By:Najla Alshami
■ During the 18th century cholera spread across the world from it's original reservoir in the Ganges delta in India .
six subsequent pandernics killed millions of people across all countries .
Epidemiology : cholera is an acute diarrheal infection caused
by vibrio cholerae .
it spreads as fecal-oral disease .
and people acquire the infection by the ingestion of facially contaminated water and food.
Description: vibrio's are short ,gram –ve which are curved organsms possessing a single polar flagellum.
The organisms have many similarities to the members of the enterobacteriaceae ,but can be readily differentiated by their ability to grow at pH(9-9.5).
Pathogenesis: After ingestion of v.cholera in drink or food , the organisms passing the acid barrier of the stomach , begin to multiply in the alkaline environment of small intestine , where they produce a potent enterotoxin known as cholera toxin .
This toxin is called "Choleragene" , that acts identically to E coli LT to stimulate the activity of the enzyme adeny 1 cyclase .
This in turn ,converts ATP->cyclic AMP "cAMP" which stimulate the secretion of cl and inhibits the absorption of Na+. also many last fluids contain large amounts of bicarbonate and K+.
Thus the patient has both a sever fluids loss and electrolyte imbalance.
Symptoms: It can take from few hours to 5 days for symptoms to appear after infection approximately (10%) infected person will have severe disease characterized by : 1-Vorniting ,profuse watery diarrhea ,leg cramps .
In these people ,repaid loss of body fluids leads to dehydration and hypovolemic shock ,which may cause death in 12-24h.
An uria develops , muscle cramps occur and patient quickly becomes wake , lethargic with loss of skin turgor ,lo B.P and absent or thready pulse. Also dry mouth ,sunken eyes and rapid weight loos.
Cholera causes : cholera is most common in places with poor sanitation , crowding ,war and famine.
The common sources of contamination of food and water include:
• Municipal water supplies.
• Food and drink sold by street vendors.
• Vegetables grown with water containing human wastes.
• Row or undercooked fish ,seafood caught in waters. polluted with sewage.
Cholera Prevention and Ltt: Although there is a vaccine against cholera , the CDC, WHO do not normally recommend it ,because it may not protect up to 1/2 of the people who receive it , and it tests only a few months.
So ,protection against cholera can be thought using bullied water , water that has been chemically disinfected such types of water to be used for :
• Drinking.
• Preparing food or drink.
• making ice.
• brushing teeth ,washing.
• face and hands.
• Washing dishes ,fruits and vegetables Ltt:
1-It is normally dehydration that leads to death from cholera so that most important treatment is to give oral by duration solution(Ros).
2- sever causes of cholera require I.V fluid replacement .
An adult weighing 70 kg will need at least 7 L of F.V fluid .
3- Antibiotic can shorten the duration of the disease Tetracycline of V.cholera in the stool of the patients.
NB:
1-Anti-diarrheal medicines are used ,because they prevent the bacteria from being flashed out of the body
2- A well cooked and salted rice soup is recommended for diarrhed patients who are unable to obtain glucose –salt solution.
Control of cholera:
1-Hands washing with soap and clean water should e done before and each patient contact.
2-To be sure water is safe to drink and use boil water or treat it with chlorine product . if boiling ,bring water to complete boil for at least 1 min .
If chlorine treatment product is not available , you can treat your water with household bleach, add 2 drops of bleach for 1 liter of water and wait 30 minutes before drinking.
3- several chlorine solution can be used for disinfection solution calculations are based on using unscented household bleach with 5-6% active chlorine:
• 2% chlorine :made by mixing 3 parts water and 2 part bleach , It used for disinfecting vomit ,faces and corpses.
• 0.2% chlorine :made by mixing 9 parts water and 1 part of bleach .used for foot baths , cleaning floors, bedding
latrines.
• 0.05% chlorine :made by mixing 9 parts water and 1 part of 0.5% chlorine solution .used for bathing soiled patients, hand washing , rinsing dishes , laundry.
References :
1-www.who.int>news>failsheet>detail.chlorea-world health organization -1 Feb 2018.
2-Volk ,Benjamine.(Essentials of medical microbiology ) 4th ed. library of congress .1991:404.
3- David Green Wod .Medical microbiology .5th ed . Churchill Livingstone .1997 :298-299.
4-https://www.cde.gov>cholera ,general information >cholera CDC may 11,2018.
5-https://www.webmd.com.chlorea: causes and symptoms ,July 14,2017.
6-https://www.medical news today , Jan.2018.
7-https://www.cdcgov.chlorea –(Infection control for cholera ) cholera ,infe ,24/7/2017.
8-https://www.CDC:chlorea-vibiro cholerae in in health care setting ."aFive- basic cholera presentation steps" July ,24,2017.
#الهيئةالعلياللادويةوالمستلزماتالطبية
