BSN-4B1

CHOLER
A
SABAULAN, CRESTINE
D.
CHOLER
A • Cholera is 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.
• Fecal-oral route
• Lack of proper sanitation - in the
developing countries. 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, 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.
 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).
 “Rice water” stools with fishy odor.
 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 - Waldemar Mordecai Haffkine
rectal swab. developed an anti cholera
 It is treated by oral rehydration solution vaccine at the Pasteur Institute,
(ORS)or a prepackaged blend of sugars Paris, in 1892.
and salts mixed with water.
 Antibiotics can help patients recover
quickly and reduce their symptoms.
ANTIBIOTICS
• Doxycycline
• Cotrimoxazole
• Erythromycin
• Quinolones
• Resistance strains emerging
 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 replacement 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.
 BSN-4B1

Dysentery
SABAULAN, CRESTINE
• 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: Bacillary dysentery:
- Occurs in warm climates - Usually contracted in colder
- Spread through contaminated climates
food and water - Caused by bacterium (single
- Only the lower abdomen (right celled organisms, move in
side) usually has pain. groups, cause diseases)
-There is pain before defecation.
- There is no fever
- There is less blood in the stool
and more mucus (mango)
*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 Sever sypmtoms:
• WasherWomans hand ·Feeling weak
• Dry wrinkled · Nausea
· Weightloss
• Hole and pail for the stool
· Delirium
• Abdominal cramps or pain, · Convulsions
• vomiting, · Coma
• fever with temperature of about
38°C or higher and dehydration,
which can become life-
threatening if left untreated.
 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.
 COMPLICATIO
Nsare few, but they can be severe.
Complications of dysentery

- 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.

• 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.
 REFERENCES

=https://oluwadairoeduserves.com/2021/04/17/why-persons-suffering-from-
dysentery-shouldnt-cook-swim-or-have-sex/
=https://www.nicd.ac.za/assets/files/2014%20SA%20Cholera%20Guidelines.pdf
=https://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0003440
= https://www.who.int/news-room/fact-sheets/detail/cholera
=https://www.who.int/selection_medicines/committees/expert/21/applications/s6_p
aed_antibiotics_appendix5_dysentery.pdf
=https://www.who.int/news-room/fact-sheets/detail/cholera
=Hinkle, J. L., Brunner, L. S., Cheever, K. H., & Suddarth, D. S. (2014).
Brunner & Suddarth's textbook Of Medical-surgical nursing. Lippincott
Williams & Wilkins.
=https://prezi.com/_g1vk0paihio/dysentery/
THANK
YOU!