Pathogenesis

V. cholerae is a gram-negative bacillus. Vibrios pass through the stomach to colonize the upper small intestine. Vibrios have filamentous protein extensions that attach to receptors on the intestinal mucosa, and their motility assists with penetration of the mu-12

cus layer. The cholera enterotoxin consists of two subunits, one of which (subunit A) is transported into the cells and causes an increase in cyclic adenosine mono-phos-

phate (cAMP), which leads to a deluge of fluid into the small intestine. This large volume of fluid results in the watery diarrhea that is characteristic of cholera. The stools are an electrolyte-rich isotonic fluid, the loss of which results in blood volume

depletion followed by low blood pressure and shock. Of note, the diarrheal fluid is highly infectious.

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