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.

1. Gastro intestinal infection
Due vibrio cholera
By : stN TUYIZERE Delphin

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.

4. Pathophysiology cont,

5. 2. Pathophysiology cont,
1. Ingestion of V. cholera
2. Resistant to gastric acid
3. Colonize small intestine
4. Secrete enterotoxin
5. Enterotoxin binds to intestinal cells
6. Chloride channels activated
7. Release Large quantities of electrolytes & bicarbonates
8. Fluid hypersecretion
9. Diarrhea
10. Dehydration

6. 3. Etiology
bacterium Vibrio cholerae

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.

12. rice water” very frequent (more
than 20-50 times / day)

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

17. B. Diagnosis
Stool culture
Confirm presence of cholera toxin
Cholera Rapid Test Dipsticks

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

25. 12. Complication
Hypovolemic shock:
Electrolytes imbalance
Renal failure
 Hypoglycemia
Hypokalemia

26. 13. Prevention
Comprehensive Multidisciplinary Approach: water, sanitation,
education, and communication
Basic health education and hygiene
Provision of safe water and sanitation

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