Response of Man to Infection with Vibrio cholerae. II. Protection from Illness Afforded by Previous Disease and Vaccine

Cash, Richard A.; Music, Stanley; Libonati, Joseph P.; Craig, James C.; Pierce, Nathaniel F.; Hornick, R. B.

doi:10.1093/infdis/130.4.325

Cited by 174 publications

(103 citation statements)

References 16 publications

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“…Asymptomatic, transient, intestinal passage of V. cholerae can occur in individuals immune to V. cholerae infection, and amelioration of the severity of the clinical features of cholera can be seen in individuals with partially protective immunity. 8,[33][34][35][36][37][38][39] Although it was not possible to discern the relative contributions of identified organisms to the clinical manifestations in any given patient, and although screening of stool for heatlabile enterotoxin-secreting Escherichia coli that can cause watery diarrhea was not routinely performed at the Centre, all patients reported in this study presented with diarrhea, almost all had watery diarrhea, and all had V. cholerae O1 or O139 isolated from their stool, suggesting that V. cholerae was playing a pathogenic role in most patients.…”

Section: Discussionmentioning

confidence: 99%

“…5,30 Community education programs stressing the importance of rehydration therapy; the wide-spread availability and early home use of oral rehydration therapy; possibly the presence of pre-existing partial immunity protective against severe cholera; and, perhaps most importantly, the liberal and effective use of intravenous fluid therapy at the Centre probably accounted for this low mortality rate due to hypovolemia. 5,8,[34][35][36][37][38]40,41 With aggressive rehydration, hypovolemia-associated morbidities, including renal dysfunction and cardiac and neurologic ischemic events, were rare. Fluid replacement therapy was well tolerated by most patients and was rarely associated with fluid overload, intravenous access related nosocomial infections, possibly electrolyte imbalances, and tetany, the latter in individuals receiving intravenous solutions containing bicarbonate and possibly related to sudden alterations in blood pH and transient induction of hypocalcemia.…”

Section: Discussionmentioning

confidence: 99%

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Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

Ryan

Dhar²,

Khan³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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Abstract. Mortality and morbidity associated with cholera acquired in a modern endemic setting have not been well defined. In Dhaka, Bangladesh from 1986 to 1996, we found that causative agents of cholera shifted over time, varying by serogroup, biotype, and serotype. At the International Centre for Diarrhoeal Disease Research (ICDDR,B: Centre for Health and Population Research) in 1996, 19,100 cholera patients were treated, 887 (4.6%) were admitted, and 33 died (mortality rate ϭ 3.7% of cholera inpatients, 0.14% of all cholera patients). When cholera inpatients who were discharged improved were compared with those who died, bacteremia (odds ratio [OR] ϭ 10.5, 95% confidence interval [CI] ϭ 2.9-37.9), radiographic evidence of pneumonia (OR ϭ 3.1, 95% CI ϭ 1.2-7.7), and acidosis as estimated by the serum bicarbonate value (OR ϭ 0.893, 95% CI ϭ 0.825-0.963) were independently associated with death by multivariate analysis. Pneumonia was the leading cause of death and accounted for two-thirds of all deaths among individuals with cholera in this study. Death in hospitalized patients with cholera acquired in a modern endemic setting is, therefore, extremely rare, and most frequently due to concomitant infection, especially pneumonia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

Ryan

Dhar²,

Khan³

et al. 2000

The American Journal of Tropical Medicine and Hygiene

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“…Volunteer trials show that the stimulation of a good local response to vibrios requires either repeated oral dosing (Frcter, 1962) or the establishment of infection with viruleut organisms (Cash et al, 1974a, b).…”

Section: Discussionmentioning

confidence: 99%

LOCAL IMMUNE RESPONSE IN MICE TO VIBRIO CHOLERAE

Bloom

Rowley

1979

Aust J Exp Biol Med

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Summary Cholera immunization schedules were investigated in mice, with emphasis placed on obtaining an immune response in the intestine. The most effective schedule for producing a good local response was found to be several orally‐given priming doses of the organism followed after 14 days by an intravenous boosting dose. Major differences between the immune responses in the spleen and the intestine were noted.

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“…Diarrhea caused by Vibrio cholerae is known to give longlasting protection against subsequent life-threatening illness (2,3,15). The serum vibriocidal antibody response has been well studied and has been shown to be correlated with protection (8,16,17,18).…”

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confidence: 99%

The Major Subunit of the Toxin-Coregulated Pilus TcpA Induces Mucosal and Systemic Immunoglobulin A Immune Responses in Patients with Cholera Caused by Vibrio cholerae O1 and O139

et al. 2004

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Diarrhea caused by Vibrio cholerae is known to give long-lasting protection against subsequent life-threatening illness. The serum vibriocidal antibody response has been well studied and has been shown to correlate with protection. However, this systemic antibody response may be a surrogate marker for mucosal immune responses to key colonization factors of this organism, such as the toxin-coregulated pilus (TCP) and other factors. Information regarding immune responses to TCP, particularly mucosal immune responses, is lacking, particularly for patients infected with the El Tor biotype of V. cholerae O1 or V. cholerae O139 since highly purified TcpA from these strains has not been available previously for use in immune assays. We studied the immune responses to El Tor TcpA in cholera patients in Bangladesh. Patients had substantial and significant increases in TcpA-specific antibody-secreting cells in the circulation on day 7 after the onset of illness, as well as similar mucosal responses as determined by an alternate technique, the assay for antibody in lymphocyte supernatant. Significant increases in antibodies to TcpA were also seen in sera and feces of patients on days 7 and 21 after the onset of infection. Overall, 93% of the patients showed a TcpA-specific response in at least one of the specimens compared with the results obtained on day 2 and with healthy controls. These results demonstrate that TcpA is immunogenic following natural V. cholerae infection and suggest that immune responses to this antigen should be evaluated for potential protection against subsequent life-threatening illness.Diarrhea caused by Vibrio cholerae is known to give longlasting protection against subsequent life-threatening illness (2, 3, 15). The serum vibriocidal antibody response has been well studied and has been shown to be correlated with protection (8,16,17,18). However, this systemic antibody response may be a surrogate marker for mucosal immune responses to key colonization factors of this organism, such as the toxincoregulated pilus (TCP). TCP is essential for V. cholerae colonization of the small intestine both in an infant mouse model of cholera (28) and during human infection (11). The gene encoding the major pilin subunit, TcpA, is located within a larger genetic element termed the Vibrio pathogenicity island or TCP/ACF element (7, 19). Although TcpA is expressed by both classical and El Tor biotypes of V. cholerae O1, as well as by V. cholerae O139, there is only 80% amino acid identity between the TcpA proteins of the two biotypes of V. cholerae O1 (12, 13, 28). TcpA of El Tor V. cholerae O1 and TcpA of V. cholerae O139 are identical (25).In previous studies of the immune responses to TcpA in patients with V. cholerae infections the workers have examined patients infected with the classical biotype of V. cholerae O1 or have utilized classical TcpA to assess immune responses in patients infected with El Tor V. cholerae O1 (9). Recent studies in which the in vivo-induced antigen technology has been used have shown ...

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Response of Man to Infection with Vibrio cholerae. II. Protection from Illness Afforded by Previous Disease and Vaccine

Cited by 174 publications

References 16 publications

Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

Mortality, morbidity, and microbiology of endemic cholera among hospitalized patients in Dhaka, Bangladesh.

LOCAL IMMUNE RESPONSE IN MICE TO VIBRIO CHOLERAE

The Major Subunit of the Toxin-Coregulated Pilus TcpA Induces Mucosal and Systemic Immunoglobulin A Immune Responses in Patients with Cholera Caused by Vibrio cholerae O1 and O139

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