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 Health & You:
CHOLERA
Oct 11, 2013
By: Eze Nkeiruka Perpetua








Nigeria: -

WHAT IS CHOLERA?

Cholera frequently is called ASIATIC or epidemic cholera.

Cholera is a severe diarrheal disease caused by the bacterium Vibrio Cholera. Transmission to human is by water or food. The natural reservoir of the organism is not known.

V.Cholera is a gram-negative bacterium which produces cholera toxin, the model for entero toxins, whose action on the mucosal epithelium is responsible for the characteristics diarrhea of the disease cholera. In its extreme manifestation, cholera is one of the most rapidly fatal illnesses known.

An estimated 3-5million case and over 100,000 deaths occur each year around the world. The infection is often mild or without symptoms, but can sometimes be severe. Approximately one in 20(5%) infected persons will have severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these people, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

Recent Epidemiology research suggest that an individual susceptibility to cholera is affected by their blood type ,those with type O blood are the most susceptible, while those with AB are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B.

About one million “V Cholera” bacteria must typically be ingested to cause cholera in normally healthy adults, although increased susceptibility may be observed in those with a weakened immune system, individuals with decreased gastric acidity ( as from the use of antacids) or those who are malnourished or immunonsuppressed.

                                      TRANSMISSION

People infected with cholera suffer acute diarrhea, this highly liquid diarrhea is referred to as “rice- water stool” which is loaded with bacteria that can infect water used by other people. Cholera is transmitted with the person through ingestion of water contaminated with the cholera bacterium, usually from feces. The sources of the contamination are typically other cholera patients when their untreated diarrhea discharge is allowed to get into water-ways or into groundwater or drinking water supplies. Any infected water and any foods washed in the water, as well as shellfish living in the affected water way can cause an infection. It takes about 100 million bacteria to infect a healthy adult, because of this high number significant contamination of food or water is required to transmit the disease.

                                  SYMPTOMS

Watery diarrhea

Vomiting

Rapid heart rate

Loss of skin Elasticity

Dry mucous membrane

Thirst

Muscle Cramps

Low blood pressure

Restlessness or irritability.

 

 HOW TO AVOID GETTING CHOLERA

  • Drink only bottled, boiled or chemically treated water and bottled or canned carbonated beverages.
  • Wash your hands often with soap and clean water
  • Do not eat raw, undercooked meats, sea foods or unpeeled fruits and vegetables.
  • Dispose of feces in a sanitary manner to prevent contamination of water and food sources
  • Eat foods that are packaged or that are freshly cooked and served hot.

                 HOW IS DIAGNOSED

The diarrhea fluid is often teeming with motile comma-shaped bacteria that can be seen with a microscope. The definitive diagnosis is made by isolation of the bacteria fluid on a selective medium thiosulfate-citrate-bile salts agar (TCBS).

 

                                                        TREATMENT

The CDC recommends rehydration with ORS (oral rehydration salts) fluids as the primary treatment for cholera. The CDC follows the guidelines developed by the WHO (World Health Organization) as follow:

 WHO Fluid Replacement or Treatment Recommendations (as per the CDC)

PATIENT CONDITION

TREATMENT

TREATMENT VALUE GUIDELINES;AGE AND WEIGHT

No dehydration

Oral rehydration salts(ORS)

Children

Children 2-9yrs:100-200ml,up to1,000ml/day

Patients>9yrs:as much as wanted, to 2000ml/day

 

Some hydration

Oral rehydration salts (amount in first four hours)

Infants

Infants 4 month-11 month (5kg-7.9kg):400-600ml

Children 1-2yrs( 8kg-10.9kg): 600-800ml

Children 2-4 yrs(11kg-15.9kg):800-1200ml

Children 5-14yrs (16kg-29.9kg):1,200-2,200ml

Patients >14yrs (30kg or more): 2200-4000ml

Severe dehydration

IV drips of Ringer Lactate or if not available, normal saline and oral rehydration salts as outlined.

Age

Age >1 year: 30ml/kg within 30 min then 70ml/kg over two and a half hours.

 

 Repeat once if radial pulse is still very weak or not detectable. Reassess the patient every one to two hours and continue hydrating. If hydration is not improving, give the iv drip more rapidly.200 ml/kg or more may be needed during the first 24 hours of treatment.

After six hours (infants) or three hours (older patients) perform a full reassessment, switch to ORS solution if hydration is improved and the patient can drink.

In general, antibiotics are reserved for more severe cholera severe infection have been effectively treated with tetracycline, doxycycline,furazolidone, erythromycin or ciprofloxacin in conjunction with IV hydration.

 

 

 

 

 

 

 

 


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