Tuesday, October 26, 2010

What is Cholera?

We have not seen this type of gastroenteritis for a long time but when we flip through the news it has been spreading in Haiti. It has caused several deaths because of severe dehydration.
Cholera is characterized by voluminous diarrhea without abdominal cramps or fever. Dehydration and shock can occur within 4-12 hours if fluids losses .are not replaced. Stools are colorless with small flecks of mucus "rice-water". Most infected people have no symptoms and some only have mild to moderate diarrhea lasting 3 to 7 days,fewer than 5% have severe watery stools with dehydration.

Humans are the only documented natural host in ingestion of contaminated water or undercooked/raw shellfish, raw or partially dried fish,moist grains,moist vegetables. Direct person to person contact has not been documented.

Oral or parenteral rehydration to correct dehydration and electrolyte abnormalities,
Oral rehydration solution is preferred unless the patient is obtunded or is in shock. The World Health Organization's oral rehydration solution has been the standard.
Antimicrobial therapy can eradicate the bacteria more quickly. The drug of choice is oral doxycycline as a single dose or a 3 day dose of tetracycline. This medications are not usually given to children younger than 8 years of age but if the patient has cholera the benefits might outweigh the risks in administering the medication. If strains are resistant to the tetracyclines you can give the ciprofloxacins, ofloxacins and the trimethoprim-sulfamethoxazoles.

Control Measures:

Hygiene - disinfection or boiling of water prevents transmission, appropriate hand washing after defecating is appropriate. Keep food promptly refrigerated.
Treatment of Contacts - administration of antibiotics within 24 hours of identification of cholera may prevent infection among household contacts
Vaccine -there is no vaccine currently available for cholera in the United states but there are 2 vaccines available but this are not proven to be effective at all, no country requires the cholera vaccine for entry

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