Cholera, typhoid fever and dysentery are some communicable diseases that are mainly caused due to ingestion of food which are contaminated with pathogenic micro-organisms.

1. Cholera,
Typhoid fever,
Dysentery
S.R.M.Senarathne
BSc Nursing Student
Faculty of medical Sciences
University of Sri Jayewardanepura

2. • Also called as infectious
diseases or transmissible
diseases.
• Diseases that are spread
from one person to the
other.
• Diseases that are caused by
germs or pathogens.
• Examples for pathogens
include: viruses
bacteria
parasites
fungi

3. • Cholera
• Typhoid fever
• Dysentery
• Chicken pox
• Diphtheria
• Filariasis
• AIDS
• Poliomyelitis
• Malaria
• Measeles
• Tuberculosis
• Tetanus
• Rabies
• Sexually transmitted diseases
Examples:

4. Cholera

5. What is Cholera?
The word cholera is from Greek which
has a meaning related to “bile”.
If cholera is not treated, it can be
fatal
Cholera is an infection in the
small intestine caused by the
bacterium Vibrio cholerae

6. Little bit about Vibrio cholerae
• Vibrio cholerae is a Gram-negative
bacterium that produces cholera toxin
• Has over 150 identified serotypes based
on O-antigen
• Only O1 and O139 are toxigenic and
cause Cholera disease (Water-borne
illness)
• Distinguishing factors: Oxidasepositive,
motile via polar flagellum, and both
respiratory and fermentative metabolism.
• Organism can multiply freely in water

7. Mode of transmission
• Cholera is transmitted by a faecal-oral
route
• Transmission occurs primarily by drinking
water or eating food that has been
contaminated by the feces of an infected
person.
• Therefore it is a fecal disease.
Contaminated seafood
Ex: Undercooked shellfishContaminated water

8. • Most people remain asymptomatic.
• Therefore people that are exposed to cholera
bacterium (Vibrio cholera) will not become ill and
may never know they have been infected.
• But they shed cholera bacteria in the stool for 7 to
14 days, the contaminated water can still infect
others.

9. Risk factors
• Poor sanitation and hygiene practices
• People in peri-urban slums, refugee camps
• The risk of cholera epidemics is highest when there are natural
disasters, war, or poverty, which forces people to live in crowded
condition without access to adequate and clean sanitation
• Lack of education, poor quality of life
• Blood types O>> B > A > AB
• Hypochlorhydria-People with low levels of stomach acid. Such as
children, older adults, and due to some medications.
• Eating raw or undercooked food. Contaminated seafood, even in
developed countries. Especially shellfish

10. Signs and symptoms
1.Profuse, watery diarrhea
-mild to moderate diarrhea
- often difficult to distinguish from diarrhea caused by
other problems.
-The stool has a characteristic appearance: a nonbilious,
gray, slightly cloudy fluid with flecks of mucus, no blood,
and a somewhat fishy, inoffensive odor
-It is frequently described as “rice-water” diarrhea.
-An untreated person with cholera may produce 10 to
20 litres of diarrhea a day with fatal results

11. 2.stomach pains 3.Muscle cramps
–Due to electrolyte
imbalance

12. 5.Vomiting of clear fluid4.Mild fever

13. 6.Decreased urinary output
7.Sunken eyes and cheeks
(sunken fontanelles in
infants)

14. 8.Dry mucous membranes
9.Poor skin turgor
(wrinkled hands)

15. 10.Tachycardia -rapid pulse 11.Postural hypotension
(Orthostatic Hypotension.)

16. 12.Somnolence -(Sleepy)
13.Weakness

17. complications
1.Severe dehydration 2.Shock

18. 3.Renal failure
-due to acute tubular necrosis. When the kidneys
lose their ability to filter excess amounts of fluids,
some electrolytes and waste build up in the body in
people with cholera, often accompanied by shock.

19. 4.Low blood sugar (hypoglycemia ) -low
levels of blood sugar (glucose) which is the body’s
primary energy source. This can happen when
someone is too ill to eat. Children are at the
greatest risk for this, causing unconsciousness,
seizures and death.

20. 4.Low potassium levels (hypokalemia ) -
Individuals with cholera lose many minerals, including
potassium in their stools. Very low potassium levels interfere
with nerve and heart functions and can be life-threatening.

21. Treatment
Cholera demands immediate treatment because the disease can cause death
within hours
Rehydration – The goal is to replace lost fluids and electrolytes using a
simple rehydration solution, oral rehydration salts (ORS). Th ORS
solution is available as a powder can be reconstituted in bold or bottled
water. Without rehydration support half the individuals with cholera die.
With medication a number of fatalities fall to less than 1 percent
Intravenous fluids– During a cholera epidemic, the majority of people can
be helped by oral rehydration alone, severely dehydrated people may also
need intravenous fluids
Antibiotics – while antibiotics are not the necessary art of cholera
treatment, some antibiotics may reduce the amount and duration of
cholera caused diarrhea. A single dose of doxycycline ( Vibramycin,
Monodox, Oracea) or Azithromycin (Zmax, Zithromax) can be helpful.
Zinc supplements – Research as shown that signs it may decrease and
shorten the duration of diarrhea in children with cholera.

23. Prevention
Cholera is rare in developed countries with a few cases related to
travel outside to developing countries or regions that are contaminated
and improperly cooked seafood. If you are traveling to a cholera-endemic
area your risk of contracting the disease is extremely low if follow these
precautions.
• Wash your hands with soap and water frequently, at least 14 seconds
before rising, if soap and water aren’t available to use alcohol-based
hand sanitizer
• Drink only safe water, including bottled, or boiled water. Hot beverages
are generally safe and canned or bottled drinks are as well. Wipe the
outside before you open them.

24. • Eat foods that are completely cooked and hot. Avoid raw
improperly cooked fish and seafood of any kind.
• Stick to first and vegetables you can peel yourself, bananas,
avocados and oranges. Do not eat grapes, salads and fruits that
are not peeled, including berries.
• Avoid dairy foods, which can be contaminated with pastured
milk.
• Cholera vaccine – for adults traveling to cholera- affected areas,
the vaccine is now available in the US. The U.S food and Durg
administration approved Vaxchora, a vaccine for prevention of
cholera. It is a liquid does take by mouth 10 days before travel.

26. What is Typhoid Fever?
• Typhoid Fever is a lifethreatening illness
caused by the bacterium Salmonella typhi
from the family Enterobacteriacea.
• Clinically characterized by typical continuous
fever for 3 to 4 weeks, relatively
bradycardia with involvement of intestinal
lymphoid tissues, reticuloendothelial system
& gall bladder.
• It is transmitted through the ingestion of
food or drink contaminated by the faeces or
urine of infected people.

27. Modes of Transmission
• The disease is transmitted by “faeco-oral route” or
“urine–oral routes” either directly through hands soiled
with faeces or urine or carriers or indirectly by ingestion
of contaminated water, milk, food, or through flies.
Contaminated ice, ice-creams, and milk products are a
rich source of infection.

28. • The bacteria itself only lives in humans
and is carried through the blood stream
and intestinal tract.
• Typhoid can be passed through animals,
only through humans.
• Flies however, are known to help
transmit the disease because when they
land on human excrement, it remains on
their appendages and can be transmitted
when they land on something else.

29. Carriers of Typhoid Fever
• A carrier is usually a healthy person who
survived the disease but in whom the
bacteria are able to survive without causing
further symptoms.
• Carriers continue to spread the disease
through their excrement without realizing
it.
• Carriers are treated with prolonged
antibiotics.
• The term chronic carrier is reserved for
those who excrete salmonella for an year
or more.

30. Typhoid Mary • It is believed that Mary Mallon
never actually had the disease
however, her mother had typhoid
while pregnant with her.
• She infected 47 people and killed
3.
• She constantly changed her
employment but the members of
the household always got sick.
• She was forced into containment
for two years and then released
under the conditions that she
could no longer be a cook.
• She assumed a false name and
began cooking again and of
course, infecting numerous
• people.
• She was forced into life-time
containment where she died 26
years later of pneumonia.

31. Symptoms

32. Death occurred from the development of other
complications such as:
Overwhelming infections
Pneumonia
Intestinal bleeding
Intestinal perforation
Kidney Failure
Peritonitis
Pancreatitis
Infections of the spine
meningitis
Inflammation of the heart muscle
Psychiatric problems
Complications

33. General: Supportive care includes
• Maintenance of adequate hydration.
• Antipyretics.
• Appropriate nutrition.
Specific: Antimicrobial therapy is the mainstay
treatment.
• Chloramphenicol, Ampicillin, Amoxicillin, Trimethoprim &
Sulphamethoxazole, Fluroquinolones
• In case of quinolone resistance – Azithromycin, 3rd generation
cephalosporins (ceftriaxone)
Management of typhoid fever:
Diet
• Fluids and electrolytes should be monitored and replaced diligently.
• Oral nutrition with a soft digestible diet is preferable in the
absence of abdominal distension or ileus.
Activity
• No specific limitations on activity are indicated.
• Rest is helpful, but mobility should be maintained if tolerable.
• The patient should be encouraged to stay home from work until
recovery

34. Dysentery

35. What is dysentery?
• Dysentery is a type of infection that
caused by bacteria. It is inflammation of
the intestines and especially the colon.
• It leads to abdominal pain and frequent
stools that contain blood and mucus.
• Dysentery is sometimes
known as “travelers diarrhea”

36. Prevalence of dysentery
Bacillary dysentery most common in
western Europe & USA country.
Amoebic dysentery most common in
developing countries.
Types of Dysentery

37. Etiology
Dysentery can be caused by bacteria, protozoa, worms or even non-
infectious agents.
1.Bacillary dysentery: 2.Amoebic dysentery: Entamoeba
Shigella bacillus histolytica
The four main Shigella species responsible for bacterial dysentery
are S. sonnei, S. flexneri, S. boydii and S. dysenteriae and this
disease is sometimes known as Shigellosis

38. Transmission
• Shigella infection is a major public health problem. It is happened
when sanitation is poor.
• Overcrowding and poor hygiene are major risk factors for
dysentery
• Dysentery is spread
by means of fecal-oral
transmission.

39. • Other modes of transmission include ingestion
of contaminated food or water, contact with a
contaminated inanimate object, and certain
mode of sexual contact.
• Vectors like the housefly can spread the disease
by physically transporting infected feces

40. Symptoms of bacillary dysentery
• stomach ache,
• diarrhea,
• no blood or mucus in the feces,
• intense abdominal pain,
• fever,
• nausea,
• vomiting

41. Symptoms of amoebic dysentery
• abdominal pain,
• fever and chills,
• nausea and vomiting,
• watery diarrhea which can contain blood , mucus or pus,
• the painful passing of stools,
• fatigue,
• intermittent constipation

42. Treatment
Bacillary
dysentery
Amoebic
dysentery
Rehydration By oral or IV By oral only
Antimicrobial Ciprofloxacin Metronidazole
Anti diarrheal Non preferable Preferable

43. Prevention• A good standard of personal hygiene will prevent the
transmission of dysentery.
• This means frequent handwashing, especially after using the
toilet or after contact with someone who is infected with
shigella. Hands should also be washed before handling and
cooking food eating handling babies and feeding the young or
elderly. To avoid spreading infection, personal items like towels
or face clothe should not be shared.
• Travelers should avoid drinking tap water in countries known to
have poor sanitation. Only drink properly sourced water, such
as bottled water.