CHOLERA
Presented by : Chandana BN
Guided by : Dr.Pallavi
Dr Sanjay
Department of swasthavritt
CONTENTS
• CAUSES
• SYMPTOMS
• MODE OF TRANSMISSION
• PATHOPHYSIOLOGY
• LABORATORY INVESTIGATION
• PREVENTION
• COMPLICATIONS
• TREATMENT
WHAT IS CHOLERA ?
AN ACUTE DIARRHEAL DISEASE CAUSED BY INFECTION OF THE INTESTINE WITH
VIBRIO CHOLERAE BACTERIA, CHARACTERIZED BY:
1. PROFUSE, WATERY DIARRHEA (OFTEN DESCRIBED AS “RICE-WATER STOOL”)
2. VOMITING
3. RAPID DEHYDRATION
4. ELECTROLYTE IMBALANCE
OVERVIEW ON VIBRIO CHOLERAE
CLASSIFICATION: • CHARACTERISTICS:
•
KINGDOM: BACTERIA
• GRAM-NEGATIVE
PHYLUM: PROTEOBACTERIA
• CURVED ROD-SHAPED (1-3 ΜM)
CLASS: GAMMAPROTEOBACTERIA
• FLAGELLATED (MOTILE)
ORDER: VIBRIONALES
FAMILY: VIBRIONACEA
• NON-SPORE-FORMING
GENUS: VIBRIO • FACULTATIVE ANAEROBE
SPECIES: V. CHOLERAE OPTIMAL GROWTH: 37°С, РН 7.4-8.4
CAUSES
CONTAMINATED WATER SOURCES
POOR SANITATION AND HYGIENE
FOOD HANDLING AND CONSUMPTION
1. HUMAN FEACES AND VOMIT
SYMPTOMS
DIARRHEA (WATERY STOOLS)
VOMITING
DEHYDRATION
ELECTROLYTE IMBALANCE
• SHOCK (SEVERE CASES)
MODE OF TRANSMISSION
1. CONTAMINATED FOOD,
2. CONTAMINATED WATER,
3. HUMAN CONTACT WHO’S IS SUFFERING FROM CHOLERA
PATHOPHYSIOLOGY OF BACTERIA
VIBRIO CHOLERA
1. INGESTION: VIBRIO CHOLERAE BACTERIA ARE INGESTED THROUGH CONTAMINATED
FOOD OR WATER.
2. COLONIZATION: BACTERIA COLONIZE THE SMALL INTESTINE, SPECIFICALLY THE
ILEUM.
• 3. ADHESION: BACTERIA ADHERE TO
• 4. TOXIN PRODUCTION: BACTERIA PRODUCE CHOLERA TOXIN (CT), WHICH CONSISTS
OF TWO SUBUNITS: A (ACTIVE) AND B (BINDING).
• 5. TOXIN BINDING: THE B SUBUNIT BINDS TO GM1 GANGLIOSIDES ON INTESTINAL
EPITHELIAL CELLS.INTESTINAL EPITHELIAL CELLS USING ADHESINS.
• 6. TOXIN INTERNALIZATION: THE A SUBUNIT IS INTERNALIZED AND ACTIVATES ADENYLATE
CYCLASE.
•
7. CAMP ELEVATION: ADENYLATE CYCLASE CONVERTS ATP INTO CAMP, LEADING TO INCREASED
INTRACELLULAR CAMP LEVELS.
8. CHLORIDE SECRETION: ELEVATED CAMP TRIGGERS EXCESSIVE CHLORIDE SECRETION INTO THE
INTESTINAL LUMEN.
9. WATER SECRETION: CHLORIDE SECRETION DRAWS WATER INTO THE LUMEN, CAUSING
DIARRHEA.
10. ELECTROLYTE IMBALANCE: LOSS OF CHLORIDE, SODIUM, POTASSIUM, AND BICARBONATE Q
LEADS TO ELECTROLYTE IMBALANCE
LABORATORY INVESTIGATIONS
1.MICROBIOLOGICAL TESTS
1. STOOL CULTURE: TCBS (THIOSULFATE-CITRATE-BILE-SUCROSE) AGAR
2. RECTAL SWAB CULTURE
• 3. BLOOD CULTURE (IN SEVERE CASES)
2. BIOCHEMICAL TEST
1. OXIDASE TEST: POSITIVE
2. CATALASE TEST: POSITIIVE
3. LACTOSE FERMENTATION: NEGATIVE
4. SUCROSE FERMENTATION: POSITIVE
5. SALT TOLERANCE TEST: POSITIVE
3.SEROLOGICAL TESTS
1. SLIDE AGGLUTINATION TEST (SAT)
2. TUBE AGGLUTINATION TEST (TAT)
4.RAPID DIAGNOSTIC TESTS (RDTS)
1. CHOLERA RAPID DIAGNOSTIC TEST (CRDT)
2. VIBRIO CHOLERAE 01/0139 ANTIGEN DETECTION TEST
OTHER TESTS
1. STOOL MICROSCOPY: WET MOUNT AND GRAM STAIN
2. COMPLETE BLOOD COUNT (CBC): TO ASSESS DEHYDRATION AND
ELECTROLYTE IMBALANCE
3. ELECTROLYTE PANEL: TO MONITOR ELECTROLYTE LEVELS
• 4. RENAL FUNCTION TESTS (RFTS): TO ASSESS KIDNEY FUNCTION
PREVENTION
SAFE DRINKING WATER
PROPER SANITATION AND HYGIENE
REGULAR WASHING OF HANDS
FOOD SAFETY
• VACCINATION
COMPLICATIONS
DEHYDRATION
ELECTROLYTE IMBALANCE
SHOCK
KIDNEY FAILURE
• DEATH (IF UNTREATED)
TREATMENT
• TREATMENT IN CHOLERA TYPICALLY INVOLVES A COMBINATION OF
•
• 1. FLUID REPLACEMENT: ORAL REHYDRATION THERAPY (ORT) OR
INTRAVENOUS (IV) FLUIDS TO REPLACE LOST FLUIDS AND ELECTROLYTES.
•
2. ANTIBIOTICS: TO SHORTEN THE DURATION AND SEVERITY OF DIARRHEA,
AND REDUCE TRANSMISSION.
• COMMONLY USED ANTIBIOTICS FOR CHOLERA TREATMENT:
•
• 1. DOXYCYCLINE
• 2. AZITHROMYCIN
• 3. CIPROFLOXACIN
• 4. ERYTHROMYCIN
• 5. FURAZOLIDONE
• 6. COTRIMOXAZOLE (TMP-SMX)
• ANTIBIOTIC TREATMENT GUIDELINES:
•
• 1. ADULTS: DOXYCYCLINE OR AZITHROMYCIN FOR 3 DAYS
• 2. CHILDREN: AZITHROMYCIN FOR 3 DAYS
• 3. PREGNANT WOMEN: AZITHROMYCIN OR ERYTHROMYCIN FOR 3 DAYS
4. SEVERE CASES: IV CIPROFLOXACIN OR FURAZOLIDONE
IMPORTANT CONSIDERATIONS
1. EARLY TREATMENT INITIATION
2. FLUID REPLACEMENT AND ELECTROLYTE BALANCE
3. ANTIBIOTIC SUSCEPTIBILITY TESTING (AS RESISTANCE VARIES)
4. TREATMENT COMPLETION TO PREVENT RELAPSE
5. VACCINATION (E.G., DUKORAL, SHANCHOL) FOR PREVENTION
• NOTE: TREATMENT PROTOCOLS MAY VARY DEPENDING ON LOCAL GUIDELINES,
SEVERITY, AND PATIENT FACTORS. CONSULT A HEALTHCARE PROFESSIONAL FOR
PERSONALIZED TREATMENT
CONCLUSION
CHOLERA IS A PREVENTABLE AND TREATABLE DISEASE
AWARENESS, HYGIENE, AND VACCINATION ARE KEY
• GLOBAL EFFORTS NEEDED TO CONTROL AND ELIMINATE CHOLERA
• GLOBAL IMPACT
• 1.3 MILLION TO 4.0 MILLION REPORTED CASES ANNUALLY
• 21,000 TO 143,000 DEATHS ANNUALLY
• ENDEMIC IN 47 COUNTRIES
REFERENCE
WORLD HEALTH ORGANIZATION (WHO)
CENTERS FOR DISEASE CONTROL AND PREVENTION (CDC)
• NATIONAL INSTITUTE OF HEALTH (NIH)
