COLLEGE OF VETERINARY

&
ANIMAL SCIENCE,BIKANER

PRESENTATION
ON
BLUE DEATH
CHOLERA

SUBMITTED TODr RAJANI JOSHI

SUBMITTED BYDURGA DEVI

ROLL NO. 5
BATCH- A

HISTORY

Originated in Indian Sub-Continent.

One of the earliest infections to be
studied by epidemiological methods.
The disease broke out in Calcutta in 1817
with grand-scale results.
India's traditional, great Kumbh festival at
Haridwar in the Upper Ganges triggered
the outbreak.
When the merchants went back to their
homes in inner Russia and Europe, the
disease went along with them.

OVERVIEW

Cholera is an acute infection of the intestine

caused by the bacterium Vibrio cholerae
Begins suddenly with painless watery diarrhoea,
nausea and vomiting.
Outbreaks can occur sporadically in any part of
the world where water supplies, sanitation, food
safety and hygiene practices are inadequate.
Cholera is typically transmitted by either
contaminated food or water.
In the developed world, seafood is the usual
cause, while in the developing world it is more
often water.
Cholera has been found in only two other animal
populations: shellfish and plankton.

VIBRIO CHOLERAE

VIBRIO CHOLERAE

It wasnt until 1876 that a German

doctor, Robert Koch discovered the
comma-shaped bacillus Vibrio cholerae

The organism is a comma-shaped, gramnegative, aerobic bacillus whose size

varies from 1-3 mm in length by 0.5-0.8
mm in diameter.
Its antigenic structure consists of a
flagellar H
antigen and a somatic O antigen.

It is the differentiation of the O Antigen

that

EPIDEMIOLOGY
The first cholera pandemic occurred in
the Bengal region of India starting in
1817 through 1824.
The second pandemic lasted from 1827
to 1835
and
affected
the United
State and
The
seventh
pandemic
originated
in 1961
in Europe.
Indonesia and is marked the emergence
of a
new strain, nicknamed El Tor, which still
persists
today in developing countries.
In October 1992, an epidemic of cholera

PATHOGENESIS

When consumed, most bacteria do not survive

the acidic conditions of the human stomach.
Few surviving bacteria conserve their energy
and stored nutrients during the passage
through the stomach by shutting down much
protein production.
The surviving bacteria exit the stomach and
reach the small intestine, they need to propel
themselves through the thick mucus that lines
the small intestine to get to the intestinal walls
where they can thrive.
Once the cholera bacteria reach the intestinal
wall they no longer need the flagella to move.

The bacteria stop producing the protein

flagellin to conserve energy and nutrients
by changing the mix of proteins which
they express in response to the changed
chemical surroundings.
On reaching the intestinal wall, V.
cholerae start producing the toxic
proteins that give the infected person a
watery diarrhea.
Faeces carries the multiplying new
generations of V. cholerae bacteria out
into the drinking water of the next host if
proper sanitation measures are not in
place.

INCUBATION PERIOD
Short incubation period (2
hours to 5 days).
75% of those infected do not
develop symptom.
100-1000 organisms may
cause disease, although a
million are needed to
consistently infect

SIGNS &
SYMPTOMS

SIGNS & SYMPTOMS

The primary symptoms of cholera are profuse,

painless diarrhea and vomiting of clear fluid.
The diarrhea is frequently described as "rice
water" in nature and may have a fishy odor.
An untreated person with cholera may
produce 10 to 20 litres of diarrhea a day with
fatal results. For every symptomatic person, 3
to 100 people get the infection but remain
asymptomatic.
Cholera has been nicknamed the "blue death"
due to a patient's skin turning a bluish-gray
hue from extreme loss of fluids.

TYPICAL
RICE
WATER
DIARRHO
EA

Typical "rice water" diarrhea.

If the severe diarrhea is not treated
with intravenous rehydration, it can
result in life-threatening
dehydration and electrolyte
imbalances.
The typical symptoms of
dehydration include low blood
pressure, poor skin turgor (wrinkled
hands), sunken eyes, and a rapid
pulse.

TRANSMISSI
ON
OF
CHOLERA

TRANSMISSION

Typically transmitted by either contaminated

food or water.
The source of the contamination is typically other
cholera sufferers when their untreated diarrheal
discharge is allowed to get into waterways.
Drinking any infected water and eating any
foods washed in the water, as well as shellfish
living in the affected waterway, can cause a
person to contract an infection.
Cholera is rarely spread directly from person to
person.
Coastal cholera outbreaks typically follow
zooplankton blooms, thus making cholera a
zoonotic disease.

SUSCEPTIBLE GROUPS

About 100 million bacteria must typically be

ingested to cause cholera in a normal healthy
adult.
Children are also more susceptible, with two- to
four-year-olds having the highest rates of
infection.
Individuals' susceptibility to cholera is also
affected by their blood type, with those with
type O blood being the most susceptible.
Persons with lowered immunity, such as
persons with AIDS or children who are
malnourished, are more likely to experience a
severe case if they become infected.

CHOLERA IN
CHILDREN
Breast-fed infants are protected.

Symptoms are severe & fever is frequent.

Shock, drowsiness & coma are
common.
Rotavirus infection may give similar
picture
& need to be excluded.

DIAGNOSIS

A rapid dip-stick test is available to

determine the presence of V. cholerae.
Treatment is usually started without or
before confirmation by laboratory analysis.
Stool and swab samples collected in the
acute stage of the disease, before antibiotics
have been administered, are the most useful
specimens for laboratory diagnosis.
Organism can be seen in stool by direct
microscopy after gram stain and dark field
illumination is used to demonstrates motility.

Serologic tests are available to

define strains, but this is needed
only during epidemics to trace the
source of infection.
Cholera can be cultured on special
alkaline media like triple sugar agar
or TCBS agar.
Total body potassium is depleted,
but serum level may be normal due
to effect of acidosis.

TREATMENT
The primary goal of therapy is to replenish
fluid losses caused by diarrhea &
vomiting.
Fluid therapy is accomplished in 2
phases:
rehydration and maintenance.
Rehydration should be completed in 4
hours & maintenance fluids should
replace
ongoing losses & provide daily
requirement.

Ringer lactate solution is preferred over

normal
saline because it corrects the associated
metabolic
acidosis.
The
drugs used for adults include
tetracycline,
doxycycline, cotrimoxazole & ciprofloxacin.
For children erythromycin, cotrimoxazole
and
furazolidone are the drugs of choice.

VACCINES

Orochol
Oral immunization of children older than
2
Dukoral
Protects against O1 Inaba
and Ogawa, Classical & El
Tor strains

PREVENTION OF CHOLERA

PREVENTION

Prevention of the disease is normally

straightforward if proper sanitation practices are
followed.
In developed countries, due to nearly universal
advanced water treatment and sanitation practices,
cholera is no longer a major health threat.
Sterilization: Proper disposal and treatment of
infected fecal waste water produced by cholera
victims and all contaminated materials (e.g.
clothing, bedding, etc.) are essential.
All materials that come in contact with cholera
patients should be sanitized by washing in hot
water, using chlorine bleach if possible.

Sewage: antibacterial treatment of general sewage by

chlorine, ozone, ultraviolet light or other effective
treatment before it enters the waterways or
underground water supplies helps prevent undiagnosed
patients from inadvertently spreading the disease.
Sources: Warnings about possible cholera
contamination should be posted around contaminated
water sources with directions on how to decontaminate
the water (boiling, chlorination etc.) for possible use.
Water purification: All water used for drinking, washing,
or cooking should be sterilized by either boiling,
chlorination, ozone water treatment, ultraviolet light
sterilization (e.g. by solar water disinfection), or
antimicrobial filtration in any area where cholera may
be present.

PUBLIC HEALTH
ASPECTS
Isolation & barrier nursing is indicated.
Notification of the case to local authorities
&
WHO.source of infection.
Trace
Resume feeding with normal diet when
vomiting has stopped & continue breast
feeding infants & young children.