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.
(Accepted July 13 2009)
(Online publication August 14 2009)
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.