INTRODUCTION
- Cholera is an acute diarrheal illness caused by infection of the intestine with the bacteria vibrio cholera
- It causes severe diarrhea lead to dehydration and if untreated death may occur.
- It spread by ingestion of contaminated food and water.
EPIDEMIOLOGY:
- It has become an increasing public health concern around the world.
- It kills an estimated 95000 people/year, and infects 2.9 m people
ETIOLOGY:
- Age & Low personal hygiene.
- Low immunity
- Low gastric acid levels
- Soil and water pollution
- Contaminated food and water
SIGNS & SYMPTOMS :
- Pain in abdomen
- Nausea
- Severe diarrhea ,watery diarrhea
- Dehydration
- Water electrolyte imbalance
- Lethargy (lack of energy)
TYPES:
1.RICE WATER DIARRHEA
* It causes painless diarrhea & vomiting of clear fluid
*Loss of 1L/HR
*Without treatment death occurs with in 18hrs-7 days
2.CHOLERA GRAVIS
*More severe
*Loss of 6L/HR
*Death with in 2-3 hrs
3.CHOLERA SICCA
*Rare & severe
DIAGNOSIS
- Stool specimen
- Cholera toxin by culture
- Cholera rapid test dipsticks
- Rectal swab method
- Catheter swab method
TREATMENT
A.RE HYDRATION PHASE
- To restore normal hydration status
- Set rate of I.V infusion in severely dehydrated patients at 50-100ml/kg/hr.
- Lactate ringer solution is preferred
B.MAINTENANCE PHASE
- To maintain normal hydration status by replacing ongoing losses.
- Oral route is preferred, use of ORS at 500-1000ml/hr.
C.ANTIBIOTIC TREATMENT
Drug Adult Child
1.DOXY 300mg –
2.TETRACYCLINE 500mg 12.5mg/kg QID -3 DAYS
3.COTRIMOXAZOLE TMP-160 TMP-5mg/kg
SMX-800 SMX-25mg/kg
4.FURAZOLIDONE 100 mg 1.25mg/kg
5.AZITHROMYCIN 1gm/PO 20mg/kg (<1gm)
6.ERYTHROMYCIN – 12.5mg/kg(6hrs/3 days)
IN PREGNANCY:
AZITHROMYCIN – 1gm/OD
ERYTHROMYCIN – 500mg/6hrs/3days
D. ZINC SUPPLEMENT
- Increase absorption of water and electrolytes
- Boosts immune system
NON-PHARMACOLOGICAL TREATMENT
- Drink and use safe water.
- Washing hands with safe water.
- Use latrines.
- Cook food well.
- Use flush toilet.
- Proper washing of clothes.
- Using sanitizer and Mask.
- Use disinfectant in cleaning
VACCINATION
1.DUKORAL
- 3ml/ single dose vial
- Not for children< 2years
2.SANCHOL
- Administrate orally in 2doses in gap of 14days
- Booster dose recommend after 2 years.
3.VAXCHORA
- Use in adults (18-64).
ABOUT DRUGS
DOXYCYCLINE & TETRACYCLINE :
MOA- Inhibits bacterial protein synthesis by binding to 30S
ribosomal subunits.
SE- Dizziness, fast heart rate, indigestion sore throat
CI- In pregnancy, breast feeding, liver and kidney dis function.
Child< 12 years ( discoloration of teeth)
COTRIMOXAZOLE :
MOA- Inhibits folic acid synthesis
SE- Rashes ,sore throat, SOB ,cough
CI-Pregnancy, renal patients
FURAZOLIDINE :
MOA-Bind to DNA &induce crosslinks
SE- lower B.P, fever, joint pain
AZITHROMYCIN & ERYTHROMYCIN :
MOA-Binds to 50S subunit of bacterial ribosome
SE – abdominal pain
cI – liver problems, slow heart rate, myasthenia gravis
RED FLAGS:
- Hypovolemic shock
PIT FALLS:
- Other diarrheal infections
- Arsenic poisoning
PEARLS:
- Adequate hydration
REFERENCE: