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
