I.

Description and history of cholera

Cholera has likely been with humans for many centuries. Reports of
cholera-like disease have been found in ndia as early as 1000
AD. Cholera is a term derived from Greek khole (illness from bile) and
later in the 14th century tocolere (French) and choler (English). n the 17th
century, cholera was a term used to describe a severe gastrointestinal
disorder involving diarrhea and vomiting. There were many outbreaks of
cholera, and by the 16th century, some were being noted in history.
England had several in the 18th century, most notable being in 1854,
when Dr. John Snow did a classic study in London that showed a main
source of the disease (resulting in about 500 deaths in 10 days) came
from at least one of the major water sources for London residents termed
the "Broad Street pump." The pump handle was removed, and the cholera
deaths slowed and stopped. The pump is still present as a landmark in
London. Although Dr. Snow did not discover the cause of cholera, he did
show how the disease could be spread and how to stop a local outbreak.
This was the beginning of modern epidemiologic studies.
Severe infectious disease endemic in ndia and some other tropical
countries and occasionally spreading to temperate climates. Worldwide in
1999 more than 254,000 people were diagnosed with cholera and there
were over 9,100 cholera-related deaths reported.
Cholera remains a global threat and is one of the key indicators of social
development. While the disease no longer poses a threat to countries with
minimum standards of hygiene, it remains a challenge to countries where
access to safe drinking water and adequate sanitation cannot be
guaranteed. Almost every developing country faces cholera outbreaks or
the threat of a cholera epidemic.

II. Clinical Manifestation of Cholera

1. There is an acute, profuse, watery diarrhea with no tenesmus or intestinal
cramping.
. nitially, the stool is brown and contains fecal materials, but soon becomes
pale gray, "rice-water in appearance with an inoffensive, slightly fishy
odor.
3. Vomiting often occurs after diarrhea has been established.
4. Diarrhea causes fluid loss amounting to 1 to 30 liters per day owing to
subsequent dehydration and electrolyte loss.
5. Tissue turgur is poor and eyes are sunken into the orbit.
6. The skin is cold, the fingers and toes are wrinkled, assuming the
characteristic "washer-moman's hand.
7. Radial pulse become imperceptible and the blood pressure unobtainable.
8. Cyanosis is present.
9. The voice becomes hoarse and then, is lost, so that the patient speaks in
whisper (aphonia).
10. Breathing is rapid and deep.
11. Despite marked diminished peripheral circulation, consciousness is
present.
1. Patients develops oliguria and may even develop anuria.
13. Temperature could be normal at the onset of the disease but becomes
subnormal in later stage especially if the patient is in shock.
14. When the patient is in deep shock, the passage of diarrhea stops.
15. Death may occur as short as four hours after onset, but usually occurs on
the first or second day if not properly treated.

Figure 1: Rice-water stool from a patient with cholera; Figure 2: Washer woman hands (loss of skin elasticity)
Note the flecks of mucus precipitated at the
Bottom of the cup that resemble rice grains.
III. Infectious agent/ etiologic agent
The causative agent of cholera is the bacterium '-ro cholerae or '-ro
coma, which was discovered in 1883 by the German physician and
bacteriologist Robert Koch.
The organisms are slightly curved rods (coma shape), gram negative (-)
and motile with a single polar flagellum.
The organisms survive well at ordinary temperature and can grow well in
temperature ranging from 22-40 degrees centigrade.
They can survive well in ordinary temperature and can survive longer in
refrigerated foods.
An enterotoxin, choleragen, is elaborated by the organism as they grow in
the intestinal tract.

Figure 3: Vibiro Cholerae

IV. Source of infection

Cholera bacteria have two distinct life cycles one in the environment
and one in humans.
a. Cholera bacteria in the environment
Cholera bacteria occur naturally in coastal waters, where they attach to
tiny crustaceans called copepods. The cholera bacteria travel with their
hosts, spreading worldwide as the crustaceans follow their food source
certain types of algae and plankton that grow explosively when
water temperatures rise. Algae growth is further fueled by the urea
found in sewage and in agricultural runoff.
-. Cholera bacteria in people
When humans ingest cholera bacteria, they may not become sick
themselves, but they still pass the bacteria in their stool. When human
feces contaminate food or water supplies, both can serve as ideal
breeding grounds for the cholera bacteria.
The bacteria are usually transmitted by people drinking contaminated
water, but the bacteria can also be obtained in contaminated food,
especially seafood such as raw oysters.
V. Period of communicability
The organisms are communicable during stool positive stage, usually a
few days after recovery, however occasionally the carrier may have the
organism for several months.
*** 3.:-atio3 Period:
4 The incubation period ranges from a few hours to five days; usually
one to three days.

VI. Prevention and treatment

. Preve3tio3
.1. Food and water supply must be protected from fecal contamination.
.. Water should be boiled or chlorinated.
.3. Milk should be pasteurized.
.4. Sanitary disposal of human excreta is a must.
.5. Sanitary supervision is important.
. Treatme3t
Treatment of cholera consist in correcting the basic abnormalities without
delay restoring the circulating blood volume and blood electrolytes to
normal levels.
.1 ntravenous treatment is achieved by rapid intravenous infusion of
alkaline saline solution containing sodium, potassium, chloride and
bicarbonate ions in proportions comparable to that in water-stool.
. Oral therapy rehydration can be completed by oral route (Oresol,
Hydrites) unless contraindicated or, if the patient is not vomiting.
.3 Maintenance of the volume of fluids and electrolytes to ensure
rehydration. This is done by careful intake and output measurement.
.4 Antibiotics
Tetracycline 500mg every 6 hours might be administered to
adults, and 125 mg/kg body weight for children every 6
hours to 72 hours.
Furazolidone 100 mg for adults and 125mg/kg for children,
might be given every 6 hours for 72 hours.
Chlorampenicol may also be given 500 mg for adults and 18
mg/kg for children every 6 hours for 72 hours.
Cotrimoxazole can also be administered 8mg/kg for 72
hours.

VII. Nursing responsibilities

. Medical septic protective care must be provided.
2. Enteric isolation must be observed.
3. Vital signs must be recorded accurately.
4. ntake and output must be be accurately measured.
5. A thorough and careful personal hygiene must be provided.
6. Excreta must be properly disposed of.
7. Concurrent disinfection must be applied.
8. Food must be properly prepared.
9. Environmental sanitation must be observed.
#eferences:
Microsoft Encarta 2009. 1993-2008 Microsoft Corporation. All rights
reserved.
http://nursingcrib.com/communicable-diseases/cholera-el-tor/
http://www.medicinenet.com/cholera/page4.htm
http://www.mayoclinic.com/health/cholera/DS00579/DSECTON=causes
http://www.who.int/topics/cholera/about/en/index.html