at the midvillous area. Many cystic vacuoles were present in the cytoplasm of epithelial cells. The possibility of fluids being transported from blood vessels to intestinal lumina through the interepithelial spaces, and the significance of these pathological findings in human cholera are discussed in this study.The classic or denudation concept of the intestinal lesion in Asiatic cholera was introduced in 1879 by Virchow (1879), who demonstrated in postmortem studies the loss of mucosa from small bowel villi. This denudation concept was denied by Gangarosa, Beisel, Benyajati, Sprinz, and Piyaratn (1960) and by Fresh, Versage, and Reyes (1964) who performed intestinal biopsies in cholera patients. Several experimental models have become available to study the pathogenesis of human cholera, and produce fluid in response to intraluminal instillation of the organism or to intraluminal administration of cholera toxin. It has been shown that an exotoxin produced by Vibrio cholerae induces not only accumulation of intestinal fluid in various experimental animals but also increases in the vascular permeability in the

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