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1. Cholera Cholera is an acute infectious diarrheal illness caused by a specific organism vibrio cholerae . Cholera can be endemic in certain tropical regions like India and China, can be local epidemic or even pandemic covering large areas of populations. The hallmark of the disease is its profuse watery diarrhea(Rice water diarrrhoea ) that can rapidly and fatally dehydrate children and adults alike. Cholera can be endemic, epidemic or even pandemic In communities, the infection most commonly spreads through infected water contaminated with faeces 1

2. Mode of transmission Cholera is transmitted by fecal-oral route Because cholera is spread by contaminated water and food vehicles, the transmission is facilitated wherever populations are not drinking or using treated water and poor sanitation Contaminated Water remains the main vehicle of transmission in many parts of the world. Faulty municipal water and sewage systems, contaminated surface water, and unsafe domestic water storage methods results in extensive water-borne cholera transmission In developed countries, cholera is not a threat because of its advanced water and sanitation systems but it can be brought in by people who frequently travel to developing countries like Uganda 2

3. Epidemiology and Geographical distribution Cholera is an ancient disease Because cholera is pandemic in nature, it travels and flows over vast distances over time. Its ancestral home is the Ganges delta, where its endemic. Ganges is a river in northern India that supplies and travels through Bangladesh to Bengal Bay. Most cases occur in remote areas of developing countries like Uganda where outbreaks have been recorded in the past Humans are the only known host of cholera, but has two main reservoirs, humans and water 3

4. Clinical picture Incubation period of 1-3 days Large volumes of Painless Watery diarrhoea (rice-water stools)by Nausea and Vomiting Abdominal cramps (pain) Fever sometimes Muscles cramps and weakness Signs of moderate dehydration may appear; Dry mucus membranes Increased thready pulse rate Hypotension Sunken eyes Decreased skin turgor Decreased urine output And thirst 4

5. Severely dehydrated patients have: Altered mental status (confusion etc) Kussmaul’s breathing (slow deep breathing) Lethargy Cold clummy skin Extreme discomfort Hypoglycaemia 5

6. Differential Diagnosis Acute bacillary dysentery (shigellosis) Acute food poisoning Severe malaria Investigations Stool culture 6

7. Management Aggressive rehydration by oral or IV routes to replace lost fluids and electrolytes Most patients only require oral rehydration with only ORS For severe dehydration, administer IV Ringer’s lactate according to severity of the dehydration Administer IV glucose (dextrose) for hypoglycemia Isolation of the infected patients 7

8. Antibiotic treatment; may reduce duration of diarrhoea Doxycycline 300mg (3 tabs) single dose Or ciprofloxacin 1g 12hourly for 3 days Or erythromycin 1g 6 hourly for 3 days Note: Ciprofloxacin is contraindicated in children below 8yrs and pregnant mothers. In this case use erythromycin 8

9. Prevention and control Inform health authorities immediately Provide barrier nursing by isolation of infected Treat water supplies and improve sanitation to remove human fecal wastes that Defecation in open air should be discouraged and emergency pit latrines should be built Educate the public the patients/public about; Rehydration with plenty of fluids Continue with feeding esp breastfeeding Improve food hygiene by cleaning utensils well, washing hands before eating and keeping food in clean and safe containers 9

10. Good personal hygiene; wash before touching food and after visiting the toilet Prompt reporting of cases Proper waste disposal Provide rehydration facilities and provide transport of patients to those facilities Advice patients to seek treatment immediately they see the signs like diarrhoea Mass media communication; on symptoms of cholera, where to seek treatment, water and food sources to be avoided and others as needed 10