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CHOLERA

CHOLERA. PRESENTED BY DR EZEOKPO BASIL CHUKWUMA DEPT OF MEDICINE FEDERAL MEDICAL CENTER ABAKALIKI. DEFINITION. THIS IS AN EPIDEMIC, ACUTE WATERY DIARRHEAL DISEASE CAUSED BY VIBRO CHOLERA. ORGANISM.

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CHOLERA

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  1. CHOLERA PRESENTED BY DR EZEOKPO BASIL CHUKWUMA DEPT OF MEDICINE FEDERAL MEDICAL CENTER ABAKALIKI

  2. DEFINITION • THIS IS AN EPIDEMIC, ACUTE WATERY DIARRHEAL DISEASE CAUSED BY VIBRO CHOLERA

  3. ORGANISM • VIBRO CHOLERA – Short, slightly curved, rapidly motile, darting, uniflagelated, gram negative bacteria. • SEROGROUPS – • 01 • 0139 – BENGAL SEROTYPES – OGAWA, INABA, HIKOJIWA BIOTYPES - CLASSICAL -- EL “TOR”

  4. EPIDEMICS • THE PRESENT PANDEMIC (7th ) • is due to EL “TOR” first recognized in • 1911 at EL TOR quarantine in the Persian Gulf • 1930s in the Celebes • 1970s in Africa • 1973 in Mississippi delta region • 1991 in Peru • Current epidemics are due to 0139 Bengal

  5. SPREAD AND SUSCEPTIBILITY • IT IS WATER BORNE – STOOL • In a setting of poverty, lack of safe water, natural disasters, refugee camps. • Contaminated food – raw, or undercooked shell fish and vegetables. • Susceptibility - In areas of yearly epidemics children of less than 5yrs are more susceptible to infection. In intermittent epidemics all age groups are equally affected. • Antacid, Proton pump inhibitors use, gastrectomies, Blood group O

  6. PATHOGENESIS • Incubation period of 12hrs to weeks • Attaches to brush borders of intestinal epithelium • Secretes exotoxin • Causes increased Adenylate cyclase activity • Leading to raised Cyclic Adenosine Monophosphate levels • This leads to decreased reabsorption of Water, Sodium, Anions with consequent watery diarrhoea. • Fluid loss is an ultra filtrate of plasma, rich in K+ and Na+

  7. CLINICAL MANIFESTATION • Severe dehydration, shock in 4-6hrs, and death in 18hrs.

  8. DIAGNOSIS • High Index of suspicion – immediate treatment • Stool microscopy – no cells • Dark-field (motile uniflagetated) • Immobilization of 01, 0139 with antisera • Culture in thiosulfate citrate-bile salt-sucrose agar

  9. TREATMENT • Early and complete rehydration • Orally with starchy food hydrates – pap, cereals, rice water solutions. • In shock and coma give IV • IV large bore needle, 50-100ml/ until strong radial pulse • Less rapidly over the next 2 hrs • Fluid loss is 10% of body weight • Change early to oral/NG • Solutions • Dhaka solution • Ringer’s Lactate

  10. PREVENTION • SAFE WATER SUPPLIES • PERSONAL AND COMMUNITY HYGEINE • IN EPIDEMICS, STRICT HAND WASHING WITH SOAP AND WATER • CASE REPORTING • SURVEILANCE • ORAL VACCINE

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