Survival of classic cholera in Bangladesh

doi:10.1016/0140-6736(91)92789-5

The Lancet

Volume 337, Issue 8750, 11 May 1991, Pages 1125-1127

https://doi.org/10.1016/0140-6736(91)92789-5 Get rights and content

Abstract

During the present cholera pandemic the El Tor biotype of Vibrio cholerae has completely displaced the classic biotype, except in Bangladesh. We studied the distribution of these two biotypes in twenty-four rural districts during epidemics in 1988-89; there was clustering of the classic biotype in the southern region and of the El Tor biotype in all other regions. These findings suggest that the southern coastal region is now (and may always have been) the habitat of classic cholera. The selective distribution of V cholerae 01 biotypes in Bangladesh may have been affected by ecological changes occurring in the country.

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Citation Excerpt :
In this worst outbreak, tetracycline and doxycycline were the drugs used in the treatment of cholera patients. During 1988–89, the classical biotype isolates from the southern coastal region of Bangladesh were found to be resistant to tetracycline, whereas the El Tor biotype isolated from the same region were sensitive [32]. Even the newly emerged V. cholerae serogroup O139 in 1993 from Karachi, Pakistan was reported to be resistant to tetracycline [33].
The unique genetic makeup and remarkable competency of Vibrio cholerae are the key factors that help the cholera pathogen adapt rapidly to adverse environmental conditions and resist the detrimental effect of antimicrobial agents. In the last few decades, V. cholerae that causes acute watery diarrhoeal disease cholera has emerged as a notorious multidrug resistant (MDR) enteric pathogen. Although chromosomal mutations can contribute to antimicrobial resistance (AMR), the frequent acquisition of extrachromosomal mobile genetic elements (MGEs) from closely/distantly related bacterial species are major players in V. cholerae drug resistance. Whole genome sequence analysis of clinical and environmental V. cholerae strains revealed that the genome of most of the recent isolates harbour integrating conjugative elements (ICEs), plasmids, superintegron, transposable elements and insertion sequences, which are the key carriers of genetic traits encoding antimicrobial resistance function. Different antimicrobial resistance genes identified in V. cholerae can contribute in antibiotic resistance by facilitating one of the following three mechanisms; (i) reduced permeability or active efflux of the antibiotics, (ii) alteration of the antibiotic targets by introducing post-transcriptional/translational modifications and (iii) hydrolysis or chemical modification of antibiotics. Here, we present an overview of the present insights on the emergence and mechanisms of AMR in V. cholerae.
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SHORT REPORTSSurvival of classic cholera in Bangladesh

Abstract

Lancet

Lancet

Seroepidemiologic studies during a simultaneous epidemic of infection with El Tor Ogawa and classical Inaba Vibrio cholerae.

J Infect Dis

Endemic cholera in rural Bangladesh, 1966-1980

Am J Epidemiol

SHORT REPORTS
Survival of classic cholera in Bangladesh