Cholera/El Tor

INTRODUCTION
An infection of the S.I. characterized by large

amt of diarrhea
Mode of Transmission: Ingestion

Reservoir: Unsanitized environment and human

carriers **Easily treated but easily fatal s/t immediate DHN

CAUSE
Causative Agent: Vibrio cholerae
Lives either in:
environment (stagnant water,

seafoods, raw vegetables and fruits) Human carrier (transmitted in the stool)

Secretes CTX, a toxin release of

H2O in the S.I.

**about a full glass of contaminated H2O is needed to cause CHOLERA

RESERVOIR/SOURCES Surface or well water.

Cholera bacteria can lie dormant in water for

long periods, and contaminated public wells

are frequent sources of large-scale cholera outbreaks.

RESERVOIR/SOURCES Seafood.
Eating raw or undercooked seafood,

especially shellfish, that originates from certain

locations can expose you to cholera bacteria.

RESERVOIR/SOURCES

Raw fruits and vegetables.

Raw, unpeeled fruits and vegetables are

frequent sources of cholera infection in areas

where cholera is endemic. In developing nations, uncomposted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the

field.

RESERVOIR/SOURCES Grains.
In regions where cholera is widespread, grains

such as rice and millet that are contaminated

after cooking and allowed to remain at room temperature for several hours become a medium for the growth of cholera bacteria.

RISK FACTORS
** Everyone is susceptible to cholera, with the exception of infants who derive immunity from nursing

mothers who have previously had cholera.

Exposure to contaminated or untreated drinking water Eating contaminated food s/a seafoods, etc. Living in or traveling to areas where there is

cholera

RISK FACTORS Hypochlorydia/Achlorydia

V. cholerae cant survive in acidic env.

Type O blood
For reasons that aren't entirely clear, people with type O blood are twice as likely to develop cholera as are people

with other blood types.

PATHOPHYSIOLOGY
Ms. Manla Lamut went to India she ate contaminated seafood V. cholerae enters GIT bacterium secretes CTX

PATHOPHYSIOLOGY
alteration of Na+ and H2O flow RAPID release of H2O in the S.I. severe, rapid diarrhea DHN S/SX

SIGNS AND SYMPTOMS Diarrhea

s/t CTX seretion Sudden Watery (rice-water stool) has a "fishy" odor

Abdominal cramps
s/t diarrhea

SIGNS AND SYMPTOMS Rapid DHN sx:

Sunken "soft spots" (fontanelles) in infants Dry mucus membranes or mouth Dry skin Excessive thirst Glassy or sunken eyes Lack of tears Low urine output Lethargy

s/t

D H N

A person with severe dehydration due

to cholera. Note the sunken eyes and decreased skin turgor which produces wrinkled hands ("Washer Woman's Hand" sign).

COMPLICATIONS

Most dangerous/MC: Severe DHN

SHOCK death
Occurs within 2-3 hours after rapid fluid loss
Occurs within 18 hours to days if not treated stat

Electrolyte Imbalance

COMPLICATIONS

Kidney (renal) failure

When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in your body a potentially life-threatening condition. In

people with cholera, kidney failure often

accompanies shock.

DIAGNOSTICS Rapid cholera dipstick tests

Blood Culture
Must be done @ night bec. Microfilariae

proliferate more @ night

Stool Culture

MEDICAL MANAGEMENT GOAL: Fluid replacement STAT!!! Rehydration.

The ORS solution is available as a powder that can be reconstituted in boiled or bottled water.

Without rehydration, approximately half the

people with cholera die.

MEDICAL MANAGEMENT

Intravenous fluids.
During a cholera epidemic, most people can be helped by oral rehydration alone, but severely dehydrated people may also need intravenous fluids.

MEDICAL MANAGEMENT Antibiotics.

While antibiotics is not a necessary part of cholera treatment, some of these drugs may reduce both the amount and duration of cholera-related diarrhea. A single dose of doxycycline (Adoxa, Monodox) or azithromycin (Zithromax, Zmax)

may be effective.

MEDICAL MANAGEMENT Zinc supplements.

Research has shown that zinc may decrease
and shorten the duration of diarrhea in children with cholera.

NURSING INTERVENTIONS

o Monitor UO to determine how severe the fluid loss is.

o Encourage OFI to replace fluid loss.

o Encourage bed rest to conserve energy.

o Admin meds as prescribed.

PROGNOSIS Severely fatal if untreated immediately.

PREVENTION Proper hand washing

Done after going to the toilet or before handling foods. Rub soapy, wet hands together for at least 15

seconds before rinsing.

If soap and water aren't available, use an alcohol-based hand sanitizer.

PREVENTION Drink only safe water, including bottled water or water you've boiled or disinfected yourself.

Use bottled water even to brush your

teeth if you are in an endemic area.

PREVENTION

Hot beverages are generally safe, as

are canned or bottled drinks, but wipe

the outside before you open them.

Eat food that's completely cooked

and hot and avoid street vendor food,

if possible.

PREVENTION

Avoid sushi, as well as raw or

improperly cooked fish and seafood of

any kind.
Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados.

PREVENTION Be wary of dairy foods, including ice

cream, which is often contaminated,

and unpasteurized milk. Prevaccinate if to be exposed to the bacteria

UPDATES IVI receives WHO Prequalification for New Oral Cholera Vaccine
Shanchol, a new oral cholera vaccine developed through the International Vaccine Institute (IVI) ready to use in a single-dose vial and is administered orally, which facilitates its implementation in large-

scale immunization programs.

THINGS TO REMEMBER:
V ibrio cholerae C TX toxin diarrhea H ighly fatal if untreated O ral route L arge loss of body fluids (severe DHN) most dangerous complication E xtraction of bld specimen for bld culture (dxc) R ice-water stool (hallmark) A bx therapy (Azithromycin/doxycycline)mainstay E vening extraction

Project in Immunity and Inflammation Lecture

Prepared by:
JANELA C. CABALLES
UNP-CN BSN-DAFFODIL BATCH 2013 S.Y. 2011-2012

Presented to: Shirley Mae Alquiza, RN MAN Instructor