Organism
vibrio cholerae (gram negative)
incubation- avg 3 days
Transmission

Faecal – oral

  • Small infecting dose may lead to carrier state
  • Large infecting dose will lead to overt disease.
Epidemiology
May become endemic where standards of environmental sanitation and personal hygiene are low (ie deltas of ganges river)
Pathogenesis
vibrios multiple in small intestine producing endotoxinàstimulates cAMPàcauses secretory diarrheaàPatients rapidly lose water sodium, potassium and bicarbonateàleads to hypovolaemia, reduced CO and acidosis.
Clinical features
Most are asymptomatic, many have mild disease and very few have fulminant disease.
Vomiting followed by diarhoea (severe and watery white-flecked with mucous=’rice water stool’)
Fever is unusual except in children
No abdo pain initially
Hypoglycaemia in kids
[image from TopNews]
Complications
Severe Dehydration- death is usually due to hypovolaemic shock +its complications (AKI)
Diagnosis
  • Direct darkfield microscopy of perianal swab
  • Culture in TCBS agar (yellow colonies overnight)
Treatment
  • FLUID REPLACEMENT = key to treatment. (with adequate hydration all patients should recover)
  • Ciprofloxacin=effectively decreasing the duration of the clinical illness by eliminating the vibrio from the faeces.
 
Prevention
Surveillance and prompt reporting allow for containing cholera epidemics rapidly.

In many endemic countries, exists as a seasonal disease, occurring during rainy seasons.

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