Cholera & Dysentery

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By

Anees Ur RahmanInam Ullaah

Sherbaz KhanSadia

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 intestinethat causes a large amount of waterydiarrhea.

It is caused by bacteria: Vibrio cholerae,which was discovered in 1883 by RobertKoch during a diarrheal outbreak in Egypt.

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The number of cholera patients worldwide isuncertain 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 ofcholera to WHO, but the number reported in 1998was 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 associatedwith 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 microscopyafter gram stain and dark field illumination is used todemonstrates motility

Cholera can be cultured on special alkaline medialike triple sugar agar or TCBS agar

Serologic tests are available to define strains, butthis is needed only during epidemics to trace thesource of infection

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Dehydration leads to high blood urea & serumcreatinine. Hematocrit & WBC will also be high dueto hemoconcentration.

Dehydration & bicarbonate loss in stool leads tometabolic 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 fluidlosses 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 normalsaline because it corrects the associated metabolicacidosis.

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 & theuse of ORS at a rate of 500-1000 ml/h isrecommended

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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 andfurazolidone are the drugs of choice.

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Drink only water that you have boiled, or that youhave treated with chlorine or iodine. Other safebeverages include tea and coffee made with boiledwater, 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 peeledyourself.

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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, acuterenal failure & death.

Electrolyte imbalance is common.

Hypoglycemia occurs in children.

Complications of therapy like over hydration & sideeffects 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) orEntamoeba histolytica

(amoebic dysentery).

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Common bacterial causes of dysentery include

infections with the bacteria Shigella and some types

ofEscherichia 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 historyand doing a brief examination.

Treatment is usually started without or beforeconfirmation by laboratory analysis.

The mouth, skin, and lips may appear dry due to

dehydration. Lower abdominal tenderness may alsobe present.

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Rehydration therapy - initially this is done using oralrehydration; the patient is encouraged to drink plenty ofliquids.

Diarrhea, as well as vomiting results in loss of fluids thathave to be replaced to prevent dehydration.

If the diarrhea and/or vomiting is profuse the medicalteam may recommend intravenous fluid replacement -the patient will be on a drip.

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Antibiotics and amoebicidal drugs - experts say thatif 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 combinationsof antibiotic and amoebicidal medication.

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To reduce the risk of contracting dysentery thefollowing precautions are suggested:

Washing one's hands after using the toilet, aftercontact with an infected person, and regularly

throughout the day.

Washing one's hands before handling, cooking andeating food, handling babies, and feeding young or

elderly people.

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Keeping contact with someone known to havedysentery 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/07-

UNICEF_Cholera_Prevention.ppt www.thelancet.com/journals/lancet/.../PIIS0140-

6736(04)15749-8

www.health.state.mn.us/divs/idepc/diseases/cholera/pre

vention.html

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