CHOLERA

Cholera is an acute diarrheal illness caused by Vibrio cholera 01 OR O139

V.CHOLERA O1 Classical and El tor biotype

CHOLERA

EPIDEMIOLOGY

Category 1 Category 2 Category 3 Category 4

1

2 2

3

5

24%INCREASE IN BURDEN OF CHOLERA FROM 2000-

2004 TO 2004-2008

2000 -2004 2004-2008

BURDEN OF INFECTIOUS DESEASES IN PAKISTAN

ACUTE RESPI-RATORY INFEC-

TIONS51%

MALARIA16%

VIRAL HEPATITIS8%

DIARRHEA AND DYSENTRY

23%

OTHERS2%

ACUTE RESPIRATORY IN-FECTIONSMALARIAVIRAL HEPATITISDIARRHEA AND DYSENTRYOTHERS

CHOLERAEPIDEMIC ENDEMIC

AGENT

ABILITY TO SURVIVE IN A

GIVEN ENVIRONMEN

T

VIRULENCE

ENVIRONMENT

SUSCEPTIBILITIES

OPPORTUNITIES

CASES CARRIERSI. PRECLINICAL OR INCUBATORY CARRIERII. CONVALLSCENT CARRIERIII. HEALTHY CARRIER IV. CHRONIC CARRIER

CASES AND CARRIERS

a) AGENTb) RESISTANCEc) TOXIN PRODUCTIONd) RESERVOIR OF INFECTIONe) INFECTIVE MATERIALf) INFECTIVE DOSE(ID)g) PERIOD OF COMMUNICABILITY

EPIDEMIOLOGICAL DETERMINANTSAGENT FACTORS

a) AGE AND SEXb) GASTRIC ACIDITYc) ECONOMIC STATUSd) IMMUNITYe) LACK OF HEALTH EDUCATION f) POOR PERSONAL HYGIENE

HOST FACTORS

ENVIRONMENTAL FACTORS

Drinking contaminated water.

eating raw or undercooked shellfish

a) Fecaly contaminated waterb) Fecaly contaminated foods and drinksc) Direct contact

MODE OF TRANSMISSION

Man Man

Incubation period

•From few hours to 5 days

MECHANISM OF ACTION OF CHOLERA TOXIN

Stage of evacuation

• Onset is abrupt

• Profuse diarrhea 40 stools in a day

Stage of collapse

• Sunken eyes

• Hallow cheeks

• Subnormal temparature

Most people remain asymptomatic. The symptoms of cholera include :

SIGNS & SYMPTOMS

profuse, watery

diarrhea

stomach pains leg cramps

Mild fever Vomiting

Sunken eyes and cheeks

Dry mucous membranes

Decreased urinary output

severe dehydration Shock

Renal failure Death

COMPLICATIONS

STOOLS FOR D/R &C/S

1-3LITRE OF WATER&1-3g OF SUSPECED WATER AND FOOD IS COLLECTED FOR CHEMICAL ANALYSIS

DIRECT HEMAGLUTINATION TES

LABORATORY INVESTIGATIONS

CONTROL OF CHOLERA

VERIFICATION OF THE DIAGNOSIS NOTIFICATION EARLY CASE FINDING ESTABLISHMENT OF TREATMENT CENTERS ORAL REHYDRATION THERAPY SANITAION MEASURES CHEMOPROPHYLAXIS VACCINATION HEALTH EDUCATION

Oral rehydration salts• Up to 80% of cases can be treated

through this.

Intravenous fluids (Ringer lactate)• For severe cases.

Antimicrobial Therapy• can diminish duration of diarrhea,

reduce volume of rehydration fluids needed, and shorten duration of V. cholerae excretion.

TREATMENT

ORS BICARBONATEINGREDIENTS QUANTITYNa bicarbonate 2.5gmNaCl 3.5gmPotassium chloride 1.5gmglucose 20gm

INGREDIENTS QUANTITYNa Citrate dehydrate 2.9gmNaCl 3.5gmPotassium chloride 1.5gmglucose 20g

ORS CITRATE

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