Cholera
Cholera is an acute diarrheal illness
caused by infection of the intestine
with the bacteria Vibrio cholerae.
Epidemiology
Cholera was prevalentthe 1800s, but
in
due to proper treatment of sewage and
drinking water, has become rare in
developed countries.
Cholera is a fecal disease, meaning that it
spreads when the feces of an infected
person come into contact with food or
water.
Incidence: 1 in 100,000 worldwide.
Over 1 million cases and nearly 10,00
fatalities.
Vibrio cholerae
Gram negative.
Type of Gammaproteobacteria
Distinguishing factors: Oxidase-positive,
motile via polar flagellum, and both
respiratory and fermentative metabolism.
Organism can multiply freely in water
Pathophysiology of cholera
V. cholerae
activation of ion
accumulates in increase CAMP
channels
stomach
NaCl influx into
G- protein stuck intestinallumen
Produces toxins
in "on" position to drag water
into lumen
Toxins will bind
to G-protein Inactivation of lead to watery
coupled GTPase diarrhea
receptor
Signs & Symptoms
Most people remain asymptomatic. The symptoms of
cholera include :
stomach leg cramps Mild fever
profuse,watery
diarrhea pains
Vomiting Sunken eyes Dry mucous Decreased
and cheeks membranes urinary output
Complications
Sin with decreased turgor Usea fan
remains etevated after to lower evate feet
being pulled p
and temperature
released
A0gly cold
compresses
Give flud
severe dehydration Shock
Renal failure Death
Risk Factors
Poor sanitary • Rare in developed countries
conditions • Common in Asia, Africa, & Latin
America
Raw or • Contaminated seafood, even in
developed countries.
undercooked food
Especially shellfish.
People with low levels of stomach
acid
Hypochlorhydria • Such as children, older adults, and
some medications.
• Reasons aren't entirely clear
Type O blood • Twice more likely
Causes (transmission mode)
Drinking Eating raw or
Contaminat undercooked
shellfish
ed water
diagnosis
Clinical diagnosis Differential diagnosis
Cholera should be
considered in all cases Enterotoxigenic e. Coli
with severe watery
diarrhea and vomiting.
Bacterial food poisoning
Traveling to affected areas
and eating shellfish
Viral gastroenteritis
No distinguishing clinical
manifestations for
cholera.
Laboratory Diagnosis
CULTURE
Vibrios often detected by
dark field or phase
contrast microscopy of
stool
Organisms are motile,
appearing like "shooting
stars"
Microscopy show sheets of
curved Gram negative
rods. Vibrio species on TCBS agar Vibrio species can be
selectively recovered from stool by cuiture on
When plated on sucrose thiosuifate-citrate-bile salts-sucrose (TC8s)agar. On
this medium,y arabaemalyticus usualty
dishes,yellow colonies green colony and
y cholerae vellow ealon
a
appear confirming cholera (indicative of the fermentation of sucrose). Courtesy
of Harriet Provine.
present
Laboratory Diagnosis
Additional methods of
detection include PCR and
monoclonal antibody
based stool tests.
Treatment
Oral rehydration salts
•Up to 80% of cases can be treated through
this.
Intravenous fluids (Ringer lactate)
•For severe cases.
Antimicrobial Therapy
• can diminish duration of diarrhea,reduce
volume of rehydration fluids needed, and
shorten durationof V. cholerae excretion.
Prevention
• Basic health education and
hygiene
• Mass chemoprophylaxis
• Provision of safe water and
sanitation
Comprehensive Multidisciplinary
Approach: water, sanitation,
education, and communication
Vaccines
Parenteral Vaccine :
•2 doses administered 2 weeks apart
•Efficacy of approximately 50% and hardly exceeds 6 months
•Not recommended
Killed WC/rBS Vaccine:
Killed whole-cell V.cholerae in combination with a recombinant
B-subunit of cholera toxin
•Safe in pregnancy and breastfeeding
•Efficacy of approximately 50% after 3 years
•Only mild side-effects
Live, attenuated CVD 103-HgR Vaccine :
•Protection as early as 1week after vaccination, with >90%
•Unknown efficacy for children under 2
•No adverse side-effects
Prognosis
The prognosis of cholera can range
depending on the severity of the
dehydration and how quickly the
patient is given and responds to
treatments.
Death (mortality) rates in untreated
cholera can be as high as 50%-60%
during large outbreaks but can be
reduced toabout 1% if treatment
protocols are rapidly put into action.
Controlling cholera
Treatment
centers
Set up treatment centers for
prompt treatment.
Sanitary
measures.
food safety and animal health
measures
Comprehensive
surveillance
data
(adapt to each situation) for
comprehensive multidisciplinary
approach.
