CHOLERA

An acute bacterial enteric disease of the GIT characterized by profuse diarrhea,

vomiting, massive loss of fluid & electrolytes, which could result in hypovolemic
shock, acidosis and death

 Vibrio cholerae/ Vibrio coma/El Tor

• Slightly curved rod (comma-shaped)

• A few hours to 5 days (1-3 days)
gram (-) & motile with a polar
flagellum

• Survives well at ordinary temperatures

& multiplies well in temperatures
ranging from 22-40°C • During the stool-positive stage, usually a

• Can survive longer in refrigerated days after recovery; occasionally, the

foods carrier may have the organism for
• An enterotoxin, choleragen, is several months
elaborated by the organism as it
grows in the intestinal tract

PATHOGNOMONIC SIGN: Rice-water stools 1. Fecal-oral transmission

2. Ingestion of contaminated food or water

3. Thru flies, soiled hands and utensils

enterotoxin → adenylate cyclase → conversion of the

adenosine triphosphate (ATP) to cyclic

adenosine monophosphate (CAMP)
1. Acute, profuse, watery diarrhea
⭣ with no tenesmus or intestinal
cramping
intact epithelium on the

• Diarrhea causes fluid loss amounting to 1

⭣
to 30 liters per day owing to subsequent
vasculature of the bowel dehydration and electrolyte loss

⭣ 2. Initially, stool is brown and contains fecal

materials, but soon becomes pale gray, “rice-
outpouring of intestinal fluids (5-10%) ➔ DHN & M. acidosis
water” in appearance with an inoffensive, slightly
• The mucosal cell is stimulated to increase secretion fishy odor
of chloride, associated with water and bicarbonate 3. Vomiting often occurs after diarrhea has been
loss.
established.
4. Tissue turgor is poor and eyes are sunken into the
orbit.
5. Cold skin and wrinkled fingers and toes (“washer- • Treatment of cholera consist of correcting the basic
woman’s hand”) abnormalities without delay – restoring the
6. Imperceptible radial pulse and unobtainable BP circulating blood volume and blood electrolytes to

7. Cyanosis normal levels.

8. Hoarse voice and then lost (patient speaks in 1. Rapid intravenous infusion of alkaline saline
whisper: aphonia) solution containing Na, K, Cl and
9. Rapid and deep breathing bicarbonate ions in proportions

10. Consciousness is present despite marked comparable to that in water-stool.

diminished peripheral circulation 2. Oral therapy rehydration (Oresol, Hydrites)

unless contraindicated or, if the patient is
11. Oliguria or anuria
not vomiting.
12. Temperature: normal at the onset of the disease
3. . Maintenance of the volume of F&E to
but becomes subnormal in later stage especially
ensure rehydration (monitor I/O carefully)
if the patient is in shock 4. Antibiotics
13. Deep shock: passage of diarrhea stops a. Tetracycline 500mg every 6 hours
14. Death may occur as short as four hours after (adults), and 125 mg/kg body

onset, but usually occurs on the first or second weight for children every 6 hours

day if not properly treated. to 72 hours

b. Furazolidone 100 mg (adults) and
125mg/kg for children every 6
hours for 72 hours
1. Rectal Swab c. Chlorampenicol 500 mg (adults)

2. Darkfield or phase microcopy and 18 mg/kg for children every 6

3. Stool Exam hours for 72 hours

d. Cotrimoxazole 8mg/kg for 72
hours.

1. Extracellular Volume ➔ DHN, Circulatory

collapse or Shock

2. Metabolic acidosis ➔ Kussmaul’s respiration

• Altered nutrition: Less than body
3. Hypokalemia ➔ abdominal distention requirements
(paralytic ileus)
• Altered tissue perfusion
4. Renal failure – from prolonged, untreated
• Activity intolerance
shock or unrelieved hypokalemia
• Knowledge deficit
5. Convulsions & tetany – loss of magnesium
• Risk for fluid volume deficit
6. Hypoglycemia (untreated children who have
been in stupor for several days) • Diarrhea

7. Corneal scarring – (stuporous patients who • Impaired skin integrity

have lost the “wink reflex”)

8. Acute pulmonary edema – may follow

hydration in cases of uncorrected metabolic
acidosis
1. Medical aseptic protective care &
handwashing
2. Enteric isolation
3. Accurate V/S and I/O
4. Personal hygiene
5. Proper excreta disposal
6. Concurrent disinfection
7. Proper food preparation
8. Environmental sanitation
9. Weigh patient daily
10. Give appropriate diet

o Food and water supply must be protected

from fecal contamination.
o Water should be boiled or chlorinated.
o Milk should be pasteurized.
o Sanitary disposal of human excreta is a must.
o Sanitary supervision is important.