cholera & dysentery
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By
Anees Ur RahmanInam Ullaah
Sherbaz KhanSadia
Reena
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At the end of this presentation the participant will be able to:
Define cholera and dysentery
Discuss its cause
List sign and symptom of cholera and dysentery
Discuss its possible treatment
Describe prevention of cholera and dysentery
Discuss its possible complication
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Cholera is an infection of the small intestinethat causes a large amount of waterydiarrhea.
It is caused by bacteria: Vibrio cholerae,which was discovered in 1883 by RobertKoch during a diarrheal outbreak in Egypt.
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The number of cholera patients worldwide isuncertain because many cases are unreported.
The number of cases is increased during epidemics
& is affected by environmental factors.
In 1994, 94 countries reported 385,000 cases ofcholera to WHO, but the number reported in 1998was 121,000. 89% of these cases were reported from
Africa.
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Cholera is caused by the bacterium Vibrio cholerae.
The bacteria releases a toxin that causes increased
release of water in the intestines, which produces
severe diarrhea.
Cholera occurs in places with poor sanitation,
crowding, war, and famine
Living in or traveling to areas where there is cholera
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People get the infection by eating or drinking
contaminated food or water.
A type of vibrio bacteria also has been associatedwith shellfish, especially raw oysters.
Exposure to contaminated or untreated drinking
water
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Abdominal cramps
Dry mucus membranes or mouth
Dry skin
Excessive thirst Glassy or sunken eyes
Lack of tears
Lethargy
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Low urine output
Nausea
Rapid dehydration
Rapid pulse (heart rate)
Sunken "soft spots" (fontanelles) in infants
Unusual sleepiness or tiredness
Vomiting Watery diarrhea that starts suddenly and has a
"fishy" odor
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Organism can be seen in stool by direct microscopyafter gram stain and dark field illumination is used todemonstrates motility
Cholera can be cultured on special alkaline medialike triple sugar agar or TCBS agar
Serologic tests are available to define strains, butthis is needed only during epidemics to trace thesource of infection
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Dehydration leads to high blood urea & serumcreatinine. Hematocrit & WBC will also be high dueto hemoconcentration.
Dehydration & bicarbonate loss in stool leads tometabolic acidosis with wide-anion gap.
Total body potassium is depleted, but serum level
may be normal due to effect of acidosis
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The primary goal of therapy is to replace fluidlosses caused by diarrhea & vomiting
Fluid therapy is accomplished in 2 phases:
rehydration and maintenance.
Rehydration should be completed in 4 hours &maintenance fluids should replace ongoing losses &
provide daily requirement.
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Ringer lactate solution is preferred over normalsaline because it corrects the associated metabolicacidosis.
IV fluids should be restricted to patients who purge>10 ml/kg/h & for those with severe dehydration.
The oral route is preferred for maintenance & theuse of ORS at a rate of 500-1000 ml/h isrecommended
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The goals of drug therapy are to eradicate infection,reduce morbidity and prevent complications.
The drugs used for adults include tetracycline,
doxycycline, cotrimoxazole & ciprofloxacin.
For children erythromycin, cotrimoxazole andfurazolidone are the drugs of choice.
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Drink only water that you have boiled, or that youhave treated with chlorine or iodine. Other safebeverages include tea and coffee made with boiledwater, and carbonated, bottled beverages with no
ice. Make sure that all vegetables are cooked, and avoid
salads.
Eat only foods that have been thoroughly cooked
and are still hot, or fruit that you have peeledyourself.
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Avoid undercooked or raw fish or shellfish,including ceviche (seafood marinated in lime
or lemon juice). Avoid foods and beverages from street
vendors.
Do not bring perishable seafood back to the
United States. Vaccination against cholera to travellers to endemic
countries & during public gatherings
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If dehydration is not corrected adequately &promptly it can lead to hypovolemic shock, acuterenal failure & death.
Electrolyte imbalance is common.
Hypoglycemia occurs in children.
Complications of therapy like over hydration & sideeffects of drug therapy are rare.
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Dysentery is bloody diarrhea, i.e. any diarrheal
episode in which the loose or watery stools contain
visible red blood.
Dysentery is most often caused by Shigella species
(bacillary dysentery) orEntamoeba histolytica
(amoebic dysentery).
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Common bacterial causes of dysentery include
infections with the bacteria Shigella and some types
ofEscherichia coli (E coli).
Other less common bacterial causes of bloody
diarrhea include Salmonella and Campylobacter
infections Dysentery is associated with environmental
conditions where poor sanitation is prevalent.
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Amebic dysentery, caused by the parasite
Entamoeba histolytica, is most commonly found in
tropical areas with crowded living conditions and
poor sanitation
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Bacillary dysentery symptoms
The signs and symptoms of dysentery can last five to
seven days or even longer.
Common symptoms are mild stomach pains and
bloody diarrhea.
There is usually a lot of diarrhea to begin with,followed by smaller amounts that are passed
frequently and sometimes painfully.
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In more severe cases, symptoms can include:
Watery diarrhea that contains blood or mucus
Nausea (feeling sick) Vomiting (being sick)
Severe abdominal pain
Stomach cramps
A high temperature (fever) of 38C (100.4F) or over
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Amoebic dysentery symptom
watery diarrhea, which can contain blood,
mucus or pus
nausea
vomiting
abdominal pain
fever and chills
bleeding from your rectum (back passage)
loss of appetite and weight loss
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A clinical diagnosis may be made by taking a historyand doing a brief examination.
Treatment is usually started without or beforeconfirmation by laboratory analysis.
The mouth, skin, and lips may appear dry due to
dehydration. Lower abdominal tenderness may alsobe present.
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Rehydration therapy - initially this is done using oralrehydration; the patient is encouraged to drink plenty ofliquids.
Diarrhea, as well as vomiting results in loss of fluids thathave to be replaced to prevent dehydration.
If the diarrhea and/or vomiting is profuse the medicalteam may recommend intravenous fluid replacement -the patient will be on a drip.
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Antibiotics and amoebicidal drugs - experts say thatif possible, the administration of medications to kill
the cause of the dysentery should be held back until
lab tests determine whether the illness is being
caused by a bacterium or amoeba.
If this is not possible, depending on the severity of
symptoms, the patient may be given a combinationsof antibiotic and amoebicidal medication.
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To reduce the risk of contracting dysentery thefollowing precautions are suggested:
Washing one's hands after using the toilet, aftercontact with an infected person, and regularly
throughout the day.
Washing one's hands before handling, cooking andeating food, handling babies, and feeding young or
elderly people.
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Keeping contact with someone known to havedysentery to a minimum.
Washing laundry on the hottest setting possible.
Avoiding sharing items such as towels and face
cloths.
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www.who.int/topics/cholera/control/en/index.html
www.cdc.gov/cholera/prevention.html
www.unicef.org/wcaro/07-
UNICEF_Cholera_Prevention.ppt www.thelancet.com/journals/lancet/.../PIIS0140-
6736(04)15749-8
www.health.state.mn.us/divs/idepc/diseases/cholera/pre
vention.html
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