CHOLERA
is caused by the gram negative rod
shaped bacteria with a small bend in
the middle and a long tail-like flagella,
and it is called Vibrio cholerae. This
bacterium has the ability to survive
both in fresh and salt water, which is an
important virulence factor, along with
the ability to produce a powerful toxin,
encoded on a filamentous phage, which
leads to the rapidly dehydrating,
secretory diarrhoea.
According to the world health
organization (WHO), cholera can in
simple terms be defined as an infection
caused by a bacterium Vibrio cholera to
the small intestines.
Cholera- found in water or food sources
that have been contaminated by feces
by a person infected with cholera.
Found and spread in places with
inadequate water treatment, poor
sanitation, and inadequate hygiene.
Methods of transmission
The organism is transmitted by
contaminated food or water with
human waste.
Lack of proper sanitation - in the
developing world Africa, Asia, S.
America Overcrowding refugee camps,
pilgrims, slums but can occur in any
environment. Eating sea food fish,
particularly shellfish, taken from
contaminated water and eaten raw or
insufficiently cooked.
Method of prevention
Drink only bottled water, Boiled water ,
or chemically treated water or
carbonated beverages.
When using bottled drinks, make sure
that the seal has not already been
broken.
 Avoid tap water and ice cubes
made from tap water.
 Wash your hands with soap and
clean water every time.
 Eat foods that are pre-packaged or
that are freshly cooked and served
hot.
 Avoid raw and undercooked meats
and seafood or unpeeled fruits and
vegetables
Incubation period
A few hours to 5 days after ingestion of
the bacteria usually two to three days,
dependant on the infectious dose and
host factors.
For every infected person, 3-100 people
do not develop disease.
Period of Communicability
Cholera is communicable as long as the
bacteria are secreted in stool. Both
asymptomatic as well as symptomatic
persons secrete infective bacteria, with
the latter group secreting for longer (5).
Sign and symptoms
 Symptoms are often mild but
sometimes serious.
 “Rice water” stools with fishy odor.
 It includes watery diarrhea and
vomiting which can quickly lead to
dehydration.
 Sudden onset of profuse painless
diarrhea and vomiting (10-20 liters
of water per day).
 Severe dehydration
 Severe hypoglycemia
 Muscle cramps, acidosis, peripheral
vasoconstriction, and ultimately
renal and circulatory failure,
arrhythmias and death may occur if
treatment is not given timeously
Treatment Methods
It is diagnosed through stool sample or
rectal swab.
It is treated by oral rehydration solution
(ORS)or a prepackaged blend of sugars
and salts mixed with water.
Antibiotics can help patients recover
quickly and reduce their symptoms.
ANTIBIOTICS
• Doxycycline
• Cotrimoxazole
• Erythromycin
• Quinolones
• Resistance strains emerging
Waldemar Mordecai Haffkine
developed an anti cholera vaccine at
the Pasteur Institute, Paris, in 1892.
Complications
- Cholera causes disease with a very
rapid onset of copious diarrhea in which
up to 1 L of fluid per hour can be lost.
- Dehydration, with subsequent
cardiopulmonary collapse, may cause
rapid progression from onset of signs
and symptoms to death.
MILD DEHYDRATION. The patient
exhibits dry oral mucous
membranes of the mouth and increased
thirst. The rehydration goal at this level
of dehydration is to deliver about 50 mL
of ORS per 1 kg of weight over a 4-hour
interval.
MODERATE DEHYDRATION. Common
findings are sunken
eyes, loss of skin turgor, increased thirst,
and dry oral mucous membranes. The
rehydration goal at this level of
dehydration is to deliver about 100
mL/kg of ORS over 4 hours.
SEVERE DEHYDRATION. The patient
with severe dehydration shows signs of
shock (ie, rapid thready pulse, cyanosis,
cold extremities, rapid breathing,
lethargy, or coma) and should receive IV
eplacement until hemodynamic and
mental status return to normal. When
improvement is evident, the patient can
be treated with ORS.
Clinical Management of Cholera
Assess any person with suspected
cholera immediately and refer to
appropriate level of care.
Persons with cholera can deteriorate
rapidly and must be assessed on arrival
at a healthcare facility, since prompt
appropriate treatment can be life-
saving.
The World Health Organization (WHO)
and the United Nations International
Children’s Emergency Fund (UNICEF)
recommend an oral rehydration
solution (ORS) for the treatment of
children and adults with dehydration
and electrolyte imbalance associated
with cholera and other forms of
diarrheal disease.
According to DOH reseachers- Despite
being a cholera-endemic country, data
on cholera in the Philippines remain
sparse until 2008 when surveillance
was strengthened. From 2008 to 2013,
42,071 suspected and confirmed
cholera cases were reported in 87% of
provinces and metropolitan areas in
the country, confirming the endemicity
of cholera in the Philippines.
According to World Health
Organization (WHO) Cholera remains a
global threat to public health and an
indicator of inequity and lack of social
development. Researchers have
estimated that every year, there are
roughly 1.3 to 4.0 million cases, and 21
000 to 143 000 deaths worldwide due
to cholera.
To prevent and control of the disease
 Drink safe water
 Water purification - add one
teaspoon (5 ml, or one capful if
bottle has a screw cap) of
 household bleach to 20-25 litres of
water. Thoroughly mix solution
with the water and allow to stand
for at least two hours (preferably
overnight) before use.
 Safe disposal of human waste
without contaminating water
sources and control of flies is
important in preventing diarrhoea.
 Avoid any potentially contaminated
food especially raw or partially
cooked fish and shellfish.
 Foods of vegetable origin should be
peeled or shelled.
 Boil or pasteurise all milk.
 Come to the health care facility as
soon as possible in case of acute
watery diarrhoea.
DYSENTERY
 Dysentery is a digestive system
disorder.
 It occurs when amoeba or bacteria
get into in the intestines and result
in severe bloody/mucus filled feces
and diarrhea.
 The amoeba or bacteria that cause
the disease, borrow into the colon
lining and break capillaries.
 The blood released is added to the
feces and leaves the body.
TYPES OF DYSENTERY
Amoebic dysentery:
- Occurs in warm climates
- Spread through contaminated food
and water
- Only the lower abdomen (right side)
usually has pain.
-There is pain before defecation.
- There is no fever
- There is less blood in the stool and
more mucus (mango)
Bacillary dysentery:
- Usually contracted in colder climates
- Caused by bacterium (single celled
organisms, move in groups, cause
diseases)
*Both types are contracted through
food, drink, or close contact with a
carrier of the disease*
Methods of transmission
-Direct contact of person to
person( fecal-oral)
- Veneral transmission among
homosexual
males (oral-anal)
- Food or drink contaminated with feces
containing the E.his. cyst
- Use of human feces (night soil) for soil
fertilizer
- Contamination of foodstuffs by flies,
and
possibly cockroaches
Method of prevention
- Should wash their hands regularly with
soap and water, especially before and
after using the bathroom and preparing
food.
- Only drink reliably sourced water, such
as bottled water
- Watch the bottle being opened, and
clean the top of the rim before drinking.
- Make sure food is thoroughly cooked
- It is best to use purified water to clean
the teeth, and avoid ice cubes, as the
source of the water may be unknown.
Incubation period
3 days in severe infection;
several months in sub-acute and
chronic form.
In average case vary from 2-4 weeks for
duration of the illness.
Sign and symptoms
 Rice watery stool one after the
other.
 rapid DHN
 WasherWomans hand
 Dry wrinkled
 Hole and pail for the stool
 Abdominal cramps or pain,
vomiting, fever with temperature of
about 38°C or higher and
dehydration, which can become
life-threatening if left untreated.
Sever sypmtoms:
·Feeling weak
· Nausea
· Weightloss
· Delirium
· Convulsions
· Coma
Treatment Methods
Treatment for mild bacillary dysentery
The kind commonly found in developed
countries with good sanitation, will
normally resolve without treatment.
Drink plenty of fluids.
In more severe cases, antibiotic drugs
(tetracycline) are available.
Treatment for amoebic dysentery
Amoebicidal medications are used to
treat Entamoeba histolyca. These will
ensure that the amoeba does not
survive inside the body after symptoms
have resolved.
Flagyl, or metronidazole, is often used
to treat dysentery. It treats both
bacteria and parasites.
If lab results are unclear, the patient
may be given a combination of
antibiotic and amoebicidal medications,
depending on how severe their
symptoms are.
COMPLICATIONS
Complications of dysentery are few,
but they can be severe.
- Dehydration: Frequent diarrhea and
vomiting can quickly lead to
dehydration. In infants and young
children, this can quickly become life-
threatening.
- Liver abscess: If amoebae spread to
the liver, an abscess can form there.
- Postinfectious arthritis: Joint pain may
occur following the infection.
- Hemolytic uremic syndrome: Shigella
dysenteriae can cause the red blood
cells to block the entrance to the
kidneys, leading to anemia, low platelet
count, and kidney failure.
- Patients have also experienced
seizures after infection.
According to the current WHO
guidelines supporting the use of
fluoroquinolones (first line), beta-
lactams (second-line) and
cephalosporins (second-line) accord
with the currently available evidence
and other international guidelines –
there is no strong reason to change this
guidance.
• Azithromycin is currently listed in
WHO guidelines as a second-line
therapy for adults with
Shigellosis and as first-line for children
in other guidelines. Due to evidence of
increasing resistance worldwide and
the uncertain potential to cause cardiac
conduction problems when
coadministered with other CYP3A4
inducing drugs, we do not recommend
upgrading this medication to a first-line
therapy without further trial evidence
of clinical efficacy and safety for
children. Listing azithromycin as a
second-line therapy may be appropriate
for regions with known
high-rates of ciprofloxacin non-
susceptibility.
Each year worldwide, there are
between 120 million and 165 million
cases of Shigella infection, of which 1
million are fatal. Over 60 percent of
these fatalities are children under 5
years old in developing countries.