By

Anees Ur Rahman Inam Ullaah Sherbaz Khan Sadia Reena

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At the end of this presentation the participant will be able to:

Define cholera and dysentery

Discuss its cause List sign and symptom of cholera and dysentery Discuss its possible treatment Describe prevention of cholera and dysentery Discuss its possible complication

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Cholera is an infection of the small intestine that causes a large amount of watery diarrhea. It is caused by bacteria: Vibrio cholerae, which was discovered in 1883 by Robert Koch during a diarrheal outbreak in Egypt.

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The number of cholera patients worldwide is uncertain because many cases are unreported. The number of cases is increased during epidemics & is affected by environmental factors. In 1994, 94 countries reported 385,000 cases of cholera to WHO, but the number reported in 1998 was 121,000. 89% of these cases were reported from Africa.

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Cholera is caused by the bacterium Vibrio cholerae. The bacteria releases a toxin that causes increased release of water in the intestines, which produces severe diarrhea. Cholera occurs in places with poor sanitation, crowding, war, and famine Living in or traveling to areas where there is cholera

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People get the infection by eating or drinking contaminated food or water. A type of vibrio bacteria also has been associated with shellfish, especially raw oysters. Exposure to contaminated or untreated drinking water

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Abdominal cramps Dry mucus membranes or mouth Dry skin Excessive thirst Glassy or sunken eyes Lack of tears Lethargy

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Low urine output Nausea Rapid dehydration Rapid pulse (heart rate) Sunken "soft spots" (fontanelles) in infants Unusual sleepiness or tiredness Vomiting Watery diarrhea that starts suddenly and has a "fishy" odor

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Organism can be seen in stool by direct microscopy after gram stain and dark field illumination is used to demonstrates motility Cholera can be cultured on special alkaline media like triple sugar agar or TCBS agar
Serologic tests are available to define strains, but this is needed only during epidemics to trace the source of infection

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Dehydration leads to high blood urea & serum creatinine. Hematocrit & WBC will also be high due to hemoconcentration. Dehydration & bicarbonate loss in stool leads to metabolic acidosis with wide-anion gap. Total body potassium is depleted, but serum level may be normal due to effect of acidosis

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The primary goal of therapy is to replace fluid losses caused by diarrhea & vomiting Fluid therapy is accomplished in 2 phases: rehydration and maintenance. Rehydration should be completed in 4 hours & maintenance fluids should replace ongoing losses & provide daily requirement.

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Ringer lactate solution is preferred over normal saline because it corrects the associated metabolic acidosis. IV fluids should be restricted to patients who purge >10 ml/kg/h & for those with severe dehydration. The oral route is preferred for maintenance & the use of ORS at a rate of 500-1000 ml/h is recommended

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The goals of drug therapy are to eradicate infection, reduce morbidity and prevent complications. The drugs used for adults include tetracycline, doxycycline, cotrimoxazole & ciprofloxacin. For children erythromycin, cotrimoxazole and furazolidone are the drugs of choice.

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Drink only water that you have boiled, or that you have treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water, and carbonated, bottled beverages with no ice. Make sure that all vegetables are cooked, and avoid salads. Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.

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Avoid undercooked or raw fish or shellfish, including ceviche (seafood marinated in lime or lemon juice). Avoid foods and beverages from street vendors. Do not bring perishable seafood back to the United States.
Vaccination against cholera to travellers to endemic countries & during public gatherings
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If dehydration is not corrected adequately & promptly it can lead to hypovolemic shock, acute renal failure & death. Electrolyte imbalance is common. Hypoglycemia occurs in children. Complications of therapy like over hydration & side effects of drug therapy are rare.

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Dysentery is bloody diarrhea, i.e. any diarrheal episode in which the loose or watery stools contain visible red blood. Dysentery is most often caused by Shigella species (bacillary dysentery) or Entamoeba histolytica (amoebic dysentery).

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Common bacterial causes of dysentery include infections with the bacteria Shigella and some types of Escherichia coli (E coli).
Other less common bacterial causes of bloody diarrhea include Salmonella and Campylobacter infections Dysentery is associated with environmental conditions where poor sanitation is prevalent.
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Amebic dysentery, caused by the parasite Entamoeba histolytica, is most commonly found in tropical areas with crowded living conditions and poor sanitation

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Bacillary dysentery symptoms The signs and symptoms of dysentery can last five to seven days or even longer.

Common symptoms are mild stomach pains and bloody diarrhea. There is usually a lot of diarrhea to begin with, followed by smaller amounts that are passed frequently and sometimes painfully.
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In more severe cases, symptoms can include: Watery diarrhea that contains blood or mucus Nausea (feeling sick) Vomiting (being sick) Severe abdominal pain Stomach cramps A high temperature (fever) of 38C (100.4F) or over

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Amoebic dysentery symptom

watery diarrhea, which can contain blood, mucus or pus nausea vomiting abdominal pain fever and chills bleeding from your rectum (back passage) loss of appetite and weight loss

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A clinical diagnosis may be made by taking a history and doing a brief examination. Treatment is usually started without or before confirmation by laboratory analysis. The mouth, skin, and lips may appear dry due to dehydration. Lower abdominal tenderness may also be present.

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Rehydration therapy - initially this is done using oral rehydration; the patient is encouraged to drink plenty of liquids. Diarrhea, as well as vomiting results in loss of fluids that have to be replaced to prevent dehydration. If the diarrhea and/or vomiting is profuse the medical team may recommend intravenous fluid replacement the patient will be on a drip.

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Antibiotics and amoebicidal drugs - experts say that if possible, the administration of medications to kill the cause of the dysentery should be held back until lab tests determine whether the illness is being caused by a bacterium or amoeba. If this is not possible, depending on the severity of symptoms, the patient may be given a combinations of antibiotic and amoebicidal medication.

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To reduce the risk of contracting dysentery the following precautions are suggested: Washing one's hands after using the toilet, after contact with an infected person, and regularly throughout the day. Washing one's hands before handling, cooking and eating food, handling babies, and feeding young or elderly people.
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Keeping contact with someone known to have dysentery to a minimum. Washing laundry on the hottest setting possible. Avoiding sharing items such as towels and face cloths.

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www.who.int/topics/cholera/control/en/index.html www.cdc.gov/cholera/prevention.html www.unicef.org/wcaro/07UNICEF_Cholera_Prevention.ppt www.thelancet.com/journals/lancet/.../PIIS01406736(04)15749-8 www.health.state.mn.us/divs/idepc/diseases/cholera/pre vention.html

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