Cholera

By Elisha Faith Espineli

CHOLERA
A.K.A El Tor Cholera is an acute bacterial enteric disease caused by Vibrio cholerae and is characterized by profuse diarrhea, vomiting, massive loss of fluids and electrolytes.

Vibrio cholerae/ Vibrio coma V. cholera is a gram-negative bacilli that are slightly curved rods (coma shaped) and motile with a single polar flagellum. The organism survives well in ordinary temperature and can survive longer in refrigerated foods. An enterotoxin, choleragen, is elaborated by the organisms as they grow in the intestinal tract.

Etiologic Agent

Mode of Transmission
Fecal transmission passes via oral route from contaminated water, milk, and other foods. Organisms can also be transmitted through ingestion of food or water contaminated with stool or vomitus of a patient. Flies, soiled hands, and utensils also serve to transmit the infection.

Diagnostic Procedures
Rectal swabs or stool specimens should be inoculated onto thiosulfate-citrate-bile-sucrose (TCBS) agar Cholera red test addition of sulfuric acid on agar with organism produces a red color.

Pathophysiology
1. The enterotoxin is elaborated by the organism as they lie in opposition with the lining cells of the intestines. 2. The toxin stimulates adenylate cyclase, which results in the increase of cyclic adenosine monophosphate (cAMP) 3. The mucosal cell is stimulated to increase secretion of chloride, associated with water and bicarbonate loss. 4. The toxin acts upon the intact epithelium, thus resulting in outpouring of intestinal fluids. 5. Fluid loss of 5% to 10% of the body weight resulting in dehydration and metabolic acidosis.

Clinical Manifestations
 Acute, profuse, watery diarrhea with no tenesmus or intestinal cramping  Stool becomes pale gray, rice water in appearance and has slightly a fishy odor  Vomiting  Subsequent dehydration and electrolyte loss  Poor skin turgor, eyes sunken into orbit  Skin is cold, finger and toes are wrinkled, washerwomans-hand

Clinical Manifestations
 Radial pulse imperceptible , BP is unobtainable  Cyanosis  Tachypnea  Oliguria and later may develop anuria Pathognomonic sign: rice watery diarrhea

Medical Management
IV Therapy - achieved by rapid IV infusion of saline solution containing sodium, potassium, chloride, and bicarbonate ions. Rehydration Therapy - oral therapy rehydration can be completed via the oral route (ORESOL, HYDRITES) unless contraindicated.

Medical Management
Antibiotics - Tetracycline 500 mg q6h for 72h - Furazolidone 100 mg q6h for 72h - Chloramphenicol 500 mg q6h for 72h - Cotrimoxazole 8mg/kg for 72h

Nursing Management
Medical aseptic protective care must be provided. Monitor and record VS accurately. Monitor I & O. Dispose excreta properly. Provide a thorough and careful hygiene for the patient. Teach client to prepare and handle food properly. Weigh the patient if necessary. Encourage appropriate diet as indicated by the health care provider.