Cholera

By
Dr.Venmathi
Dept of Community Medicine
 Scheme of presentation
• Introduction – history to present
• Epidemiology
• Diagnosis and treatment
• Control and prevention measures
• Conclusion
 Introduction
• Intestinal infection - acute diarrheal illness
caused by bacteria Vibrio cholerae.
• fecal disease - meaning that it spreads when
the feces of an infected person come into
contact with food or water.
• Incidence: 1 in 100,000 worldwide.
• Over 1 million cases and nearly 10,000
fatalities.
CAUSATIVE AGENT DISCOVERY
• John Snow (1813- 1858)
• Water borne transmission of Cholera (1855)
• Filippo Pacini (1812- 1883)- discovered
• Robert Koch1884: Rediscovers Vibrio cholerae
 Epidemiological triad

VIBRIO CHOLERAE

AGENT

Poor Sanitation
HOST ENVIRONMENT Contaminated
water and food
Human
Ignorance
Climatic
conditions
 Morphology
• Gram negative
• Comma shaped
• Sheathed, polar
• Flagellum
• Facultative anaerobic
• Asporogenous
• Growth stimulated by NaCl
• Organism can multiply freely in water
 Transmission
• TRANSMISSION
• Fecal-oral route
• Entry = oral
• Discharge = fecal
• Incubation period 2hrs-5 days
• Infection 7-14 days, but most people do not
become ill or show any symptoms
• Only about 10-20% of infected people show
moderate or severe symptoms.
• Moderate symptoms difficult to differentiate
from other types of acute diarrhoea
• Group O blood group highest risk
Pathogenesis
 Secrete enterotoxin

Enterotoxin binds to intestinal cells

Chloride channels activated

Release Large quantities of electrolytes & bicarbonates

Fluid hypersecretion

Diarrhea

Dehydration
Symptoms and signs
• Mild diarrhea
• Sudden severe diarrhea
• Mucus and intestinal tissue visible in feces
• Muscle cramps
• Scaphoid abdomen
• Vomiting
• Loss of skin turgor
• Weak pulse
Complications
 Diagnosis
• Clinical symptoms and signs
• Isolation of V. cholerae from stool
• Live V. cholerae in stool (ca. 1.0 x 108 cells per
ml) - indentification via dark-field microscopy
• Measurement of serum antibodies using ELISA
– Antibacterial antibodies: vibriocidal assays
– Antitoxin antibodies
Treatment
 Prognosis
The prognosis of cholera ranges depending on
• The severity of the dehydration
• How quickly the patient is given
• Responding to treatments
 Control measures
• Blocking routes of transmission
– water disinfection (source and /or household), hand
washing, sanitation, good food hygiene and well-
cooked
• Treatment centers
– for prompt treatment.
– Sanitarymeasures.
– food safety
– Comprehensivesurveillance (adapt to each situation)
comprehensive multidisciplinary approach.
 Prevention
• Basic health education and hygiene
• Mass chemoprophylaxis
• Provision of safe water and sanitation
• Comprehensive Multidisciplinary Approach
(water, sanitation, education, and
communication)
 Sample collection
• Cholera – sample stools
• Collected as soon as possible
• Collected using rectal swabs
• Transported in Cary Blair medium – within 7
days
• Not refrigerated
 References
• Park text book of Social and Preventive
Medicine
• Rajvir Bhalwar book of Community Medicine
Thank you..