The Nature of the Gastrointestinal Lesion in Asiatic Cholera and Its Relation to Pathogenesis: A Biopsy Study

Summary

  1. 1.A serial intestinal biopsy study of patients with classical epidemic and endemic Asiatic cholera demonstrates that the intestinal epithelium in this disease is intact, contrary to the classical textbook concept that a mucolytic enzyme causes desquamation of the epithelium during life.
  2. 2.The histological abnormalities of the small bowel in cholera revealed an acute enteritis manifested by a mononuclear cell inflammatory exudate, vascular congestion, marked goblet cell hyperplasia with eventual exhaustion atrophy, and increased “turn-over” of epithelial cells. Except in degree, the lesion in cholera could not be differentiated from that in cases of nonspecific diarrhea observed during this epidemic.
  3. 3.The additional finding of a separate, underlying, chronic, atrophic enteritis suggested that a dietary or nutritional factor may be important in predisposing an individual to cholera.
  4. 4.Mucus rather than desquamated cells gives the “rice-water” stool its characteristic appearance.

Author Notes

Walter Reed Army Institute of Research, Washington, D. C.

Department of Medicine, Chulalongkorn Hospital Medical School, Bangkok, Thailand.

Department of Pathology, Chulalongkorn Hospital Medical School, Bangkok, Thailand.

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