CHOLERA
Nino Markhvashvili
CHOLERA
• Cholera is an acute diarrheal illness caused by infection of the
intestine with the bacteria Vibrio cholerae.
• Cholera is an infectious disease that causes severe watery
diarrhea, which can lead to dehydration and even death if untreated.
• It is spread by ingestion of contaminated food or water
•V cholerae is
• comma-shaped,
• gram-negative aerobic or facultative anaerobic
bacillus
• bacillus that varies in size from 1-3 µm in length by
0.5-0.8 µm in diameter
•Grows in salt and fresh water
•Can survive and multiply in brackish water by infecting
copepods
•Has over 150 identified serotypes based on O-antigen
•Only O1 and O139 are toxigenic and cause cholera
disease
HOST FACTORS
1. Age: Children: 10x more susceptible than adults, and elderly also
higher susceptible.
2. Sex: Equal in both male and female.
3. Immunity: Less immune, higher risk.
4. People with low gastric acid levels.
5. Blood types: O >> B > A > AB
ENVIRONMENTAL FACTORS
• Contaminated water and food.
• Certain human habits favoring water and soil pollution.
• Low standard of personal hygiene.
• Lack of education and poor quality of life.
• INCUBATION PERIOD
• From a few hours up to 5 days, but commonly 1-2 days
MODE OF TRANSMISSION
• Feacally contaminated water.
• Contaminated food and drinks.
• Direct contact.
PATHOPHYSIOLOGY
1. V. cholerae accumulates in stomach
2. Produces toxins
3. Toxins will bind to G-protein coupled receptor
4. Increase cAMP
5. G-protein stuck in "on" position
6. Inactivation of GTPase
7. Activation of ion channels
8. NaCl influx into intestinal lumen to drag water into lumen
9. Lead to watery diarrheal
Clinical Manifestations
• Usually mild, or no symptoms at all 75% asymptomatic
• Vomiting
• Cramps
• Profuse, painless diarrhea and vomiting of clear fluid. "Rice water"
• Without treatment, death in 18 hours-several days
CHOLERA GRAVIS
• More severe symptoms
• Rapid loss of body fluids: 6 liters/hour, 10⁷ vibrios/mL
• Rapidly lose more than 10% of body weight
• Dehydration and shock
• Death within 12 hours or less
CHOLERA SICCA
• Cholera sicca is an old term describing a rare, severe form of
cholera that occurs in epidemic cholera.
• This form of cholera manifests as ileus and abdominal distention
from massive outpouring of fluid and electrolytes into dilated
intestinal loops.
• Mortality is high, with death resulting from toxemia before the
onset of diarrhea and vomiting
CHOLERA IN CHILDREN
• Breast-fed infants are protected.
• Symptoms are severe & fever is frequent.
• Shock, drowsiness & coma are common.
• Hypoglycemia is a recognized complication, which may lead to
convulsions.
• Rotavirus infection may give a similar picture & need to be
excluded.
CONSEQUENCES OF SEVERE
DEHYDRATION
1. Intravascular volume depletion
2. Severe metabolic acidosis
3. Hypokalemia → cardiac arrest
4. Low blood sugar (hypoglycemia)
1. Seizures
2. Coma, especially in the young
5. Cardiac and renal failure
6. Sunken eyes, decreased skin turgor
7. Almost no urine production
DIAGNOSIS EVALUATION
• Stool specimen.
Rectal swab method
Catheter method
Blotting Paper method
• Confirm presence of cholera toxin by culture.
Dark field or phase contrast microscopy.
Culture of stool specimen on selective thiosulfate-citrate-bile salts-sucrose (TCBS) agar
plate.
Yellow colonies are formed.
•
DIAGNOSIS EVALUATION
• CBC • Elevated Hct / Neutrophil CT.
• Serum Electrolytes • K+ (low normal or high) and anion
gap acidosis
• Assess severity of volume
• ECG depletion
• Antisera • Serogroup confirmation (Either O1
or O139)
• Darkfield Phase contrast
microscopy of stool • Large quantity of curved bacteria
TREATMENT
• For Diarrhoea
Fluoroquinolones
• Ciprofloxacin, norfloxacin, ofloxacin
Azoles
• Ornidazole, tinidazole
• For Dehydration
• Oral rehydration source (ORS)
• Ringer lactate (RL)
• Sodium chloride (NS)
TREATMENT
• For Vomiting
• 5-HT3 receptor blockers
• Ondansetron, granisetron
• Loperamide, kaolin-pectin suspension
PREVENTION
VACCINATIONS (ORAL)
• Dukoral; CHOLERA AND TRAVELORS DIARHEA VACCINE ; 3 ml
given
• Shanchol ; is is a bivalent cholera vaccine .
• Vaxchora ; for vibrio cholera serogroup o
REFERENCES
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