it lacks dehydration management part

1. PRESENTED BY:
Manglam Kumari
M.Sc Nursing 1st year
CON,ILBS
PRACTICE TEACHING

2. Father of epidemiology?
What he suggests?
HINT FOR TOPIC:

4. TERMINOLOGY
 Pandemics
 Epidemiology
 Gram negative bacteria
 Bacteriophage
 AMP cycle

5. INTRODUCTION
 Cholera is an acute, secretory diarrhoea caused
by infection with Vibrio cholerae of the O1 or
O139 serogroup.
 It is endemic in more than 50 countries and also
causes large epidemics.
 Since 1817, seven cholera pandemics have
spread from Asia to much of the world.
 The seventh pandemic began in 1961 and
affects 3–5 million people each year, killing 120
000

6. DEFINITION
Cholera is an acute diarrhoeal infection caused
by ingestion of food or water contaminated with
the bacterium Vibrio cholerae.
Organ affected –

7. HISTORY OF CHOLERA
 5th century B.C
 Indian subcontinent for centuries
 In 1817 it spread to other part of world.
 1854,John snow proposed it is communicable
disease
 Filipo Pacini first observed comma shaped
 1884, Robert Koch first isolated vibrio cholerae
 In 2010 Haiti major outbreak of cholera in seen

8. VIBRIO CHOLERAE
•Vibrio cholerae is a
Gram-negative,
comma-shaped
bacterium. The
bacterium's natural
habitat is brackish or
saltwater.
•V. cholerae is a
facultative anaerobe
and has a flagellum at
one cell pole as well
as pili.

9. EPIDEMIOLOGY
INDIA
The estimated actual burden of cholera is in the
India of 3 to 5 million cases and 28,000 to 130
000 deaths per year.
WORLD
W.H.O estimates that 3–5 million cases occur per
year, pre- dominantly in Asia and Africa, with
periodic major epidemics including that in Haiti
in 2010.

10. EPIDEMIOLOGICAL TRIAD
INCUBATION
PERIOD : 12h- 5
days

11. Agent :
V.Cholerae O1 and O139
Resistance :
 Killed within 30 min by heating
 Remain in ice for 4-6 weeks or longer.
 Drying & sunshine will kill them in a few hour.
Toxins production :
 Multiply in the lumen of the small intestine and
produce an exotoxin.
 The exotoxin has no affect on any other tissue
except the intestinal epithelial cells.
EPIDEMIOLOGICAL TRIAD CONT...

12.  Infective material : stool
 Infective dose : 10’11
HOST :
 Age and sex : all ages and both sexes
 Gastric acidity : ph5 or lower
 Population mobility
 Economic status
 Immunity
EPIDEMIOLOGICAL TRIAD CONT...

13. Environment
 Poor environmental sanitation
 Flies
 Soil pollution
 Low standard quality of personal hygiene
 Lack of education
EPIDEMIOLOGICAL TRIAD CONT...

14. PATHOPHYSIOLOGY
After ingestion of V cholerae, most of the
bacteria are killed by gastric acid.
Surviving organisms colonise the small
intestine and elaborate cholera toxin, the
major virulence factor for pathogenic strains.
Cholera toxin is a protein exotoxin that consists
of one A subunit associated with five B subunits
It activates adenylate cyclase and raise
intracellular cyclic AMP leads to chloride secretion
through the apical chloride channel and secretory
diarrhoea.

15. TRANSMISSION

16. CLINICAL MANIFESTATION
 a) Stage of evacuation
 b) Stage of collapse
Sunken eyes,hollow cheek,washerman
hand,anuria
 c) Stage of recovery

17. DIAGNOSIS
 History collection
 Collection of stools
 Vomitus examination
 Water
 Food culture
 Microscopy with dark feild illumination
Rubber catheter
Rectal swab

18. MANAGEMENT
Medical management
 Doxycycline 300mg single dose
 Erthromycin (children) 250 mg q.d x3
 Tetracyclin 12.5mg/kg
 Azithromycin(pregnant women)- 20mg/kg
 ORS solution

19. CONTINUE
Nursing management
 Deficient fluid volume related to excessive fluid loss through
the stool or emesis
 Imbalanced Nutrition: Less Than Body Requirements related
to loss of fluids through diarrhoea, inadequate intake
 Risk for infection related to vibrio cholerae penetration into
GI
 Impaired Skin Integrity: perianal, related to irritation from
diarrhoea
 Anxiety related to separation from parents, unfamiliar
environment, a stressful procedure.
 Interrupted Family Processes related to crisis situations, lack
of knowledge about diseases, treatment of clients.
 Deficient fluid volume related to excessive fluid loss through
the stool or emesis

20. COMPLICATION
 Electrolyte imbalance
 Hypokalemia
 Hyponatremia
 Hypoglycemia
 Renal failure
 Shock
 Blue death

21. PREVENTION
 Chemoprophylaxis
 Environmental sanitation
 Hand washing
 Safe handing of food
 Safe drinking water
 Closed defecation
 Oral Cholera Vaccine (OCV)
 Health education
Dukoral > 2yr
Sanchol <2yr

22. RECENT STUDY
 Diagnostic techniques for rapid detection of
Vibrio cholerae O1/O139
Ramamurthy T1, Das B2, Chakraborty S3, Mukhopadhyay AK4, Sack
DA3(Aug16,2019)
In preventing and spread of epidemic cholera, rapid
diagnostic tests (RDTs) are useful in screening
suspected stool specimens, water/food samples.
Several RDTs developed recently are considered
as investigative tools in confirming cholera cases,
as the culture techniques are difficult to establish
and/or maintain.

23. CONTINUE
 Preventing cholera in India: Synthesizing evidences
through a systematic review for policy discussion on the
use of oral cholera vaccine.
Panda S1, Chatterjee P2, Deb A2, Kanungo S2, Dutta S2.(Aug 9,2019)
OCV could play an important role as one of the elements in such
multi-component cholera prevention effort. OCV
administration through public health system in Odisha
identified logistic challenges, with low uptake of the second
dose at 46%, while 61% of the target population received the
first dose. We identified accumulating global evidence on the
advantage and efficacy of single-dose based approach, where
the same OCV, as licensed in India, was used.

25. CONCLUSION
Cholera is an acute enteric infection caused by the
ingestion of bacterium Vibrio cholerae present in
faecally contaminated water or food. Primarily
linked to insufficient access to safe water and
proper sanitation, its impact can be even more
dramatic in areas where basic environmental
infrastructures are disrupted or have been
destroyed.