Cholera

• Definition • Aetiology
• Cholera is an acute • V. cholera is found free
infection of the living in fresh water, it is
gastrointestinal tract only
caused by the Gram- • pathogenic in humans.
negative bacterium It can contaminate
Vibrio cholera. shellfish.
• Transfer from human
carriers is via the faeco–
oral route.
• The serovar 0:1 is the major
pathogenic strain and
• is divided into two biotypes;
classical and the more
• widespread El Tor (named
after the quarantine camp
• in which it was discovered).
Phage typing can be used to
• examine epidemics to try and
see if the observed conditions
• originated from a single source
(see Fig.
• Pathophysiology
• 1 V. cholera is damaged by
stomach acid therefore
patients on acid
suppressing medication
are particularly susceptible
to infection.
• 2 Once in the small bowel
proliferation occurs and
there is production of an
exotoxin.
• 3 The B subunit of the
exotoxin binds to intestinal
epithelium
• expressing theGM1
ganglioside and the A unit
activates adenylate cyclase
(see Fig. ). The result is an
increase in cellular levels
of cAMP and massive
secretion of isotonic fluid
into the intestinal lumen.
• 4 A second toxin termed
zonula occludens toxin
(ZOT)
• damages the tight
junctions between
enterocytes allowing
• the passage of water
and electrolytes
• Clinical features
• The incubationperiod is
between a
fewhoursand1week.
• Most patients have a mild
self-limiting diarrhoeal
illness but in severe cases
there may be watery
diarrhoea with mucous,
termed rice water stool.
• It is vital to adequately
fluid resuscitate
patients with such
diarrhoea to prevent
the onset of
hypovolaemic shock.
• Investigations • Management
• The diagnosis is often • This depends on disease
severity.
made on clinical features
• Assessment of
alone, pending the
hypovolaemia may be made
results of stool cultures using clinical indices such as
which are diagnostic. the difference between lying
• However, stool and standing blood pressure,
microscopy may reveal the heart rate, skin turgor,
the characteristic motile urine output and urea and
electrolyte measurement
organisms.
• A postural drop of 15
mmHg or more suggests
volume depletion
• In significant volume
depletion intravenous • Traditional solutions use
saline should be
administered.
• The fluid input and output
should be documented
hourly and reviewed with
care
• In mild cases oral rehydration
is the treatment of choice
using a solution containing
sodium, potassium, chloride
and citrate.
glucose to facilitate
absorption, rice-based
polymers have been used in
place of glucose with some
evidence of benefit in reducing
duration of diarrhoea
• Tetracycline or
ciprofloxacin can be
used to shorten
duration and reduce
severity of illness