Epidemiology and Infection

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Epidemiology and Infection (2010), 138:347-352 Cambridge University Press
Copyright © Cambridge University Press 2009

Original Papers

Salmonellae and cholera

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

A. K. SIDDIQUEa1 c1, G. B. NAIRa2, M. ALAMa1, D. A. SACKa3, A. HUQa4, A. NIZAMa5, I. M. LONGINI Jr.a6, F. QADRIa1, S. M. FARUQUEa1, R. R. COLWELLa4, S. AHMEDa1, A. IQBALa1, N. A. BHUIYANa1 and R. B. SACKa3

a1 International Centre for Diarrhoeal Disease Research, Bangladesh
a2 National Institute of Cholera and Enteric Diseases, Kolkata, India
a3 Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
a4 University of Maryland Pathogen Research Institute, College Park, MD, USA
a5 Rollins School of Public Heath, Emory University, Atlanta, GA, USA
a6 Department of Biostatistics, University of Washington, Seattle, WA, USA
Article author query
siddique ak [PubMed]  [Google Scholar]
nair gb [PubMed]  [Google Scholar]
alam m [PubMed]  [Google Scholar]
sack da [PubMed]  [Google Scholar]
huq a [PubMed]  [Google Scholar]
nizam a [PubMed]  [Google Scholar]
longini im [PubMed]  [Google Scholar]
qadri f [PubMed]  [Google Scholar]
faruque sm [PubMed]  [Google Scholar]
colwell rr [PubMed]  [Google Scholar]
ahmed s [PubMed]  [Google Scholar]
iqbal a [PubMed]  [Google Scholar]
bhuiyan na [PubMed]  [Google Scholar]
sack rb [PubMed]  [Google Scholar]


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)

Key Words:Cholera; El Tor toxin; epidemic; severe dehydration; Vibrio cholerae


c1 Author for correspondence: Dr A. K. Siddique, MBBS, MPH, Public Health Sciences Division (PHSD), ICDDR,B, Mohakhali, Dhaka, Bangladesh. (Email: siddique@icddrb.org)


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.