Cholera
is an acute diarrheal infection caused by ingestion of food or water contaminated
with the bacterium Vibrio cholerae
Cholera is an extremely virulent disease that can cause severe acute watery diarrhrea.
Cholera causes severe diarrhea and dehydration
Etiologic Agent- bacterium Vibrio cholerae
There are many serogroups of V. cholerae, but only two – O1 and O139 – cause
outbreaks.
V. cholerae O1 has caused all recent outbreaks.
V. cholerae O139 first identified in Bangladesh in 1992 – caused outbreaks in the
past, but recently has only been identified in sporadic cases.
Mode of Transmission
drinking water or eating food contaminated with the cholera bacterium.
In an epidemic, the source of the contamination is usually the feces of an infected
person that contaminates water and/or food. The disease can spread rapidly in
areas with inadequate treatment of sewage and drinking water.
Raw or undercooked contaminated seafood.
Incubation Period- It can take anywhere from a few hours to 5 days for symptoms to
appear after infection. Symptoms typically appear in 2-3 days.
Period of Communicability- Patients are infectious from the onset of symptoms until
seven days after resolution of diarrhea.
Signs and Symptoms
profuse watery diarrhea
vomiting
leg cramps.
rapid loss of body fluids leads to dehydration and shock.
loss of skin turgor
dry mucous membranes
hypotension and thirst
Without treatment, death can occur within hours.
Diagnostic Procedure
Stool examination. Although observed as a gram-negative organism, the
characteristic motility of Vibrio species cannot be identified on a Gram stain, but it is
easily seen on direct dark-field examination of the stool.
Stool culture. V cholerae is not fastidious in nutritional requirements for growth;
however, it does need an adequate buffering system if fermentable carbohydrate is
present because viability is severely compromised if the pH is less than 6, often
resulting in autosterilization of the culture.
Serotyping and biotyping. Specific antisera can be used in immobilization tests; a
positive immobilization test result (ie, cessation of motility of the organism) is
produced only if the antiserum is specific for the Vibrio type present; the second
antiserum serves as a negative control.
Hematologic tests. Hematocrit, serum-specific gravity, and serum protein are
elevated in dehydrated patients because of resulting hemoconcentration; when
patients are first observed, they generally have a leukocytosis without a left
shift.
Treatment Modalities
Rehydration. The goal is to replace lost fluids and electrolytes using a simple
rehydration solution, oral rehydration salts (ORS). The ORS solution is available as a
powder that can be made with boiled or bottled water.
Intravenous fluids. Most people with cholera can be helped by oral rehydration
alone, but severely dehydrated people might also need intravenous fluids.
Antibiotics. While not a necessary part of cholera treatment, some antibiotics can
reduce cholera-related diarrhea and shorten how long it lasts in severely ill people.
Zinc supplements. Research has shown that zinc might decrease diarrhea and
shorten how long it lasts in children with cholera.
Nursing Management
Assess for dehydration.
Rehydrate the patient, and monitor frequently. Then reassess hydration status.
Maintain hydration: replace ongoing fluid losses until diarrhea stops.
Give an oral antibiotic to the patient with severe dehydration.
Feed the patient.
Prevention
Drink only bottled, boiled, or chemically treated water or carbonated beverages.
When using bottled drinks, make sure that the seal has not already been broken
Avoid tap water and ice cubes made from tap water.
If bottled water is not available, you can disinfect water by boiling it for one minute
or filtering it, and then adding two drops of household bleach or half of an iodine
tablet per liter of water.
Wash your hands with soap and clean water every time you use the bathroom, and
before you eat or prepare food. If soap and water are not available, use an alcohol-
based hand cleaner that is at least 60% alcohol.
Eat foods that are pre-packaged or that are freshly cooked and served hot. Avoid
raw and undercooked meats and seafood or unpeeled fruits and vegetables.
Dispose of feces in a place away from water that is used for drinking or food,
especially if you have had cholera.
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