CHOLERA

• An acute bacterial enteric disease of the GIT characterized by profuse diarrhea, vomiting, massive loss of fluid and electrolytes that could result to hypovolemic shock, acidosis, and death

ETIOLOGIC AGENT

VIBRIO CHOLERA/VIBRIO COMA

¤ Slightly curved rods,gram-negative and motile with a single polar flagellum

¤ Survive well at ordinary temperature and can grow well in temp. ranging from 22-40 degrees celcius

¤ Can survive longer in refrigerated foods

PATHOGNOMONIC SIGN

Rice-watery stool

INCUBATION PERIOD

The incubation period ranges from a few hours to five days; usually in one to three days

PERIOD OF COMMUNICABILITY

The organisms are communicable during stool positive stage, usually few days after recovery, however occasionally the carrier may have the organism for several months

CLINICAL MANIFESTATIONThere is an acute, profuse, watery diarrhea with no tenesmus or intestinal crampingInitially, the stool is brown and contains fecal materials, but soon becomes pale gray, “rice-water” in apperance with an inoffensive, slightly fishy odorVomiting often occurs after diarrheaSkin turgor and sunken eyesDiarrhea that causes fluid lossSkin is cold, fingers and toes are wrinkledCyanosisHoarse voiceRapid breathingOliguriaDeath may occur as short as four hours after onset, but usually occurs on the first or the second day if not properly treated

VIBRIO CHOLERA

HUMAN FAECAL POLLUTION

INGESTION

FECAL-ORAL

VOMIT, FECALYSIS

MAN

DIAGNOSTIC EXAMS

Rectal swabDarkfield or phase microscopyStool exam

MODALITIES OF TREATMENT

IV – rapid IV infusion of alkaline saline solution containing sodium, potassium, chloride, and bicarbonate ionsOral therapy rehydrationMaintenance of the volume of fluid and electrolyte lost after rehydrationAntibiotics – tetracycline 500mg q6, furazolidone 500mg for adults and 125mg for children q6 for 72 hours, chloramphenicol 5oomg for adults and 18mg/kg for children q6 for 72 hours, cotrimoxazole 8mg/kg for 72 hours

NURSING MANAGEMENT

Provide medical aseptic protective careObserve enteric isolationRecord an accurate vital signAccurately measure the I and OProvide a thorough and careful personal

hygieneProper disposal of excretaApplication of concurrent disinfectionProperly preparation of foodObserve environmental sanitation

PREVENTION

Food and water supply must be protected from fecal contamination

Water should be boiled or chlorinatedMilk should be pasteurizedSanitary disposal of human excreta is a mustSanitary supervision is important

TYPHIOD FEVER

Is a bacterial infection on transmitted by contaminated water, milk, shellfish, or other food.

An infection of the GIT affecting the lymphoid tissues of the small intestine

ETIOLOGIC AGENT

Salmonella typhosa/typhi- gram-negative, motile and non-spore forming- Pathogenic to man only- A hardy organism and easily survives in natural

habitat like water or inorganic materials

INCUBATION PERIOD

From five to forty days with a mean of ten to twenty days

PERIOD OF COMMUNICABILITY

Variable As long as the patient is

excreting the microorganism, he is still capable of infecting others

SOURCES OF INFECTION

o A person who recovered from the disease or one who took care of a patient with typhoid and was infected can be considered a potential carrier

o Ingestion of shellfish taken from waters contaminated by sewage disposal can be a source of infection

o Stool and vomitus of infected individual are sources of infection

CLINICAL MANIFESTATION

1. ONSETheadachre, chilly sensation, aching all over the

bodyNausea, vomiting, and diarrheaBy the 4th and 5th day, all symptoms are worstFever is higher in the morning than it was in the afternoonBreathing is accelerated, the tongue is furred, the skin is dry and hot, abdomen is distended and tenderRose spots appear on the abdominal wallOn the second week symptoms become more aggravated

2. TYPHOID STATEIntense symptoms decline in severityTongue protrudes, becomes dry and brownTeeth and lips accumulate a dirty-brown collection of dried mucus and bacteria known as sordesPatient seems to be staring blanklyTwitching of the tendon especially the wristPatient mutters deliriously and picks up aimlessly and bedclothes in his fingers in continuous fashionThere is a constant tendency for patient to slip down to the foot part of the bedRambling delirium sets in the severe cases

COMPLICATIONS

Hemorrhage or perforationPeritonitisBronchitis and pnuemoniaMeteorism or excessive distention of the

bowelsThrombosis and embolismEarly heart failureTyphoid spine or neuritisSepticemiaReiter’s syndrome

SALMONELLA TYPHOSA/TYPHI

HUMAN GALLBLADER CARRIER AND HUMAN URINARY

CARRIER

INGESTION OF BACTERIA

CONTAMINATED FOOD AND BY DIRECT CONTACT

FECALYSIS, VOMITING

MAN

DIAGNOSTIC PROCEDURE

Typhidot – confirmatoryELISAWidalRectal swab

MODALITIES OF TREATMENT

Chloramphenicol Ampicillin Co-trimoxazole Ciprofloxacin or Ciftriaxone 3rd and 4th generation drugs are administered

if the patient does not respond to Chloramphenicol

NURSING MANAGEMENT

Maintain or restore fluid and electrolyte balance

Monitor patient’s vital signPrevent further injury of patient with typhoid

psychosisMaintain good personal hygiene and mouth

careCooling measures are necessary during febrile

stateWatch for signs of intestinal bleeding

PREVENTION AND CONTROL

Sanitary and proper disposal of excretaProper supervision of food handlersEnteric isolationAdequate protection of provision of safe drinking water supplyReporting of cases to health authorities