choler

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INTRODUCTIO
Cholera is an acute Diarrhoeal disease caused by V . Cholera 01 &
0139 N

WHO REPORT -
-STARTED IN 1817
2024
2023- 535321cases &4007 deaths
2024-733956 cholera &5162 deaths
YEMEN had the top out break in 2024 DEC
CHARACTERISTIC OF
A BACTERIALDISEASE
INFECTION This Photo by Unknown Author is licensed under CC BY-NC-ND

Transmitted through food and water or by contaminating of water with cholera bacteria
INCUBATION-7to 14 days in stool
INITIAL SYMPTOMS - START in 12 hrs to 5 days after infection
• IRRITABILITY ,
• FATIGUE ,
• SUNKEN EYES,
• DRY MOUTH,
• EXTREME THIRST,
• SHRIVELED SKIN,
• LOW BP
• IRREGULAR HEART BEAT
• Watery diarrhea, sometimes described as "rice-
water stools"
• VOMOTING , LEG CRAMP,
Pathophysiology of cholera
to the toxin produced disease
• Cholera, caused by the bacterium Vibrio cholerae, leads to severe diarrhea and dehydration due

• the bacteria, which disrupts electrolyte balance and causes massive fluid secretion into the
small intestine
• In the case of cholera, contaminated water and feces of persons infected with V. cholerae are
the primary sources of infection.
 • The mechanism of invasion begins as soon as the bacterium establishes
itself in the bowel
• Following the colonization of the epithelial layer of the small intestine
by penetrating the mucous.
• The attachment Vibrio onto the microvilli of the small intestine is aided
by the so-called pili on the bacterium which is one of the major factors
which attributes to the darting motility
• The production of an endotoxin by the bacteria, called CT, is the major
key for the virulence mechanism.
• It is proved that only toxigenic strains of Vibrio, i.e., Vibrio that
produces CT, are capable of causing cholera.
• The CT that is made is comprised of six protein subunits: one A subunit
and five copies of B subunits, generally denoted as AB5. B subunit is
also known as the binding factor
• Which binds to the GM1 ganglioside receptor of the epithelial cells of
the small intestine. Once bound with the target cells
• It forms a toxin complex which is then endocytosed by the cell. As soon
as the process of endocytosis takes place, the enzymatic activation of A
subunit occurs leading to increased adenylate cyclase activity,
• This in turns leads to increased permeability of the chloride channels
subsequently mediating the efflux of more ATP-mediated chloride ions
and secretion of mere H2O, Na+, K+ and HCO3− into the lumen of the
intestine.
EPIDEMIOLOG
• Cholera is an indication of the prevalence of unsanitary conditions especially with the

Y
growing populations in developing countries
• It is a plight that about 3–5 million cases of cholera are reported each year with the
advancements of health and medical professionals across the globe . When 52 countries
reported 236,896 cases in 2006 with a fatality rate of 2.7%, a total of 589,854 cases were
reported in 2011 from 58 countries
 HOS
• Affect the age group of young children under 5
T
• Affect both the age group
• Cause dehydration and loose motion in children

Environme
Favorable Poor Sanitation ,Hygiene
factorsnt
- Unsafe Drinking Water
Overcrowding and Poverty
Lack of WASH Infrastructure:
INACTIVATED BY- vaccination Inactivated oral
cholera vaccines (OCVs),
like
Dukoral and Shanchol,
The cholera is spread in rainy season in india
 DYNAMICS OF DISEASE
MODETRANSMISSION
OF
Only natural host -> HUMANS
TRANSMISSION
Transmission -> by contaminated water, food
through infected faces
PORTAL ENTRY -> throught digestive tract
NCUBATION PERIOD -> 7 to 14 days
PERIOD OF
TheCOMMUNICABILITY
onset of symptoms until 7 days after the
resolution of diarrhea.
CLINICAL
• Cholera, a severe diarrheal illness, is characterized by sudden onset of
FEATURES
watery diarrhea, often described as "rice-water stool,"
• Along with vomiting, dehydration, and potentially life-threatening
complications like shock and death if left untreated
• Early Symptoms (within hours to 5 days of exposure)
• Later Symptoms (if left untreated)
 EARLY
• Watery Diarrhea: The hallmark of cholera is profuse, painless,
SYMPOTOMS
watery diarrhea, sometimes resembling "rice water" due to its
pale, cloudy appearance with flecks of mucus
• Vomiting: Nausea and vomiting are common, especially in the early
stages of the infection.
• Dehydration: Rapid fluid loss through diarrhea and vomiting can
lead to dehydration, which can be severe and potentially life-
threatening.

Later Symptoms (if left

• Leg Cramps: Muscle cramps, particularly in the legs, are a
common symptom.
Dehydration: As mentioned, severe dehydration can
untreated)
lead to various complications, including
• Dry Mouth and Thirst: A dry mouth and extreme thirst are signs of Dehydration
Sunken Eyes: The eyes may appear sunken or glassy.
• Dry, Shriveled Skin: Skin may become dry and lose its elasticity.
• Low Urine Output: Reduced urination or lack of urine output is a sign of
dehydration.
•• Low
Rapid Heart
Blood Rate: The
Pressure: heart
Blood may beat
pressure faster
may drop to to
due compensate
fluid loss. for low blood
 RECOVER
UNCOMPILCATED CONDITION-> With prompt treatment, especially rehydration,
Y is rapid and the mortality rate is very low, typically less than 1%.
cholera recovery
Severity depends upon risk factors like-> children >5
• over population
• unhygienic food and water
• poor sanitation
• non potable water

DIAGNOSIS ACC TO
• According to the World Health Organization (WHO), cholera diagnosis involves confirming the presence of
Vibrio cholerae O1WHO
or O139, either through culture, seroagglutination or PCR, and demonstrating the
bacterial strain as toxigenic (by PCR) if no confirmed outbreak exists
• In the Bengal Delta region, cholera epidemics typically follow a seasonal pattern, with one peak in spring
(March to May) and another following the rainy season (September to November)
• In Africa, epidemics occur in different regions during the rainy season, with recent
outbreaks being reported in Zanzibar, the Eastern DRC, Angola, and West Africa.
• Haiti experienced a recent outbreak from 2017 to 2018 due to Hurricane Matthew, and the WHO reported
800,000 cholera cases and approximately 10,000 deaths from cholera since the outbreak
 TREATMEN
Step 1. Assess for dehydration.
Step 2. TRehydrate the patient, and monitor
frequently. Then reassess hydration status
Step 3. Maintain hydration: replace ongoing
fluid losses until diarrhoea stop.
Step 4. Give an oral antibiotic to the patient
with severe dehydration.
Step 5. Feed the patient.

STEP 1. Assess for dehydration

- Severe dehydration
- Some dehydration
- No signs of dehydration
Table 1. Assessment of the diarrhoea patient for
dehydration
1. LOOK AT:
Well, alert Restless,
Lethargic or unconscious,
CONDITION floppy
irritable

EYES NORMAL SUNKEN VERY SUNKEN&DRY

TEARS PRESENT ABSENT ABSENT

MOIST
MOUTH & TOUNGE DRINKS DRY VERY DRY
NORMALLY

THIRST,DRINKS DRINKS POORLY OR NOT

THIRST NOTHIRST
EAGERLY ABLE TO DRINKS

goes back
THIRST goes back slowly goes back to very slowly
quiclky

GOES BACK GOES BACK

2 FEEL: SKIN PINCH GOES BACK VERY SLOWLY
QUICKLY SLOWLY

The patient If the patient has

has two or more If the patient has two or
NO SIGH OF signs, including at more signs, including at
3. DECIDE:
DEHYDRATIO least one sign, least one sign, there is
N there is SOME SEVERE DEHYDRATION
DEHYDRATION
 STEP 2. Rehydrate the patient, and monitor frequently. Then
FOR SEVERE DEHYDRATION: reassess hydration
Give IV fluid immediately to replace fluid deficit. Use
Ringer's lactate solution or, if not available, normal saline.
• Start IV fluid immediately. If the patient can drink, begin
giving oral rehydration salts (ORS) solution by mouth while
the drip is being set up.
• For patients aged 1 year and older, give 100 ml/kg IV in 3 hours,
as follows
->- 30 ml/kg as rapidly as possible (within 30 minutes);
then
->- 70 ml/kg in the next 22 hours.
• For patients less than 1 year, give 100 ml/kg IV in 6 hours, as
follows:
- 30 ml/kg in the first hour; then
- 70 ml/kg in the next 5 hours.
! Monitor the patient very frequently. After the initial 30 ml/kg have
been given
! Give ORS solution (about 5 ml/kg/h) as soon as the patient can
drink, in addition to vI fluid
! Reassess the patient after 3 hours (infants after 6 hours), using
Table 1:
- If there are still signs of severe dehydration (this is rare), repeat
 FOR SOME
! DEHYDRATION:
Give ORS
solution:ORS solution in the amount recommended on
- Administer
Table 2
-Table
If [Link] passes amount
Approximate watery stools
of ORSor wants more
solution ORS
to give in the
solution
first 4 than
hours
Less
4-11 12 -23 2-3 15 yrs or
Age than 4
months months yrs
5-14 yrs
oider
months

Weigh less than 5- 8- 11- 16-29.9 30kg or

5kg 7.9kg 10.9kg 15.9kg kg more
t

ORS-
1200-
SOULTION 200-4OO 400-600 600-800 800-1200 2200-4000
2200
IN ML
 • Monitor the patient frequently to ensure that ORS solution is taken satisfactorily
and to detect patients with profuse ongoing diarrhoea
• Reassess the patient after 4 hours, using Table 1:
-> If signs of severe dehydration have appeared (this is rare),
rehydrate for severe dehydration
- If there is still some dehydration, repeat the procedures for some
dehydration &start to offer food & other fluid
- If there are no signs of dehydration, go on to Step 3 to maintain hydration by replacing ongoing fluid
losses.
FOR NO SIGNS OF DEHYDRATION:
Give ORS packets to take home.
Give enough packets for 2 days.
AMOUNT OF SOULTION ORS PACKETS
AGE
AFTER EACH LOOSE STOOL NEEDED

LESS THAN 29 ENOUGHT FOR

50-100ML
MONTHS 500mL/DAY

ENOUGHT FOR
2-9 YRS 100-200mL
1000mL/DAY

10 YRS OR ENOUGHT FOR

AS MUCH AS WANTED
MORE 2000ml/day
 The patient or the caretaker to return if any of the
- Increased number of watery stools
following signs
- Eating or drinking poorly
- Marked thirst
- Repeated vomiting
- Fever
- Blood in stool

STEP 3. Maintain hydration (of the patient who presented with severe or some dehydration):
replace ongoing fluid losses until diarrhoea stops
Maintain normal hydration. The aim is to replace stool losses as they occur with an equivalent
amount of ORS solution.
Give the AMOUNT OF SOULTION
AGE AFTER EACH LOOSE

patient: STOOL

LESS THAN 24
1000mL
MONTHS

2-9YRS 2000mL

10YRS/MORE AS MUCH AS WANTED

 Continue to reassess the patient: for signs of dehydroprofuse ongoing diarrhoea require more
frequent monitoring. If signs of action at least every 4hrs to ensure that enough ORS solution is
being taken. Patients withsome dehydration are detected the patient should be rehydrated
continuing with treatment to maintain hydration.
Keep the patient under observation, if possible, until diarrhoea stops, or is infrequent and of
small volume. This is especially important for any patient who presented with severe dehydration.
STEP 4. Give an oral antibiotic to the patient with severe
Start antibiotics. If the patient is severely dehydrated and older than 2 years, give an antibiotic.
dehydration
Start the antibiotic after the patient has been rehydrated (usually in 4-6 hours), and vomiting
has stopped.

Antibiotics CHILDREN ADULTS

DOXYCYCLINEA SINGLE DOSE .............. 300mg

TETRACYCLINE4xday for 3day 12.5mg/kg 500mg

TRIMETHOPRIM(TMP)SULFAME
TMP 5mg/kg TMP 160Mg&SMX
THOXAZLE(SMX)2xa day for 3
SMX 25mg/kg 800mg
days

FURAZOLIDANE 4x a day for

1.25mg/kg 100mg
3days
STEP 5. Feed the patient
Resume feeding with a normal diet when vomiting has stopped.
Continue breast-feeding infants and young children.

PREVENTION &
CONTROL
The most important thing that one could do to avoid the
disease is to prevent it. Cholera could be prevented by:
• Drink water which is boiled.
• Avoid consumption of raw foods.
• Avoid dairy products as much as possible.
• Wash fruits and vegetables before you eat.
• Washing your hands before you eat is a good way to keep
the disease away.
• Drink plenty of water and it is recommended to drink
about 8 ounces of water every day.
• Bathe and wash clothes or diapers 30 meters (100 feet)
from drinking water sources.
 CONTROL OF
A. Isolation and Quarantine Requirements
-MinimumCHOLERA
Period of Isolation of Patient
-Minimum Period of Quarantine of Contacts
B. Protection of Contacts of a Case
C. Managing Special Situations
-Locally Acquired Case
-Reported Incidence Is Higher than Usual/Outbreak
Suspected
D. Preventive Measures
-Environmental Measures
-Personal Preventive Measures/Education
-International Travel
THANKBY MINU
SATHEESH

YOU