It is a human toxic-infection caused by the presence in the intestine of vibrio cholerae. It is an acute infectious disease of the small intestine, caused by the bacterium vibrio cholera and characterized by profuse watery diarrhea, vomiting, muscle cramps, severe dehydration, and depletion of electrolytes. Vibrio cholerae is a Gram-negative, comma shaped rod, which is motile with a single terminal flagellum.
2. 1.Gastro intestinal infection Due
vibrio cholera
1.1 Introduction
It is a human toxic-infection caused by the presence in the intestine of
vibrio cholerae. It is an acute infectious disease of the small intestine,
caused by the bacterium vibrio cholera and characterized by profuse
watery diarrhea, vomiting, muscle cramps, severe dehydration, and
depletion of electrolytes. Vibrio cholerae is a Gram-negative, comma
shaped rod, which is motile with a single terminal flagellum.
3. 2. Pathophysiology
V cholerae is
comma-shaped,
gram-negative aerobic or facultative anaerobic bacillus
bacillus that varies in size from 1-3 Aμm in length by 0.5-0.8 Aμm in
diameter
Its antigenic structure consists of
flagellar H antigen
somatic O antigen.
7. 4. Transmission
A person can get cholera by drinking water or eating food
contaminated with cholera bacteria. In an epidemic, the source of the
contamination is usually the feces of an infected person that
contaminates water or food. The disease can spread rapidly in areas
with inadequate treatment of sewage and drinking water.
8. 5. Incubation
Ranges from a few hours to 5 days, Average is 1-3 days Shorter
incubation period High gastric pH (from use of antacids), Consumption
of high dosage of cholera.
9. 6. Risk factor
Age: Children: 10x more susceptible than adults, And Elderly also
higher susceptible.
Sex: Equal in both male and female.
Immunity: Less immune higher risk.
People with low gastric acid levels
10. Other RISK FACTORS
Poor sanitary conditions: Rare in developed countries and Common
in Asia, Africa, & Latin America
undercooked food: Contaminated seafood, even in developed
countries Especially shellfish.
Hypochlorhydria: People with low levels of stomach acid Such as
children, older adults, and some medications.
11. 7. Signs and symptoms
watery diarrhea (more than 20-50 times / day) without abdominal
pain
stool is very liquid
looking like “rice water” very frequent
abundant vomiting without effort and nausea, vomit of "rice water
“appearance.
13. Diarrhea and vomiting lead to significant dehydration with painful
muscle cramps, the hydro -electrolytic disorders are severe and the
patient is often in acidosis and hypokalemia.
There is also oliguria or anuria (hypovolemic shock + acute renal
failure).
Ultimately the patient falls into a state of algidity: Cold extremities,
severe hypotension, hypothermia, rapid pulse, persistent skin folds.
14. 8. DIAGNOSIS
A. Clinical evaluation of dehydration
Mild dehydration : 3 - 5% loss of body weight
(Plan A)
No signs of dehydration
15. Moderate dehydration : 6-9% loss of
body weight
(Plan B)
Able to drink plus 2 or more of the following:
Sunken Eyes and / or Skin pinch 1 - 2 seconds
Restlessness / Irritability
16. Severe dehydration : 10-15% loss of
body weight
(Plan C)
Pulse fine but unable to drink plus:
Sunken Eyes
very slow Skin pinch ≥ 2 seconds
sensorium abnormally sleepy or lethargic
drinking poorly or not at all
18. 9. Nursing intervention
Discus with patient the importance of fluid replacement during
diarrheal episodes.
Teach patient the importance of good perianal hygiene
Give drugs as prescribed
19. 10. More detailed guidelines for the
treatment of cholera are as follows:
1. Evaluate the degree of dehydration upon arrival
2. Rehydrate the patient
3. Register output and intake volumes on predesigned charts and
periodically review these data.
4. Treat the causes
20. 11. Treatment
A. REHYDRATION
If dehydration and shock give appropriate treatment as follows:
Consider ABC
20ml/kg of normal saline (NS) or Ringers Lactate(RL) as quickly as
possible IV in 15 minutes
Repeat the bolus of NS or RL 3-4 times if persistence of Signs of shock
Treat as severe dehydration after correction of shock
21. If severe dehydration without shock
(Plan C)
Ringers Lactate /N.S Age < 12 months
Step 1 : 30 mls / kg over 1 hour
Step 2 :70 mls / kg over 5 hours
Ringers Lactate /N.S Age ≥ 12 months to 5years
Step 1: 30 mls / kg over 30 mins
Step 2 : 70 mls / kg over 2.5 hours
Then re-assess child, if signs of severe dehydration persists repeat step 2. If signs improve
treat for moderate dehydration
22. If moderate dehydration (Plan B):
Give ORS 75ml/kg during 4 hours
After 4 hours: Reassess the child and classify the child for
dehydration
Select the appropriate plan to continue treatment
Begin feeding the child in clinic
23. If no dehydration (Plan A):
Treat the child as an outpatient; give ORS 10ml/kg after each watery
stool.
24. B. ANTIMICROBIAL THERAPY
Adults
Doxycycline, 300 mg po single dose, Ciprofloxacin, 1g po single dose OR
Azithromycin 1g po single dose.
Pregnant
Erythromycin 500 mg/ 6 hours for 3 days OR azithromycin, 1g po single dose
Children> 3yrs
Erythromycin 12.5mg/kg/ 6 hours for 3dys OR azithromycin 20 mg/kg, in a single
dose, without exceeding 1 g
Children < 3yrs
Erythromycin 12.5mg/kg/ 6 hours for 3dys OR azithromycin 20 mg/kg, in a single
dose