 Welcome back to our meds smarter lecture series, or we're taking a smarter approach to preparing future physician Before we get started if you'll take just a quick minute and click that like button and also Subscribe and turn the bell on so that you'll be notified when we post new videos Let's continue on with more gram-negative specifically. Let's talk about Vibrio cholera Once again, like we said it is a gram-negative organism. It is Flagellated so it has a flagella associated with it. It's going to be a polar for jet flagella It can also have some of these fembre off of the side of it, but it's just one single flagella The shape of the Vibrio cholera is going to be comma-shaped. You can see that here in this picture It is oxidase positive And it will grow in an alkaline media Typically Vibrio cholera is found in developing countries Oftentimes in a contaminated water source a lot of times you see people that have Vibrio cholera the Cholera goes through them. They have the side effects, which is a profuse rice water diarrhea That can get out into potential drinking water in these developing countries and it can spread that way through infected water So this rice water diarrhea is is due is due to an introtoxin that will permanently activate our GS pathway which will cause an increase in cyclic AMP and it does this by binding to a dental cyclase Which then will lead to an efflux of water and sodium into our intestinal tract Causing that water or rice water stools there Cholera is sensitive to stomach acid so stomach acid can decrease its infectivity It does require a large inoculum unless the hosts as a decrease in the gastric acidity So it's ID 50 we talked about that earlier is very high For it to be able to cause infections So we've already covered this but how does it transmit contaminated water? So some Cholera has been present upstream in the water coming down and somebody drinks the water that has that cholera in it Or uncooked food and we treat this with oral rehydration This is the most important thing for Patients that have cholera is just that they stay hydrated because that rice water diarrhea can easily dehydrate the patient So we want to orally rehydrate them pretty quickly so that they don't get into a dehydrated state Let's continue on and discuss helicobacter pylori H. Pylori is a curved Flagellated gram negative rod that is triple positive. So what is triple positive? It is triple positive for catalase it is positive for oxidase and it is positive for urease So all three of these are positive with H. Pylori The urease in particular is important because we can actually use that to help detect the presence of this infection So we do a urease breath test where we give a patient a small sample of urea And then we test their breath to see if it has any of that urea that has been broken down by the H. Pylori and That can help us diagnose this. So what's happening here is the urease will produce ammonia That creates an alkaline environment and helps H. Pylori survive that in acidic environment in the stomach Most commonly this will be found in the anterum of the stomach That can lead us to gastritis and peptic ulcers The biggest risk factor for H. Pylori infections is going to be peptic ulcer disease It can also lead us to a gastric adenocarcinoma or a malt lymphoma So it is important that we treat H. Pylori infections and there are two different types of treatments that we use The first initial treatment is known as a triple therapy and what we're going to do is use three different medications to help decrease the Ability of this particular bacteria to survive. So first and foremost, we're going to use amoxicillin If they do have a penicillin allergy, we can switch that amoxicillin to metronidazole Then we add chlorothromycin and a proton pump inhibitor. Okay, so you can think of the triple therapy as Antibiotics cure Pylori ACP amoxicillin chlorothromycin proton pump inhibitor. That's your triple therapy Now we can actually make a quadruple therapy We can add bismuth in if we have any concern of a macroliter resistance If you found this material helpful for your studying, please like and consider subscribing to the channel Also share this video so that more people can benefit from it like you have