Thandavarayan Ramamurthy

• Ph. D., FNA, FNASc, FAAM
• INSA-Senior Scientist at National Institute of Cholera and Enteric Diseases

Background Public health is seriously threatened by transmission of zoonotic infection through the food chain. Factors like increasing population, deforestation, high demand for animal protein, and trade of sub-clinically infected animals are the main causes of the spread of infections from asymptomatic animals to humans. Despite several national p...

Background Traditional and fermented foods are widely consumed by the ethnic population of Northeast India. These foods are not only very nutritious, easily available, and reasonably priced, but also boost immunity and protect from various seasonal infections and have been reported through several investigations. However, pathogens transmitted by t...

Background Food safety is a global concern, which is often underestimated owing to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, and shifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented food...

Background & objectives Food and waterborne illnesses remain a neglected public health issue in India. Events with large gatherings frequently witness outbreaks of acute diarrheal diseases due to consumption of contaminated food or water or poor food handling practices. In the present study, an outbreak of acute diarrhoeal disease (ADD) occurring a...

Robust digital infrastructure is vital and the need of the hour, especially in the healthcare sector, for real-time data generation, analysis, and quick decision-making. Food- and water-borne illnesses represent a prominent cause of morbidity and mortality worldwide. India, a developing nation with diverse cultures and food practices, poses a high...

Age-stratified path analyses modeled associations between enteric pathogen reservoirs, transmission pathways and height-for-age z-scores (HAZ) to identify determinants of childhood growth in the Kolkata, India site of the Global Enteric Multicenter Study (GEMS). Models tested direct associations of potential pathogen reservoirs with HAZ at 60-day f...

Circulation of antimicrobial resistant (AMR) bacteria in the environment, animals, and humans is a major concern. Food chain is an important link to spread AMR across the biosphere. Global warming, preserved and fast foods availability, random use of un-prescribed antimicrobials, unplanned bio-waste management, and using high doses of antibiotics a...

Background Foodborne and waterborne diseases and outbreaks are a neglected public health issue worldwide. In developing countries, diarrheal disease caused by foodborne and waterborne infections is a major cause of ill health. There is a lack of information on foodborne pathogens, their transmission routes, outbreaks, and related mortalities, due t...

Introduction An acute gastrointestinal illness outbreak was reported in a higher educational institution among students and faculties in East Sikkim, India, from January to February 2023. The investigation was conducted to identify the source of the infection and causative pathogens and prevent the spread of the outbreak. Methods We defined a case...

Food and waterborne outbreaks are a neglected public health problem in India. However, it is important to identify the source of infection and the causative pathogen to curb the outbreak quickly and minimize mortality and morbidity. A retrospective descriptive study was conducted with a line list of 130 diarrheal cases. Epidemiological investigatio...

Background Quantitative molecular assays are increasingly used for detection of enteric viruses. Methods We compared the clinical severity using modified Vesikari score (mVS) of enteric viruses detected by conventional assays (enzyme immunoassays [EIA] for rotavirus and adenovirus 40/41 and conventional polymerase chain reaction for astrovirus, sa...

Vibrio cholerae is a cholera-causing pathogen known to instigate severe contagious diarrhea that affects millions globally. Survival of vibrios depend on a combination of multicellular responses and adapt to changes that prevail in the environment. This process is achieved through a strong communication at the cellular level, the process has been r...

Background The primary aim of this study was to investigate the occurrence, characteristics, and antimicrobial resistance patterns of various Shigella serogroups isolated from patients with acute diarrhea of the Infectious Diseases Hospital in Kolkata from 2011–2019. Principal findings During the study period, Shigella isolates were tested for the...

Background Food safety is a critical factor in promoting public health and nutrition, especially in developing countries like India, which experience several foodborne disease outbreaks, often with multidrug-resistant pathogens. Therefore, implementing regular surveillance of enteric pathogens in the human-animal-environment interface is necessary...

BACKGROUND Food safety is a global concern, which is often underestimated owing to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, and shifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented food...

We isolated a Vibrio fluvialis strain (IDH5335) from a stool sample collected from a patient with diarrhea. In this announcement, we report the complete genomic sequence of this organism, which was obtained by combining Illumina and Oxford Nanopore sequencing data.

Objectives: Recent advancement in understanding neurological disorders has revealed the involvement of dysbiosis of the gut microbiota in the pathophysiology of Parkinson’s disease (PD). We sequenced microbial DNA using fecal samples collected from PD cases and healthy controls (HCs) to evaluate the role of gut microbiota. Methods: Full-length bac...

Antimicrobial resistance (AMR) in bacteria is an important global health problem affecting humans, animals, and the environment. AMR is considered as one of the major components in the “global one health”. Misuse/overuse of antibiotics in any one of the segments can impact the integrity of the others. In the presence of antibiotic selective pressur...

Cholera remains a major global public health problem, for which oral cholera vaccines (OCVs) being a valuable strategy. Patients, who have recovered from cholera, develop antibody responses against LPS, cholera toxin (CT), toxin-coregulated pilus (TCP) major subunit A (TcpA) and other antigens; thus, these responses are potentially important contri...

Diarrheal disease remains a great public health problem in many countries. Enteric infections caused by several viral, bacterial and parasitic species not only affect the host, but also alter the gut microbiome. The host physiology dictates the intestinal milieu and decides the composition and richness of gut microbiota, which forms a homeostatic e...

Helicobacter pylori is a ubiquitous bacterium and contributes significantly to the burden of chronic gastritis, peptic ulcers, and gastric cancer across the world. Adaptive phenotypes and virulence factors in H. pylori are heterogeneous and dynamic. However, limited information is available about the molecular nature of antimicrobial resistance phe...

Aims: The present study aimed to document the comparative analysis of differential hyper-virulent features of Vibrio cholerae O1 strains isolated during 2018 from cholera endemic regions in Gujarat and Maharashtra (Western India) and West Bengal (Eastern India). Methods and results: A total of 87 V. cholerae O1 clinical strains from Western Indi...

Cholera is a life-threatening infectious disease that remains an important public health issue in several low and middle-income countries. In 1992, a newly identified O139 Vibrio cholerae temporarily displaced the O1 serogroup. No study has been able to answer why the potential eighth cholera pandemic (8CP) causing V. cholerae O139 emerged so succe...

Purpose: The multidrug resistance Enterobacteriaceae cause many serious infections resulting in prolonged hospitalization, increased treatment charges and mortality rate. In this study, we characterized bla NDM-5-positive multidrug resistance commensal Escherichia coli (CE) isolated from diarrheal patients in Kolkata, India. Methods: Three CE st...

Advanced research in health science has broadened our view in approaching and understanding the pathophysiology of diseases and has also revolutionised diagnosis and treatment. Ever since the establishment of Braak’s hypothesis in the propagation of alpha-synuclein from the distant olfactory and enteric nervous system towards the brain in Parkinson...

Cholera was first described in the areas around the Bay of Bengal and spread globally, resulting in seven pandemics during the past two centuries. It is caused by toxigenic Vibrio cholerae O1 or O139 bacteria. Cholera is characterised by mild to potentially fatal acute watery diarrhoeal disease. Prompt rehydration therapy is the cornerstone of mana...

Aims: This study analyzes the prevalence and antimicrobial resistance (AMR) of major diarrheagenic Escherichia coli (DEC) pathotypes detected in hospitalized diarrheal patients in Kolkata, India, during 2012-2019. Methods and results: A total of 8,891 stool samples were collected from the Infectious Diseases Hospital, Kolkata and screened for th...

The increase of aged population in the twenty-first century is not only due to the advancement in medical science, but also several other factors such as education, industrialization, nutritive foods, hygienic practices, and stable income. Global population growth rate is rapid at one billion per decade and it is expected that the world population...

Cholera caused by toxigenic Vibrio cholerae is a major public health problem in many developing countries, where outbreaks and sporadic infections occur at regular intervals. WHO has registered 499,447 cases, including 2990 deaths with case fatality rate of 0.6% in 2018 [1]. The disease is characterized by profuse watery diarrhea that rapidly leads...

Emergence and rapid spread of multi-drug resistant (MDR) bacteria including Vibrio cholerae are a global public health issue. Much attention has been paid to natural compounds, such as spices and herbs to find novel antimicrobial compounds as they are considered to be cheaper alternatives to develop as a drug. Here, we show that methanol extract of...

Vibrio parahaemolyticus (Vp) is an aquatic Gram-negative bacterium that may infect humans and cause gastroenteritis and wound infections. The first pandemic of Vp associated infection was caused by the serovar O3:K6 and epidemics caused by the other serovars are increasingly reported. The two major virulence factors, thermostable direct hemolysin (...

Objective: To analyze and compare the Rome IV Criteria of Functional Constipation between PD and HC, with that followed by MDS-NMS, intended for determining clinical symptoms of constipation. Background: Gastrointestinal symptoms such as decreased bowel movements and defecatory dysfunction are chronic non-motor symptoms of Parkinson's disease, pati...

Background The association between childhood diarrheal disease and linear growth faltering in developing countries is well-described. However, the impact attributed to specific pathogens has not been elucidated, nor has the impact of recommended antibiotic treatment. Methods The Global Enteric Multicenter Study (GEMS) enrolled children seeking hea...

Background Cholera, an acute diarrheal disease is a major public health problem in many developing countries. Several rapid diagnostic tests (RDT) are available for the detection of cholera, but their efficacies are not compared in an endemic setting. In this study, we have compared the specificity and sensitivity of three RDT kits for the detectio...

Cholera is one of the major public health problems in the state of Odisha, India since centuries. The current paper is a comprehensive report on epidemiology of cholera in Odisha, which was documented from 1993. PubMed and Web of Knowledge were searched for publications reporting cholera in Odisha during the period 1993–2015. The search was perform...

Introduction. Cholix toxin (ChxA) is an ADP-ribosylating exotoxin produced by Vibrio cholerae . However, to date, there is no quantitative assay available for ChxA, which makes it difficult to detect and estimate the level of ChxA produced by V. cholerae . Hypothesis/Gap Statement. It is important to develop a reliable and specific quantitative ass...

Diphtheria is a respiratory disease caused by the bacterium Corynebacterium diphtheriae . Although the development of a toxin-based vaccine in the 1930s has allowed a high level of control over the disease, cases have increased in recent years. Here, we describe the genomic variation of 502 C. diphtheriae isolates across 16 countries and territorie...

Cholera affects about three million people annually and kills several thousands. Since 1817 seven cholera pandemics have been described. While the nature of the strains responsible for the first four pandemics are not known, the fifth and sixth pandemics are associated with Vibrio cholerae O1 classical biotype. In the 1960s, V. cholerae El Tor repl...

Background The Global Enteric Multicenter Study (GEMS) determined the etiologic agents of moderate-to-severe diarrhea (MSD) in children under 5 years old in Africa and Asia. Here, we describe the prevalence and antimicrobial susceptibility of non-typhoidal Salmonella (NTS) serovars in GEMS and examine the phylogenetics of Salmonella Typhimurium ST3...

Vibrio cholerae serogroup O1 is responsible for epidemic and pandemic cholera and remains a global public health threat. This organism has been well established as a resident flora of the aquatic environment that alters its phenotypic and genotypic attributes for better adaptation to the environment. To reveal the diversity of clinical isolates of...

The endemicity of cholera in India has been well researched. Among the other endemic areas, Indian subcontinent appears to be the cradle of Vibrio cholerae genovariants, which subsequently spread worldwide. In contrast, all the cholera cases recorded in Russia are of imported origin. In the past century, such importations might result in epidemics,...

Background Shigella is a leading cause of childhood diarrhea and target for vaccine development. Microbiologic and clinical case definitions are needed for pediatric field vaccine efficacy trials. Methods We compared characteristics of moderate to severe diarrhea (MSD) cases in the Global Enteric Multicenter Study (GEMS) between children with cult...

The human pathogen Vibrio cholerae is the causative agent of severe diarrheal disease known as cholera. Of the more than 200 “O” serogroups of this pathogen, O1 and O139 cause cholera outbreaks and epidemics. The rest of the serogroups, collectively known as non-O1/non-O139 cause sporadic moderate or mild diarrhea and also systemic infections. Path...

Significance Genome fluidity is directly associated with the emergence and evolution of many bacterial pathogens. Horizontally acquired genetic elements, which harbor fitness traits, are open source for the bacterial evolution. The genome of Vibrio cholerae is equipped with multiple mobile genetic elements (MGEs), which are crucial for disease deve...

Antimicrobial resistance (AMR) has been recognized as a global challenge as many diseases are becoming difficult to treat with the existing drugs. Rapid spread of AMR in several species of bacteria has been an added factor for the higher rates of morbidity and mortality. There are evidences that show human pathogens have acquired antimicrobial resi...

The human gut harbours a multifaceted and dynamic population of microorganisms, which affect human homeostasis and health. Robust network among gut microbes plays an important role in human health and disease by influencing immunity, nutrition and pathogenesis. The gut microbes are frequently exposed to antibiotics, which are used to prevent and/or...

Antimicrobial peptides play an important role in host-defence against Vibrio cholerae . Generally, V. cholerae O1 classical biotype is polymyxin B (PB) sensitive and El Tor is relatively resistant. Detection of classical biotype traits like cholera toxin B-subunit gene ctxB1 and PB sensitivity in El Tor strains have been reported in recent years, i...

S Non‐O1/non‐O139 nontoxigenic Vibrio cholerae associated with cholera‐like diarrhea has been reported in Kolkata, India. However, the property involved in the pathogenicity of these strains has remained unclear. We examined the character of 25 non‐O1/non‐O139 nontoxigenic V. cholerae isolated during 8 years from 2007 to 2014 in Kolkata. Determinat...

Background: V. parahaemolyticus is autochthonous to the marine environment and causes seafood-borne gastroenteritis in humans. Generally, V. parahaemolyticus recovered from the environment and/or seafood is thought to be non-pathogenic and the relationship between environmental isolates and acute diarrhoeal disease is poorly understood. In this st...

Diphtheria is a potentially fatal infection mostly caused by toxigenic Corynebacterium diphtheriae strains and occasionally by toxigenic C. ulcerans and C. pseudotuberculosis strains. Diphtheria is generally an acute respiratory infection, characterized by the formation of a pseudomembrane in the throat, but cutaneous infections are possible. Syste...

Background The Global Enteric Multicenter Study (GEMS) was a 3-year case-control study that measured the burden, aetiology, and consequences of moderate-to-severe diarrhoea (MSD) in children aged 0–59 months. GEMS-1A, a 12-month follow-on study, comprised two parallel case-control studies, one assessing MSD and the other less-severe diarrhoea (LSD)...

Non-typhoidal salmonellae (NTS) are a major cause of acute diarrhea with characteristic multidrug resistance. In a hospital based study, 81 NTS were isolated and tested for serotypes and antimicrobial resistance (AMR). Salmonella enterica isolates were classified into 7 different typable serovars and 19 (23%) isolates remained untypable. The most c...

The self-transferring integrative and conjugative elements (ICEs) are large genomic segments carrying several bacterial adaptive functions including antimicrobial resistance (AMR). SXT/R391 family is one of the ICEs extensively studied in cholera-causing pathogen Vibrio cholerae. The genetic characteristics of ICE-SXT/R391 in V. cholerae are dynami...

[This corrects the article DOI: 10.3389/fpubh.2019.00203.].

Cholera caused by the toxigenic Vibrio cholerae is still a major public health problem in many countries. This disease is mainly due to poor sanitation, hygiene and consumption of unsafe water. Several recent epidemics of cholera showed its increasing intensity, duration and severity of the illness. This indicates an urgent need for effective manag...

Toxigenic Vibrio cholerae is responsible for 1.4 to 4.3 million cases with about 21,000–143,000 deaths per year. Dominance of O1 and O139 serogroups, classical and El tor biotypes, alterations in CTX phages and the pathogenicity Islands are some of the major features of V. cholerae isolates that are responsible for cholera epidemics. Whole-genome s...

The unique genetic makeup and remarkable competency of Vibrio cholerae are the key factors that help the cholera pathogen adapt rapidly to adverse environmental conditions and resist the detrimental effect of antimicrobial agents. In the last few decades, V. cholerae that causes acute watery diarrhoeal disease cholera has emerged as a notorious mul...

The progressive rise in antibiotic resistance among enteric pathogens in developing countries is becoming a big concern. India is one of the largest consumers of antibiotics, and their use is not well regulated. V. fluvialis is increasingly recognized as an emerging diarrheal pathogen of public health importance. Here we report the emergence of azi...

Background: Diarrheal diseases remain a leading cause of illness and death among children younger than 5 years in low-income and middle-income countries. The Global Enteric Multicenter Study (GEMS) has described the incidence, aetiology, and sequelae of medically attended moderate-to-severe diarrhoea (MSD) among children aged 0-59 months residing...

The role of Vibrio parahaemolyticus in causing diarrhoeal disease is well known. However, phenotypic and genetic traits of this pathogen isolated from diverse sources have not been investigated in detail. In this study, we have screened samples from diarrhoeal cases (2603), brackish water fish (301) and aquatic environments (115) and identified V....

Cholera, caused by the Gram-negative bacterium Vibrio cholerae, remains a major problem in developing countries. Although the disease can be managed by oral rehydration therapy, antibiotics are widely used nowadays to treat the disease. However, chemoprophylaxis has been proven to have no effect on the spread of the disease, but acts as a major dri...

The Bay of Bengal is known as the epicenter for seeding several devastating cholera outbreaks across the globe. Vibrio cholerae, the etiological agent of cholera, has extraordinary competency to acquire exogenous DNA by horizontal gene transfer (HGT) and adapt them into its genome for structuring metabolic processes, developing drug resistance, and...

Vibrio cholerae causes fatal diarrheal disease cholera in humans due to consumption of contaminated water and food. To instigate the disease, the bacterium must evade the host intestinal innate immune system; penetrate the mucus layer of the small intestine, adhere and multiply on the surface of microvilli and produce toxin(s) through the action of...

Antimicrobial resistance (AMR) among bacterial species that resides in complex ecosystems is a natural phenomenon. Indiscriminate use of antimicrobials in healthcare, livestock, and agriculture provides an evolutionary advantage to the resistant variants to dominate the ecosystem. Ascendency of resistant variants threatens the efficacy of most, if...

In the HTML version of this Letter, the affiliations for authors Andrew S. Azman, Dhirendra Kumar and Thandavarayan Ramamurthy were inverted (the PDF and print versions of the Letter were correct); the affiliations have been corrected online.

Background Enterotoxigenic Escherichia coli (ETEC) encoding heat-stable enterotoxin (ST) alone or with heat-labile enterotoxin (LT) cause moderate-to-severe diarrhea (MSD) in developing country children. The Global Enteric Multicenter Study (GEMS) identified ETEC encoding ST among the top four enteropathogens. Since the GEMS objective was to provid...

Yemen is currently experiencing, to our knowledge, the largest cholera epidemic in recent history. The first cases were declared in September 2016, and over 1.1 million cases and 2,300 deaths have since been reported¹. Here we investigate the phylogenetic relationships, pathogenesis and determinants of antimicrobial resistance by sequencing the gen...

Vibrio cholerae strains producing cholera toxin (CT) and toxin co-regulated pilus (TCP) and belonging to O1 and O139 serogroups are responsible for cholera. However, non-CT producing V. cholerae from non-O1/non-O139 serogroups have been increasingly isolated from diarrheal stools and extra-intestinal infections. In this study, we have developed a m...

Acute diarrheal disease is a major health problem and second most common cause of death in children under five years of age. Conventional diagnostic methods are laborious, time consuming and occasionally inaccurate. We examined SYBR-Green real-time PCR for the detection of ten uncommon bacterial pathogens using fecal specimens from acute diarrheal...

Cholera, caused by the Gram-negative bacterium Vibrio cholerae, has ravaged humanity from time immemorial. Although the disease can be treated using antibiotics along with administration of oral rehydration salts and controlled by good sanitation, cholera is known to have produced mayhems in ancient times when little was known about the pathogen. B...

The underestimation of Shigella species as a cause of childhood diarrhea disease has become increasingly apparent with quantitative (q)PCR based diagnostic methods versus culture. We sought to confirm qPCR-based detection of Shigella via a metagenomics approach. Three groups of samples were selected from diarrheal cases from the Global Enteric Mult...

Dendrogram of XbaI-digested pulsed-field gel electrophoresis profiles of the clinical isolates of Shigella dysenteriae isolates. Scale bar indicates degree of similarity.

1% agarose gel analysis of plasmid DNA profile of S. dysenteriae and S. boydii isolates (A); S. flexneri isolates (B); S. sonnei isolates (C). Marker positions have been indicated on left. Abbreviations: S. dysenteriae, Shigella dysenteriae; S. boydii, Shigella boydii, S. flexneri, Shigella flexneri; S. sonnei, Shigella sonnei.

Dendrogram of XbaI-digested pulsed-field gel electrophoresis profiles of the clinical isolates of Shigella boydii isolates. Scale bar indicates degree of similarity.

To understand the genetic basis of high drug resistance in Shigella, 95 clinical isolates of Shigella spp. (2001–2010) were obtained from the Infectious Diseases Hospital, Kolkata, India. Ninety-three isolates were resistant to three or more antibiotics. Resistance to nalidixic acid, trimethoprim, streptomycin, and co-trimoxazole was most common in...

Objective: The purpose of this article is to examine how psychosocial distress and HSV-1 might interact to foster early cognitive vulnerability in otherwise healthy middle-aged adults. Several environmental risk factors, including mental stress and chronic viral infections, can increase cognitive vulnerability and lead to cognitive decline. Conside...

Objective: Recurrent Clostridium difficile infection (CDI) and the emergence of strains with reduced susceptibility to metronidazole and vancomycinwarrants alternative therapy. Hence, we tested the potential efficacy of the natural compound berberine hydrochloride (BBRHCl) against toxigenicC. difficile.Methods: Three representative polymerase chain...

Wave upon wave of disease The cholera pathogen, Vibrio cholerae , is considered to be ubiquitous in water systems, making the design of eradication measures apparently fruitless. Nevertheless, local and global Vibrio populations remain distinct. Now, Weill et al. and Domman et al. show that a surprising diversity between continents has been establi...

Emergence of antimicrobial resistant Gram-negative bacteria has created a serious global health crisis and threatens the effectiveness of most, if not all, antibiotics commonly used to prevent and treat bacterial infections. There is a dearth of detailed studies on the prevalence of antimicrobial resistance (AMR) patterns in India. Here, we have is...