A 57-year-old man was hospitalized in New York with a 2-day history of severe watery diarrhea. The illness had begun 1 day after his return from Ecuador. The patient was dehydrated and suffering from...

A 57-year-old man was hospitalized in New York with a 2-day history of severe watery diarrhea. The illness had begun 1 day after his return from Ecuador. The patient was dehydrated and suffering from an electrolyte imbalance (acidosis, hypokalemia). He made an uneventful recovery after fluid and electrolyte replacement was instituted to compensate for the losses resulting from the watery diarrhea. Stool cultures were positive for Vibrio cholerae.

1. What are the characteristic clinical symptoms of cholera?

2. What is the most important virulence factor in this disease? What other virulence factors have been described? What are the modes of their action?

3. How did this patient acquire this infection? How does this situation differ from the acquisition of infections caused by V. parahaemolyticus or V. vulnificus?

4. How can cholera be controlled in areas in which infection is endemic?