| ID | 180 |
|---|---|
| Name | CHOLERA |
| Cause | |
| Signs Symptoms | |
| Diagnosis | Diagnosis: 1. Vibrios may be identified in the wet or stained stool preparations-observing characteristic movement under microscope. Culture of the stool or rectal swab is used to isolate & identify the organisms. 2. Polymorphonuclear leucocytosis is usual. 3. There is a rise in the sp. gr. and Hematocrit values of blood. 4. Stool C/S. |
| Investigations | |
| Management | |
| Introduction | Cholera is a severe acute gastro-intestinal infection, caused by Vibrio cholere. Transmission is normally through infected drinking water, shellfish and contaminated food. |
| History | |
| Etiology | |
| Clinical Features | Clinical features: 1. Acute onset of severe painless diarrhoea followed by vomiting, typical rice water material is passed. 2. In severe cases an enormous quantity of fluid and electrolyte is lost; resulting in intense dehydration & agonising muscular cramps. 3. The skin becomes cold, clammy and wrinkled and the eyes sunken. 4. The blood pressure falls, the pulse become imperceptible and the urine output falls. 5. The patient may die from acute circulatory failure. This is the classical picture of cholera, the majority of infections cause only a mild illness with slight diarrhoea. |
| Preventions | |
| Treatment | Treatment: 1. To maintain the circulation and prevent renal failure by replacement of water and electrolytes- a. The treatment of ordinary acute diarrhoea and mild cholera can be easily carried out by oral hydration ( e.g. by ORS). b. In severe cases or when there is vomiting, fluids are given intravenously. A large needle is inserted into a large vein and fluid is run in as rapid as possible until pulse and blood pressure return. The rest of the estimated deficit is replaced more slowly. Satisfactory fluid includes Cholera saline, Ringer’s lactate solution, Hartman’s solution or Darrow’s solution, c. If intravenous fluid or apparatus are not available fluid may administered via a nasogastric tube. 2. Vomiting usually stops once the patient is rehydrated and fluids should then be given orally every hour (500ml/hr.). The presence of glucose in the oral fluid has been shown to promote electrolyte absorption. 3. Renal failure is managed. 4. Drugs- i. Tetracycline 250mg 6 hourly for 3 days; Or, Cotrimoxazole 960mg twice daily for 3 days; Or, Ciprofloxacin 500mg twice daily for 3 days, ii. Chlorpromazine 50mg 6 hourly reduces intestinal secretion & fluid loss. Prevention: 1. Cholera vaccine injection is available for active immunisation against cholera. Vaccine contains heat killed inaba and ogawa subtype of cholera bacteria; 1 ml & 1.5ml ampoule and 10ml & 50ml vial. Period of immunity 6 months Dosage & admin: Adult: 1st dose- 0.5m1. s.c or i.m; 2nd dose- 1ml s.c or i.m (or 0.2ml intradermally) after 4 weeks (or 7 days if rapid immunization is necessary). Child: 1st dose- under 1 year, not recommended; 1-5 years, 0.lml s.c or i.m; 5-10 years, 0.3ml s.c or i.m. 2nd dose- 1-5 years, 0.3ml s.c or i.m (or O.lml intradermally); 5-10 years, 0.5ml s.c or i.m (or 0.lml intradermally). Interval, same as adult. Booster dose- necessary after 6 months; give the same as 2nd dose. 2. Dukoral oral cholera vaccine (SBL Vaccine/Healthcare) is available for active immunization against diseases caused by V. cholera & enterotoxigenic Escherichia Coli (ETEC). The vaccine is presented as 3ml suspension in vail & the sodium hydrogen carbonate buffer as effervescent granules in sachet. Comp: A total of Ixl011 bacteria of the V. cholera with recombinant cholera toxin B subunit (rCTB) Img are present in the vaccine. Dosage & admin: Adults & children aged over 6 years: 2 doses; Children 2 to 6 years: 3 doses. Doses are to be given at intervals of at least one week but less than 6 weeks apart. If more than 6 weeks elapse between doses, basic immunization should be re-started. Immunization should be completed at least one week prior to traveling or potential exposure to the pathogens. Preparation of vaccine: See in the therapeutic part under immunization chapter. |
| Complications | Complications: 1. Pulmonary oedema due to over hydration following excess i.v fluid therapy. 2. Pyrexial convulsion. 3. Encephalopathy. 4. Tetany. 5. Meteorism. 6. Hypoglycemia. 7. Hypokalemia. 8. Hypernatremia. 9. Malnutrition. 10. Uremia. |
| Prognosis | |
| Types | |
| Classification | |
| Observation | |
| Pathology |
© Pakistan Drug Directory. All Rights Reserved.
Designed By: Pakistan Drug Directory Team