Vibrio cholerae
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Presentation followed by MCQs discussing cholera and its manifestations, pathogenesis, and treatment.
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Vibrio cholerae
- 1. SEVERE VOMITING AND WATERY DIARRHEA Case Files: Microbiology Camille Renee Saint James School of Medicine CCBS3 2061 STV Source: espemed.com.mx
- 2. CASE 23 A 35-year-old woman presents to the emergency room with a 2-day history of severe diarrhea (approx. 1 L/hr) and vomiting after eating shrimp that seemed undercooked. Her symptoms started abruptly, with watery diarrhea followed by vomiting. Her skin is dry and tents when lightly pinched. A complete blood count shows an elevated white blood cell count and an elevated hematocrit. A metabolic panel shows hypokalemia and low serum bicarbonate. You assess this patient to be in hypovolemic shock and metabolic acidosis, and institute appropriate therapy. Source: Case Files:
- 3. CHIEF COMPLAINT Symptoms Severe Watery Diarrhea Profuse Vomiting Signs Skin ‘tenting’ Metabolic Acidosis Hypokalemia Increased WBC count Hypovolemic Shock Source: paramedicine.comSource: Case Files: Microbiology
- 4. SKIN TENTING INDICATES DEHYDRATION Skin tenting occurs because of a loss of elasticity
- 5. VOMITING & DIARRHEA DDX 1) E. coli infection 2) Viral Gastroenteritis i.e. Rotavirus, Norovirus 3) Aeromonas 4) Vibrio parahaemolyticus 5) Vibrio cholerae Source: margotbworldnews.com Source:
- 6. 1ST DDX: ESCHERICHIA COLI Source: cdn.phys.org Gram Negative bacilli Causes: Shiga-like dysentery Traveler’s diarrhea Hemolytic uremic syndrome Responsible for up to 45% of Source: skinsight.comSource: emedicine.com
- 7. 2ND DDX: VIRAL GASTROENTERITIS Source: tabletsmanual.com Sporadic - Mostly caused by rotavirus in infants Acute gastroenteritis of adults – mostly caused by norovirus Fecal-oral Source: emedicine.com
- 8. 3RD DDX: VIBRIO SPECIES Gram Negative comma-shaped bacilli Single Polar Flagellum Serotypes O1 (El Tor) and O139 (Bengal) Consumption of contaminated seafood i.e. shellfish, plankton Grows in Alkaline Source: http://upload.wikimedia.org/Source: Case Files:
- 9. 4TH DDX: AEROMONAS Gram negative rod Cholera-like or dysenteric gastroenteritis Consumption of contaminated seafood Skin infections are Source: medical-labs.netSource: Santhosh, SJSM Source: oscarfish.com
- 10. DDX: PROCESS OF ELIMINATION
- 12. SELECTING THE CAUSATIVE ORGANISM Vibrio cholerae vs. Vibrio parahaemolyticus or Vibrio vulnificus Vibrio vs. Aeromonas
- 13. DDX: TABLE OF CHARACTERISTICS
- 14. VIBRIO SPECIES CAN BE O129 RESISTANT! O129 (2,4-diamino-6,7-diisopropylpteridine) differential disc is Vibriostatic Authors: Hofer E1, Reis EM, Quintaes BR, Rodrigues DP, Feitosa IS, Angelo MR, Ribeiro LH. O1 (El Tor) and O22 serogroups were isolated from patients with enteritis in Ceará, Brazil during 1991-1993 2/7,058 V. cholerae Samples Were Resistant To O129 Additionally, these O129-resistant strains of V. cholerae O1 and O22 Were ALSO Resistant To Trimethoprim/ Sulfamethoxazole
- 15. DX: VIBRIO CHOLERAE Gram Negative curved bacilli with Single Polar Flagellum IP: 1-3 days Fecal-oral transmission Serotypes O1 (El Tor) and O139 (Bengal) are Responsible for Epidemic Disease Consumption of contaminated seafood Grows in Alkaline Media Source: cholera1.wikispaces.comSource: Case Files:
- 16. MOST COMMON MODES OF TRANSMISSION Contaminated Water Ingestion of Raw Shellfish Flooding in Underdeveloped Countries Poor Hygiene Source: zipheal.com Source: blogcdn.comSource: Case Files-
- 17. THE MECHANISM OF CHOLERA TOXIN (CTX) Bacteria attach to upper intestine via pili and subsequently colonize Cholera enterotoxin 1 A subunit 5 B subunits B subunits bind to a GM1 ganglioside receptor on the mucosal cell to allow entry of the A subunit A subunit Overactivates Adenylate Cyclase (Gs protein) Hypersecretion of Water, Chloride and other Source: Microsoft OfficeSource: Case Files: Source: emedicine.com
- 19. DIAGNOSTIC TESTS Clinical diagnosis Stool sample Cary Blair media TCBS agar (yellow colonies) Hanging drop test Darting motility Alkaline peptone water (enrichment media) Crystal VC® dipstick Source: amsrapidtest.comSource: www.cdc.govSource: microrao.com
- 20. DIAGNOSTIC TESTS Specific anti- serum can be used in immobilization tests i.e. cessation of motility of the organism Electron Source: thumbs.dreamstime.comSource: emedicine.com
- 21. SUPPORTIVE MANAGEMENT OF CHOLERA Oral or Intravenous Rehydration (1st line therapy) Ringer’s Lactate Solution (50-100 mL/kg/hr) Oral Rehydration Salts (ORS) It should take approximately 4 hours to Return the Patient toSource: c1.staticflickr.com Source: tspwiki.com Source: emedicine.com Isotonic, bicarbona te- containin g fluids are key!
- 22. SECOND LINE THERAPY Oral Antibiotics (2nd Line Therapy) Doxycycline (preferred) Tetracycline Azithromycin Erythromycin Trimethoprim/Sulfamethoxaz ole Ciprofloxacin Ampicillin Norfloxacin Source: bipolarbrain.comSource: emedicine.com
- 23. VIBRIO SPECIES CAN BE O129 RESISTANT! O129 (2,4-diamino-6,7-diisopropylpteridine) differential disc is Vibriostatic Authours Hofer E1, Reis EM, Quintaes BR, Rodrigues DP, Feitosa IS, Angelo MR, Ribeiro LH. O1 (El Tor) and O22 serogroups were isolated from patients with enteritis in Ceará, Brazil during 1991-1993 2/7,058 V. cholerae Samples Were Resistant To O129 Additionally, these O129-resistant strains of V. cholerae O1 and O22 Were ALSO Resistant To Trimethoprim/ Sulfamethoxazole
- 24. REHYDRATION IS LIFE SAVING Rehydration Usually Results in Patient Recovery If Left Untreated, complications include: Hypoglycemia: patient becomes too ill to eat Hypokalemia: abundant loss of electrolytes Acute Tubular Necrosis or Renal Failure: kidney malfunction associated with hypovolemic shock Source: . globalparent.unicef.ieSource: Mayoclinic.org
- 25. OVERALL TREATMENT PLAN 5 Steps
- 26. WHEN TO SUSPECT CHOLERA According to the World Health Organization, a case of cholera is suspected when: Area with disease Not known to be present A patient aged 5 years or older develops Severe Dehydration or dies from Acute Watery Diarrhea Area With Noted Cholera epidemic Source: b.3cdn.netSource: who.int
- 27. MORTALITY Access to Intravenous Therapy Determines Cholera’s Rate of Mortality Before IV therapy, death caused by cholera was Greater Than 50%; it is now <1% with appropriate therapy Mortality rate is still the Highest in Africa due to the lack of Source: . www.medindia.netSource: emedicine.com Source: Toronto Notes
- 28. REDUCE THE INCIDENCE OF CHOLERA Prevent cholera transmission by: Engaging in appropriate hygienic practices Drinking chlorinated or boiled water EnsuringSource: www.getreadyforflu.org Source: filteredwatertap.com Source: Case Files:
- 29. GASTRIC ACIDITY FIGHTS CHOLERA Cholera bacilli usually Cannot Survive in Acidic Environments Patients with Achlorhydria (Low Levels of Stomach Acid) from taking antacids, H2 blockers, or proton pump inhibitors are at a Greater Risk of Developing CholeraSource: . cdn.return2health.net Source: Mayoclinic.org
- 30. PASSIVE IMMUNITY Infants Who Derive Passive Immunity from nursing mothers who have previously had cholera are Not Susceptible to Cholera Source: . foodnavigator-asia.comSource: Mayoclinic.org
- 31. VACCINES FOR TRAVELERS Vaccines are available in Select Countries 1. Parenteral Approximately 50% efficacy 2. Killed whole cell V. cholerae with recombinant B-subunit of CTX (Dukoral) Approximately 50% efficacy after 3 years 3. Live attenuated CVD 103-HgR >90% efficacy after 1 week Source: . static.ddmcdn.comSource: slideshare.net Source: Toronto Notes
- 33. QUESTION 1 Which of the following statements is true of cholera enterotoxin? a) Produces its effect by stimulating adenylate cyclase activity in mucosal cells b) Causes destruction of the intestinal mucosa allowing for invasive infection c) Causes a net efflux of ions and water from tissue into the lumen of the large intestine d) Is a protein with a molecular weight of approximately 284,000 daltons Source: sharinginhealth.caSource: Case Files:
- 34. ANSWER A.Vibrio cholerae consists of an enterotoxin A subunit that increases adenylate cyclase activity, causing hypersecretion of chloride and bicarbonate. This prevents sodium and chloride to be absorbed into cells, resulting in a massive secretion of fluid into the intestinal lumen. Source: Case Files:
- 35. QUESTION 2 What differential medium is used to distinguish Aeromonas spp. from Vibrio spp.? a) Xylose lysine desoxyscholate (XLD) agar b) O129 differential disc c) Hektoen enteric agar d) Buffered charcoal yeast extract agar e) Mannitol salt agar
- 36. ANSWER B.To distinguish between Vibrio and aeromonas, an O129 differential disc (2,4- diamino-6,7-di-isopropylpteridine phosphate) susceptibility is done: Vibrio = “S” (susceptible) Aeromonas =“R” (resistant) Source: Santhosh, SJSM
- 37. QUESTION 3 What is the first-line treatment for cholera? a) Administering the antimicrobial agent doxycycline b) Provide vaccination to stimulate the patient’s immune system c) Volume replacement with isotonic bicarbonate fluid (i.e. Ringer’s lactate solution) d) Administering the antimicrobial agent
- 38. ANSWER C. The treatment of cholera involves volume replacement with isotonic, bicarbonate-containing fluids, either using oral rehydration solutions in mild to moderate dehydration or IV fluids, such as Ringers lactate solution, in the profoundly dehydrated or those unable to tolerate oral intake. Source: Case Files:
- 39. QUESTION 4 Which of the following culture plates may be used to isolate Vibrio species, based on its requirement of salt for growth? a) Thayer-Martin medium b) MacConkey agar c) Blood agar d) TCBS agar Source: . c1.staticflickr.com
- 40. ANSWER D.Thiosulfate-citrate-bile salts-sucrose (TCBS) agar is the culture medium used to selectively isolate Vibrio species. Blood agar detects hemolysis, Thayer-Martin medium isolates Neisseriae, and MacConkey agar detects lactose-fermenting organisms. Source: Santhosh, SJSM
- 41. QUESTION 5 An individual experiences watery diarrhea and fever after eating raw shellfish in San Francisco. When cultured onto a selective medium called TCBS, it yielded green colored colonies. Which among the following is the organism that is responsible for the above manifestations and symptoms? a) Salmonella typhi b) Vibrio parahaemolyticus c) Vibrio cholerae d) Clostridium difficile e) Campylobacter jejuni Source: vibrio-cholerae.org/Source: Santhosh, SJSM
- 42. ANSWER B.Like V. cholerae, V. parahaemolyticus causes acute gastroenteritis following ingestion of contaminated seafood such as raw fish or shellfish. The patient will develop vomiting, abdominal cramps, fever, and diarrhea. It is diagnosable on TCBS agar as green colonies. Source: Case Files:
- 43. GOOD JOB! Source: . slvrdlphn.com
- 44. ACKNOWLEDGEMENTS Professors Dr. Mohamed Shata Dr. Rana Zeine Dr. Anwural Siddiqui Dr. Fatima Marankan Dr. Daphne Santhosh
- 45. REFERENCES 1. Liberman, M.A. & Ricer, E. (2010). Lippincott’s illustrated Q&A review of biochemistry. Wolters Kluwer: Hong Kong 2. Kumar, V., Abbas, A.K., & Fausto, N. (2005). Robbins and cotran pathologic basis of disease, 7th ed. Elsevier Saunders: Philadelphia 3. Toy, E.C., Uthman, M.O., Uthman, E., & Brown, E.J. (2008). Case files: microbiology. United States of America: McGraw-Hill Companies, Inc. 4. Cholera diagnosis. (2014). Retrieved March 3, 2015 from http://www.cdc.gov/cholera/diagnosis.html 5. Cholera. (2014). Retrieved March 6, 2015 from http://www.mayoclinic.org/diseases- conditions/cholera/basics/definition/con-20031469 6. Le, T., Bhushan, V., & Sochat, M. (2014). First aid for the usmle step 1. McGraw-Hill: Chicago 7. Cholera. (2015). Retrieved March 9, 2015 from http://emedicine.medscape.com/article/962643-overview
Notas del editor
- I will be discussing a case of severe vomiting and watery diarrhea, it’s clinical presentation, and how we would be able to manage this in our practice. ADD REFERENCES ONTO EACH SLIDE, avoid ‘you’ during presentation – act as though the audience are doctors DDX slides
- Without further ado, here is the case... (recite case and highlight main points-severe diarrhea/vomiting after eating shrimp, dehydrated skin, elevated WBC means her body is fighting an organism, hypokalemia, low bicarbonate, HYPOVOLEMIC SHOCK).
- Our patient’s main chief complaint is watery diarrhea and profuse vomiting, and upon examination we found metabolic acidosis, hypokalemia, increased WBC and an allover HYPOVOLEMIC SHOCK. NO FEVER! Serum sodium is usually 130-135 mmol/L, reflecting the substantial loss of sodium in the stool. Serum potassium usually is normal in the acute phase of the illness, reflecting the exchange of intracellular potassium for extracellular hydrogen ion in an effort to correct the acidosis. Hyperglycemia may be present, secondary to systemic release of epinephrine, glucagon, and cortisol due to hypovolemia. Patients have elevated blood urea nitrogen and creatinine levels consistent with prerenal azotemia. The extent of elevation depends on the degree and duration of dehydration. A reduced bicarbonate level (< 15 mmol/L) and an elevated anion gap occur as a result of increases in serum lactate, protein, and phosphate levels. The arterial pH is usually low (approximately 7.2). Calcium and magnesium levels are usually high as a result of hemoconcentration. Cholera-related diarrhea comes on suddenly and may quickly cause dangerous fluid loss — as much as a quart (about 1 liter) an hour. A loss of 10 percent or more of total body weight indicates severe dehydration. SHOCK = Shock. This is one of the most serious complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. If untreated, severe hypovolemic shock can cause death in a matter of minutes.
- Based on these two symptoms, we need to come up with a list of differentials. The differentials I have come up with, based on years and years of studying medicine, are E coli, gastroenteritis caused by a virus, aeromonas, or vibrio species.
- First up: E coli. It’s a gram negative bacilli that causes dysentery, traveler’s diarrhea and HUS, and is responsible for MANY cases of diarrhea. skinsight.com
- VIRAL GASTROENTERITIS is next. It causes acute gastroenteritis in adults from NOROVIRUS but is more common in children. Transmitted fecal-orally, so this may be a cause of her symptoms.
- A unique strain of V cholerae O1 (biotype El Tor, serotype Inaba), which is related closely to, but distinguishable from, the strain of the seventh pandemic was recognized in Louisiana and along the Gulf of Mexico in 1973. Since then, this strain has become indigenous to the Gulf coast, although its environmental reservoirs and ecology remain unclear. Of note, none of the toxigenic V choleraestrains associated with the US Gulf Coast (01, 0141, and 075) have caused more than sporadic cases and small outbreaks of diarrhea in the United States.[6] In October 2005, toxigenic V cholerae infection due to the consumption of contaminated and improperly cooked seafood was reported from Louisiana after Hurricanes Katrina and Rita. he V cholerae O139 serogroup (also known as Bengal), which emerged from Madras, India in October 1992, has spread throughout Bangladesh and India and into neighboring countries; thus far, 11 countries in Southeast Asia have reported isolation of this serogroup. Some experts regard this as an eighth pandemic. In mid-October 2010, a cholera epidemic broke out in Haiti, which has been worsened by heavy rains in 2011. As of June 20, 2011, 363,117 cases of cholera and 5,506 deaths have been reported.[12] The epidemic is the first in Haiti in at least a century, and the source may have been a United Nations peacekeeping team from Nepal that came to Haiti after the catastrophic earthquake that hit the Caribbean nation on January 12, 2010.[13, 14] Analyses performed by US and Haitian laboratories indicate that the strain involved in the outbreak is V cholerae El Tor O1 from the ongoing seventh pandemic predominant in South Asia . This may have consequences beyond Haiti, since this strain is more hardy and virulent, with an increased resistance to antibiotics
- Next Differential: Aeromonas. She ate seafood, and aeromonas is a waterborne organism, causing cholera-like symptoms. Aeromonas however tends to cause skin infections ie necrotizing fasciitis. She may be at the early stage and the dermatological manifestations aren’t appearing as yet, though it is unlikely.
- Based on the amount of diarrhea this patient is experiencing, we HAVE to aim straight for either Aeromonas or Vibrio. E coli can give patients diarrhea and vomiting but not to THIS EXTENT.
- COLLAPSE INTO ONE ROW (ENTEROBACTERIA E. COLI) MASSIVE DIARRHEA VS BLOODY DIARRHEA (EXPLAIN with toxigenesis, invasive vs noninvasive)
- It is important to understand that vibrio species may be resistant to treatment. In one study held in Brazil, two of 7,058 samples obtained from patients with enteritis were resistant to O129 (diamino diisopropylpteridine) and were ALSO resistant to trimethoprim/sulfamethoxazole. Vibrio has also been reported to be resistant to Tetracycline ALTERNATIVE TREATMENTS WOULD BE VANCOMYCIN OR LINEZOLID
- Our final diagnosis is VIBRIO CHOLERAE. http://cholera1.wikispaces.com/
- Cholera is transmitted by contaminated water and seafood. So flooding will allow the spreading of the organisms. Poor hygiene will not make this situation any better!
- The cholera toxin uses a lysogenic phage for transduction. Bacteria attach to the intestines with its pili, and its enterotoxin has 1 A subunit and 5 B subunits. The B subunit binds to a ganglioside receptor on the mucosal cell, and the A subunit will overactivate a G protein. Transduction Generalized A “packaging” event. Lytic phage infects bacterium, leading to cleavage of bacterial DNA. Parts of bacterial chromosomal DNA may become packaged in viral capsid. Phage infects another bacterium, transferring these genes. Specialized An “excision” event. Lysogenic phage infects bacterium; viral DNA incorporates into bacterial chromosome. When phage DNA is excised, flanking bacterial genes may be excised with it. DNA is packaged into phage viral capsid and can infect another bacterium. Genes for the following 5 bacterial toxins are encoded in a lysogenic phage (ABCDE): ? ShigA-like toxin ? Botulinum toxin (certain strains) ? Cholera toxin ? Diphtheria toxin ? Erythrogenic toxin of Streptococcus pyogenes CTX = cholera toxin The B subunits are responsible for binding to a ganglioside (monosialosyl ganglioside, GM1) receptor located on the surface of the cells that line the intestinal mucosa.
- This is a diagram illustrating the mechanism of signaling by the toxin through the G protein, inducing massive secretion of water and electrolytes into the intestinal lumen.
- Diagnosis is usually made clinically, but the TCBS agar and hanging drop test has darting motility. We can grow using the alkaline peptone water. There is also a rapid dipstick test that we can dip in stool to confirm that the patient is infected with vibrio cholerae. http://www.cdc.gov/cholera/diagnosis.html Alkaline enrichment media As Vibrio has the ability to grow at a high pH or in bile salts, which inhibit many other Enterobacteriaceae, peptone water (pH 8.5-9) or selective media containing bile salts (eg, thiosulfate-citrate-bile-sucrose-agar [pH 8.6]). Specific antisera can be used in immobilization tests. A positive immobilization test result (ie, cessation of motility of the organism) is produced only if the antiserum is specific for the Vibrio type present; the second antiserum serves as a negative control. Vibrio antisera may be unavailable in countries where cholera is not endemic. In endemic regions, this is an excellent quick method of identification, even in small laboratories. Classic and El Tor biotypes also can be identified using the same method. This is useful for epidemiologic studies. Rapid cholera dipstick tests are now available, enabling health care providers in remote areas to confirm diagnosis of cholera earlier. Quicker confirmation helps to decrease death rates at the start of cholera outbreaks and leads to earlier public health interventions for outbreak control. Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar (TCBS) is ideal for isolation and identification. Reagents for serogrouping Vibrio cholerae isolates are available in all state health department laboratories in the U.S. Commercially available rapid test kits are useful in epidemic settings but do not yield an isolate for antimicrobial susceptibility testing and subtyping, and should not be used for routine diagnosis. (http://www.cdc.gov/cholera/diagnosis.html)
- We can also use anti serum immobilization tests to inhibit the organisms movement so that we can see it better in the lab. Specific antisera can be used in immobilization tests. A positive immobilization test result (ie, cessation of motility of the organism) is produced only if the antiserum is specific for the Vibrio type present; the second antiserum serves as a negative control. Vibrio antisera may be unavailable in countries where cholera is not endemic. In endemic regions, this is an excellent quick method of identification, even in small laboratories. Classic and El Tor biotypes also can be identified using the same method. This is useful for epidemiologic studies.
- ABCs!! The treatment for cholera is supportive. We have to support the person so they don’t DIE! Therefore we rehydrate using ringer’s lactate solution. Oral rehydration salts may also be mixed with water containing electrolytes and glucose.. Everything the body needs in order to rehydrate itself back to its normal set point. Everything usually takes about 4 hours. TREATMENT: Antibiotics. While antibiotics are not a necessary part of cholera treatment, some of these drugs may reduce both the amount and duration of cholera-related diarrhea. A single dose of doxycycline (Monodox, Oracea, Vibramycin) or azithromycin (Zithromax, Zmax) may be effective. Rehydration. The goal is to replace lost fluids and electrolytes using a simple rehydration solution, oral rehydration salts (ORS). The ORS solution is available as a powder that can be reconstituted in boiled or bottled water. Without rehydration, approximately half the people with cholera die. With treatment, the number of fatalities drops to less than 1 percent. Furazolidone has been the agent routinely used in the treatment of cholera in children; however, resistance has been reported, and ampicillin, erythromycin, and fluoroquinolones are potentially effective alternatives. The use of quinolones is contraindicated in children with cholera. Tetracycline Trimethoprim Ciprofloxacin Ampicillin Erythromycin Norfloxacin
- We can also use antibiotics to kill the bacteria, but this is ONLY AFTER rehydrating the patient. For example, doxycycline, azithromycin, etc. Furazolidone is the medication we like to use for children. Tetracycline Trimethoprim Ciprofloxacin Ampicillin Erythromycin Norfloxacin
- But remember: Some vibrio species may be resistant! ALTERNATIVE TREATMENTS WOULD be? Vibrio species can also be resistant to Tetracycline
- Rehydration usually results in patient recovery! But if left untreated, the patient may become hypoglycemic from malnutrition, undergo hypokalemia because of the loss of electrolytes, or necrosis of a very special organ that that is responsible for filtration. Eventually, DEATH BY DEHYDRATION may occur. BEFORE IV THERAPY, MORTALITY RATE WAS MORE THAN 50%!! MORTALITY RATE STILL HIGHEST IN AFRICA Rehydration is the first priority in the treatment of cholera. Rehydration is accomplished in 2 phases: rehydration and maintenance. The goal of the rehydration phase is to restore normal hydration status, which should take no more than 4 hours. Set the rate of intravenous infusion in severely dehydrated patients at 50-100 mL/kg/hr. Lactated Ringer solution is preferred over isotonic sodium chloride solution because saline does not correct metabolic acidosis The goal of the maintenance phase is to maintain normal hydration status by replacing ongoing losses. The oral route is preferred, and the use of oral rehydration solution (ORS) at a rate of 500-1000 mL/hr is recommended. If untreated, the diarrhea and vomiting lead to isotonic dehydration, which can lead to acute tubular necrosis and renal failure. Because the dehydration is isotonic, water loss is proportional between 3 body compartments, intracellular, intravascular, and interstitial. http://www.mayoclinic.org/diseases-conditions/cholera/basics/definition/con-20031469 Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) — the body's main energy source — may occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death. Low potassium levels (hypokalemia). People with cholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life-threatening. Kidney (renal) failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in your body — a potentially life-threatening condition. In people with cholera, kidney failure often accompanies shock.
- The WHO has guidelines for when we would suspect cholera, based on whether we are in an area of known cholera cases or not.
- BEFORE IV THERAPY, MORTALITY RATE WAS MORE THAN 50%!! MORTALITY RATE STILL HIGHEST IN AFRICA due to a lack of IV equipment.
- We can reduce the incidence of cholera by being hygienic, drinking clean water, and making sure we cook our food properly!! The use of antacids, histamine receptor blockers, and proton pump inhibitors increases the risk of cholera infection and predisposes patients to more severe disease as a result of reduced gastric acidity. The same applies to patients with chronic gastritis secondary to Helicobacter pylori infection or those who have undergone a gastrectomy. Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren't available, use an alcohol-based hand sanitizer. Drink only safe water, including bottled water or water you've boiled or disinfected yourself. Use bottled water even to brush your teeth. Hot beverages are generally safe, as are canned or bottled drinks, but wipe the outside before you open them. Eat food that's completely cooked and hot and avoid street vendor food, if possible. If you do buy a meal from a street vendor, make sure it's cooked in your presence and served hot. Avoid sushi, as well as raw or improperly cooked fish and seafood of any kind. Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can't be peeled, such as grapes and berries. Be wary of dairy foods, including ice cream, which is often contaminated, and unpasteurized milk. Cholera vaccine Because travelers have a low risk of contracting cholera and because the traditional injected vaccine offers minimal protection, no cholera vaccine is currently available in the United States. A few countries offer two oral vaccines that may provide longer and better immunity than the older versions did. If you'd like more information about these vaccines, contact your doctor or local office of public health. Keep in mind that no country requires immunization against cholera as a condition for entry.
- One interesting fact is that gastric acid fights cholera infection. So if patients have a decreased amount of acid if they are taking medication like…? They will have a greater risk of acquiring the infection. Reduced or nonexistent stomach acid (hypochlorhydria or achlorhydria). Cholera bacteria can't survive in an acidic environment, and ordinary stomach acid often serves as a first-line defense against infection. But people with low levels of stomach acid — such as children, older adults, and people who take antacids, H-2 blockers or proton pump inhibitors — lack this protection, so they're at greater risk of cholera.
- Everyone is susceptible to cholera, with the exception of infants who derive immunity from nursing mothers who have previously had cholera
- Vaccines are only in select countries, Canada and developing countries, and the most effective one is the live attenuated one! Pathogen is inactivated by heat or chemicals; maintaining epitope structure on surface antigens is important for immune response.
- PREZI NOTES: So to summarize: Cholera is usually seen in areas with a lack of advanced healthcare equipment and sanitation ie areas in Central Africa, and you can see Haiti is highlighted as well, which had an outbreak several years back. The dots represent people who brought the vibrio in because of traveling i.e. Canada, US, Australia, etc. In countries like Kenya, cholera can easily be transmitted through the unclean water that these children collect for themselves and their families. The same thing goes for areas in South Asia like India. The water looks a bit cleaner but it may still be contaminated. The outbreak in Haiti was an endemic that quote unquote put cholera on the map. It was a very sad situation. People were dying from dehydration. Here is a short broadcast on the outbreak: These beds are termed ‘cholera cots’. I would imagine they had these available during the outbreak in the hospitals. They have conveniently placed holes in the centre for the massive diarrhea that these children and adults experience This is a photo of the infamous ‘rice water stool’. We hear about it over and over but I thought it would be great to show you a picture of what it looks like. It doesn’t really look like stool. It looks like water with some coagulations mixed in. TCBS, or thiosulfate-citrate-bile salts-sucrose agar, is used to identify vibrio species. It contains salt because Vibrio is a halophile and requires salt to grow. You see signature ‘yellow colonies’ on this agar. Here is a video imaging of the Vibrio species, with DARTING or ‘shooting star’ motility. They shoot so fast, it’s hard to catch em! A lot of them are hanging out, but many of them are shooting around. Ringer’s lactate solution is what we use intravenously for the severely dehydrated. It is composed of water, dextrose, lactate and electrolytes
- sharinginhealth.ca
- pixshark.com