Prof.Dr. Fhim ShaltoutProfessor of Meat Hygiene

Faculty of Veterinary MedicneBenha University, Egypt.

Cholera is an infection in the small intestine caused by the bacterium Vibrio cholerae. The main symptoms are profuse, watery diarrhea and vomiting. Transmission occurs primarily by drinking water or eating food that has been contaminated by the feces of an infected person, including one with no apparent symptoms.

The Bacteria that causes Cholera

Gram-negative rods. Curves or Comma shaped. Non-spore forming Highly motile-single polar flagella Associated with salt water Oxidase positive Tolerate alkaline conditions to pH9.0 Readily cultivated, Simple nutritional

requirements. Facultative anaerobe

Acute infectious diseaseAcute infectious disease is often fatalis often fatal characterized by severe characterized by severe

vomiting, diarrhoea, and vomiting, diarrhoea, and collapsecollapse

Caused By: Vibrio cholerae

•Indirect transmissionIndirect transmissionVehicle borneVehicle borne

•Reaches water through:Reaches water through:VomitingVomitingDiarrhoeaDiarrhoea

•Carriers active or passiveCarriers active or passive•Produces toxins in small Produces toxins in small intestines that cause severe intestines that cause severe diarrhoea and dehydrationdiarrhoea and dehydration

Through:Through: Contaminated waterContaminated water Contaminated foodContaminated food Eating with unwashed handsEating with unwashed hands

Also house flies and other Also house flies and other insectsinsects

The primary symptoms of cholera are profuse, painless diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, one to five days after ingestion of the bacteria. 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 liters (3 to 5 US gal) 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.

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.

A person with severe dehydration due to cholera - note the sunken eyes and decreased skin turgor which produces wrinkled hands

Host drinks waterHost drinks water Bacteria moves through the stomachBacteria moves through the stomach Reach the intestine & produce flagellaReach the intestine & produce flagella Propel through mucus of the sm. Propel through mucus of the sm.

intestineintestine Produce toxin causing diarrheaProduce toxin causing diarrhea Feces carry new bacteria into drinking Feces carry new bacteria into drinking

waterwater

VomitingVomiting Muscle crampsMuscle cramps Sudden onset and watery, Sudden onset and watery,

painless diarrheapainless diarrhea Stool has a characteristic Stool has a characteristic

“rice water” appearance “rice water” appearance (gray, slightly cloudy with (gray, slightly cloudy with bits of mucus, and a slightly bits of mucus, and a slightly sweaty odor)sweaty odor)

VomitingVomiting Muscle crampsMuscle cramps Sudden onset and watery, Sudden onset and watery,

painless diarrheapainless diarrhea Stool has a characteristic Stool has a characteristic

“rice water” appearance “rice water” appearance (gray, slightly cloudy with (gray, slightly cloudy with bits of mucus, and a slightly bits of mucus, and a slightly sweaty odor)sweaty odor)

Stage 1

Stage 2 Dehydration, Thirst and Dehydration, Thirst and

ShockShock Cold Skin, sunken Eyes, Cold Skin, sunken Eyes,

weak pulse and feint high-weak pulse and feint high-pitched voice pitched voice

Reduced urine Reduced urine Muscle cramps and Muscle Muscle cramps and Muscle

weakness weakness

Dehydration, Thirst and Dehydration, Thirst and ShockShock

Cold Skin, sunken Eyes, Cold Skin, sunken Eyes, weak pulse and feint high-weak pulse and feint high-pitched voice pitched voice

Reduced urine Reduced urine Muscle cramps and Muscle Muscle cramps and Muscle

weakness weakness

Stage 3 Start to recoverStart to recover Mild to severe diarrhoeaMild to severe diarrhoea Shock and dehydrationShock and dehydration Loss of important Loss of important

minerals and electrolytesminerals and electrolytes Intense thirst Intense thirst Reduced urinationReduced urination Muscle cramps/weaknessMuscle cramps/weakness

Start to recoverStart to recover Mild to severe diarrhoeaMild to severe diarrhoea Shock and dehydrationShock and dehydration Loss of important Loss of important

minerals and electrolytesminerals and electrolytes Intense thirst Intense thirst Reduced urinationReduced urination Muscle cramps/weaknessMuscle cramps/weakness

Oral Rehydration Therapy (ORT)Oral Rehydration Therapy (ORT) Solution of salts and sugars, taken by the Solution of salts and sugars, taken by the

mouthmouth Also homemade solutions (water, sugar, Also homemade solutions (water, sugar,

table salt, baking soda, and fruit)table salt, baking soda, and fruit) Sometimes intravenousSometimes intravenous

TetracyclineTetracycline Shortens the course of the disease Shortens the course of the disease Weaken the symptoms.Weaken the symptoms.

1. Specimens: stool, vomitus.2. Stained smear3. Culture: alkaline peptone water of

agar plate, and TCBS agar plate.4. Quick immunological methods:

immunofluorescent “ball” test; PCR.

Squatter campsSquatter camps Bad hygieneBad hygiene Unsafe preparation of foodUnsafe preparation of food Drinking contaminated waterDrinking contaminated water To bathe / swim in contaminated waterTo bathe / swim in contaminated water

ImmunizationImmunization Boiling water, covering foodBoiling water, covering food EducationEducation Personal and domestic hygienePersonal and domestic hygiene Prevention of contamination of water Prevention of contamination of water

suppliessupplies Improvement of sewage systemsImprovement of sewage systems Access to health careAccess to health care

For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes.

Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil for at least 10 minutes at 375°F (190°C), while keeping the pieces well separated.

Although cholera may be life-threatening, 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.

Although cholera may be life-threatening, 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.