CHOLERA

CHOLERA

Cholera is an acute infection of Vibrio cholerae uses subtle clinical profus characterized by diarrhea and vomiting , which quickly lead to progressive dehydration and shock , due to infection . Vibrio eltor can also cause the same disease .

CONTAGION

Infectious materials

- Water , contaminated food

- V. eltor may live long in the water and food

Transmission source :

- Patients mild infection , asymptomatic carrier

- Cholera asiatica : Asymptomatic : Clinical = 4 : 1

Cholera eltor : Asymptomatic : Clinical = 10 : 1

( iceberg pnenomenon )

- All ages are susceptible to cholera

- Endemic areas : child > adult , male > female

- Immunity : type humoral

PATHOGENESIS AND PATHOLOGY

oral transmission

Through the gastrointestinal acid ( alkaline ) producing enterotoxin

attached to the intestinal mucosa 10-30 minutes later secretion of fluid

adenyl cyclase maximum : 3-4 hours lasts 8-12 hours

No mucosal damage

Enterotoxin adenyl cyclase stimulating intestinal secretion of isotonic fluid along the bowel ( cyclic AMP increases )

No effect on gastric secretion ; absorption colon

Isotonic faecal material ; K 4 times ; bikarbonas 2 times

Secretion Speed ​​: 1,000 cc / hour ; longer without antibiotics : 5 days

CLINICAL MANIFESTATIONS

Severe disease varies : mostly asymptomatic , mild diarrhea

INCUBATION TIME : 2-6 DAYS :

• Starting watery diarrhea , abundant , without mules , without

   tenesmus

• Feces turns white liquid , turbid , odorless foul / fishy , smells

  sweet, like rice water

• Vomiting after diarrhea ; muscle spasms ( due to electrolyte

  disturbance )

• Symptoms of loss of water , electrolytes , acidosis

• Signs of dehydration : hoarse voice ( vox Cholerica ) , sunken

  eyes, dry lips , sunken abdomen ( scaphoid ) , wrinkled fingers

  ( hand washer )

• Signs circulatory disorders ; metabolic acidosis

DIAGNOSIS

CLINICAL :

Dx cholera in endemic areas is easy , light , whereas outside the endemic area Dx > hard stools often , without nausea / mules , normal temperature , such stools washing rice , fast backward state due to dehydration , shock and acidosis

BACTERIOLOGICAL :

Rectal swabs , preserved in transport media

DIAGNOSIS :

- Vibrio cholerae

- Clostridium perfringens

- Staphylococcus aureus

- Escherichia coli

- Bacillus cereus

DEHYDRATION

Dehydration criteria : use of clinical methods

1 . Pierce method is based on clinical signs of dehydration :

    - Mild dehydration : 5 % BB liquid needs

    - Dehydrated medium : 8 % BB liquid needs

    - Severe dehydration : 10 % BB liquid needs

2.Pemeriksaan Plasma Specific Gravity : the solution zn Cupri

  sulfate or Refraksimeter

TREATMENT

CAUSAL AND SYMPTOMATIC SIMULTANEOUSLY

- Rehydration in 2 stages: initial rehydration; maintenance

- Infusion therapy on;

   * Severe dehydration, hypovolemic shock, uncontrollable vomiting,

      severe complications

- Cases of mild and moderate: Oral rehydration with oral material

- Criteria dehydration: using clinical methods, CVP, BJ Plasma

          BJ Plasma - 1,025

          Fluid deficit = x B x 4 ml

                          0001

Antibiotics: tetracycline 50 mg / kg divided into 4 doses of co-trimoxazole

PREVENTION

Hygiene and sanitation improvement

- Repair dining facilities - drinks

- Immunization:

- Standard Mixture: 10 billion vibrio die,

- Protection 60-80% in the past 3-6 months