Today is our topic of discussion Definition of Cholera
Definition of Cholera
Definition:
Cholera is an acute diarrhoeal disease caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae.
Epidemiological features:
Cholera has both epidemic and endemic potential. Both patterns depend on the characteristics of the agent and the environment. Epidemics of cholera are characteristically abrupt and often create an acute public health probelm.
Agent factors:
Agent:
Vibrio cholerae
Resistance:
V. cholerae are killed within 30 minutes by heating at 56°C or within a few seconds by boiling. May remain in ice for 4-6 weeks or longer. Drying and sunshine kill them in a few hours.
Toxin:
An exotoxin in the intestine binds with intestinal mucosa and produces diarrhoea.
Reservoir of infection:
Man (cases and carriers)
Infective material:
Stools and vomits of cases and carriers.
Infective dose:
About 10″ organisms are required to cause diarrhoea.
Period of communicability:
A case of cholera is infectious for a period of 7 to 10 days.
Host factors:
Age and sex:
Cholera affects all ages and both sexes. un voz diw noblida
Gastric acidity:
The bacterium is destroyed in an acidity of pH 5 or lower. god
Population movement:
Movement of population results in increased risk.
Economic status:
Incidence is higher in low socio-ecnomic group.
Environmental factors:
A community with poor environmental sanitation is a factor for contamination of food and water. Besides these, low standard of personal hygiene, lack of education and poor quality of life are also responsible.
Mode of transmission:
1. Faecal contamination of water
2. Contamination of food and drinks (finom )atni gnuoY tenoiting to not s
3. Direct contact
Incubation period:
From less than one day upto five days.
Clinical feature:
A typical case of cholera shows three stages –
Stage of evacuation:
Onset is abrupt with profuse, painless, watery diarrhoea followed by vomiting; may be 40 stools/ day. The stool has a ‘rice water’ appearance.
Stage of collapse:
Patient soon passes into a stage of collapse due to dehydration. Classical signs: sunken eyes, hollow cheeks, scaphoid abdomen, sub-normal temperature, washerman’s hands & feet, feeble pulse, unrecordable bood pressure, loss of skin elasticity, shallow and quick respirations and diminished urine; restless and complains of intense thirst and cramps in leg and abdomen. Death may occur at this stage due to dehydration and acidosis.
Stage of recovery:
Patient begins to show signs of clinical improvement. BP rises, temperature becomes normal and urine formation starts. If anuria persists, patient may die of renal failure.
Laboratory diagnosis of cholera: Demonstration of the bacteria in the samples-
a. Stools
b. Vomitus
c. Suspected water
d. Food samples: Samples of food suspected to be contaminated
Treatment:
Same as ‘management of diarrhoea’ described above.
Control of cholera:
1. Verification of diagnosis
2. Notification
3. Early case finding
4. Establishment of treatment centres
5. Rehydration therapy: Oral, IV and maintenance therapy
6. Antibiotics: Given as soon as vomiting stopped
7. Epidemiological investigations
8. Sanitation measures:
a. Water control
b. Proper excreta disposal
c. Food sanitation
d. Disinfection practices
9. Chemoprophylaxis
10. Vaccination
11. Health education
Complications of diarrhoeal illness/cholera and management:
Paralytic ileus –
Due to hypokalaemia (potassium depletion), evidenced by abdominal distension. Corrected and prevented by ORS solution or potassium-rich foods such as bananas, coconut water or dark green leafy vegetables and K-supplements (oral or parenteral).
High fever:
Paracetamol
Rectal prolapse:
Gently push back the prolapse using a surgical glove or a wet cloth and refer.
Convulsions:
If repeated convulsions, IM diazepam.
Death:
Arrest of vital functions.
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