Electron microscopic study on the jejunal mucosa in human cholera

Small intestinal mucosa obtained from six fasting patients with cholera by a peroral biopsy technique was studied with the electron microscope. The cultures of their rectal swabs were all positive for Vibrio cholerae. In the absorptive cells, large pseudopod-like cytoplasmic processes with deformed microvilli or without microvilli (blebs) projected into the intestinal lumen from the apical cell surface, interrupting the microvillous border. In the crypts some of the undifferentiated crypt cells possessed pseudopod-like cytoplasmic projections which extended into the crypt lumen. The swelling of mitochondria, the disappearance of their cristae, an increase in the number of vesicles of the Golgi apparatus, and the dilatation and vesiculation of endoplasmic reticulum were observed in the epithelial cells. The apical portion of the cells became oedematous in some of the epithelial cells. Cytoplasmic fragments enclosed by a plasma membrane, desquamated epithelial cells, cytoplasmic organelles, and secretory granules were lying free in the intestinal lumen. Marked irregular widening of the interepithelial spaces in the jejunal mucoa was observed at the midvillous area. Many cystic vacuoles were present in the cytoplasm of epithelial cells. The possibility of fluids being transported from blood vessels to intestinal lumina through the interepithelial spaces, and the significance of these pathological findings in human cholera are discussed in this study.