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El Tor cholera with severe disease: a new threat to Asia and beyond

  • A. K. SIDDIQUE (a1), G. B. NAIR (a2), M. ALAM (a1), D. A. SACK (a3), A. HUQ (a4), A. NIZAM (a5), I. M. LONGINI (a6), F. QADRI (a1), S. M. FARUQUE (a1), R. R. COLWELL (a4), S. AHMED (a1), A. IQBAL (a1), N. A. BHUIYAN (a1) and R. B. SACK (a3)...

During epidemics of cholera in two rural sites (Bakerganj and Mathbaria), a much higher proportion of patients came for treatment with severe dehydration than was seen in previous years. V. cholerae O1 isolated from these patients was found to be El Tor in its phenotype, but its cholera toxin (CT) was determined to be that of classical biotype. Whether the observed higher proportion of severe dehydration produced by the El Tor biotype was due to a shift from El Tor to classical CT or due to other factors is not clear. However, if cholera due to strains with increased severity spread to other areas where treatment facilities are limited, there are likely to be many more cholera deaths.

Corresponding author
*Author for correspondence: Dr A. K. Siddique, MBBS, MPH, Public Health Sciences Division (PHSD), ICDDR,B, Mohakhali, Dhaka, Bangladesh. (Email:
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An Abstract of this article was presented at the 42nd US–Japan Cholera and other Bacterial Enteric Infections Joint Panel Meeting, 2007 held in Austin, TX, 5–7 December 2007.

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This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

4. D Barua . History of cholera. In: D Barua , WB Greenough III, eds. Cholera. New York, London: Plenum Medical Book Company, 1992, pp. 136.

5. R Sakazaki . Bacteriology of V. cholerae and related organism. In: D Barua , WB Greenough III, eds. Cholera. New York, London: Plenum Medical Book Company, 1992, pp. 3755.

8. GB Nair , Spread of Vibrio cholerae O139 Bengal in India. Journal of Infectious Diseases 1994; 169: 10291034.

11. RB Sack , A 4-year study of the epidemiology of Vibrio cholerae in four rural areas of Bangladesh. Journal of Infectious Diseases 2003; 187: 96101.

15. A-M Svennerholm , J Holmgren . Identification of Escherichia coli heat – labile enterotoxin by means of a ganglioside immunosorbent assay (GM1-ELISA) procedure. Current Microbiology 1978; 1: 1923.

16. M Iwanaga , Culture conditions for stimulating cholera toxin production by Vibrio cholerae O1 El Tor. Microbiology and Immunology 1986; 30: 10751083.

18. GB Nair , New variants of Vibrio cholerae O1 biotype El Tor with attributes of the classical biotype from hospitalised patients with acute diarrhoea in Bangladesh. Journal of Clinical Microbiology 2002; 40: 32963299.

19. SM Faruque , Genomic analysis of the Mozambique strain of Vibrio cholerae O1 reveals the origin of El Tor strain carrying classical CTX prophage. Proceedings of the National Academy of Sciences USA 2007; 104: 51515156.

20. GB Nair , Cholera due to altered El Tor strains of Vibrio cholerae O1 in Bangladesh. Journal of Clinical Microbiology 2006; 44: 42114213.

22. AK Siddique , Why treatment failed to prevent cholera deaths among Rwandan refugees in Goma, Zaire. Lancet 1995; 345: 359361.

23. DA Sack , RB Sack , CL Chaignat . Getting serious about cholera. New England Journal of Medicine 2006; 355: 649651.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
  • URL: /core/journals/epidemiology-and-infection
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