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home - Colon - Colonic Infection - Cholera Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Cholera

Regulation of VirulenceIt is controlled by ToxR regulon (a transmembrane protein) which is Tox R and and ToxS acting syner-gistically with TcpP and TcpH whose production controlled by environmental changes. Other Virulence Factors-Zot (zonula occludens toxin) and Ace (accessory cholera enterotoxin) are encoded by genes in core region of the CTXphi genome.Zot disrupts intercellular tight junctions increasing small intestinal permeability.Ace increases ion transport and fluid secretion in small bowel. Colonization: Toxin-coregulated pilus (TCP)is required for coloniza-tion of the small intestine.TCP is encoded by the tcpA gene.Other adhesion factors (eg haemagluttinin are also present. Cell surface receptor GM1 One catalytic A subunit and five B subunits A subnit needs to be cleaved to become active Golgi apparatus Endoplasmic reticulum ADP-ribosylation of adenylate cyclase in ER PersistentcAMP production Phosphorlates CFTR Cl- released TcpPH ToxRS ToxT CTXphiparticle TCP receptor Microbiology Cholera >190 serotypes (based on O antigen of cell surface lipopolysaccharide 01 Strain Non-01 Strain Classical El Tor Subspecies:InabaOgawaHikojima Epidemic cholera due to 01 and 0139- endemic in Asia and Africa Cause gastroenteri-tis but no epidem-ics. Factors increasing toxin production:Low temp (25-30ºC).Osmolarity [NaCl]50-60 mmol).High aeration.Acidic pH (6.5).Presence of certain amino acids (asparagine, serine, glutamate, and arginine), phosphate, and trace elements. Written by Dr Sebastian Zeki

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