Cholera typhoid fever dysentery

Cholera, typhoid fever and dysentery are some communicable diseases that are mainly caused due to ingestion of food which are contaminated with pathogenic micro-organisms.

1. Cholera, Typhoid fever, Dysentery S.R.M.Senarathne BSc Nursing Student Faculty of medical Sciences University of Sri Jayewardanepura

2. Looking For a Home Also called as infectious diseases or transmissible diseases. Diseases that are spread from one person to the other . Diseases that are caused by germs or pathogens . Examples for pathogens include: viruses bacteria parasites fungi

3. Cholera Typhoid fever Dysentery Chicken pox Diphtheria Filariasis AIDS Poliomyelitis Malaria Measeles Tuberculosis Tetanus Rabies Sexually transmitted diseases Examples:

4. Cholera

5. What is Cholera? The word cholera is from Greek which has a meaning related to “bile”. If cholera is not treated, it can be fatal Cholera is an infection in the small intestine caused by the bacterium Vibrio cholerae

6. Little bit about Vibrio cholerae Vibrio cholerae is a Gram-negative bacterium that produces cholera toxin Has over 150 identified serotypes based on O-antigen Only O1 and O139 are toxigenic and cause Cholera disease ( Water-borne illness ) Distinguishing factors: Oxidasepositive , motile via polar flagellum , and both respiratory and fermentative metabolism. Organism can multiply freely in water

7. Mode of transmission Cholera is transmitted by a faecal -oral route Transmission occurs primarily by drinking water or eating food that has been contaminated by the feces of an infected person. Therefore it is a fecal disease. Contaminated seafood Ex: Undercooked shellfish Contaminated water

8. Most people remain asymptomatic. Therefore people that are exposed to cholera bacterium (Vibrio cholera) will not become ill and may never know they have been infected. But they shed cholera bacteria in the stool for 7 to 14 days, the contaminated water can still infect others.

9. Risk factors Poor sanitation and hygiene practices People in peri -urban slums, refugee camps The risk of cholera epidemics is highest when there are natural disasters , war , or poverty , which forces people to live in crowded condition without access to adequate and clean sanitation Lack of education, poor quality of life Blood types O>> B > A > AB Hypochlorhydria -People with low levels of stomach acid. Such as children, older adults, and due to some medications. Eating r aw or undercooked food. Contaminated seafood, even in developed countries. Especially shellfish

10. Signs and symptoms 1.Profuse , watery diarrhea - mild to moderate diarrhea - often difficult to distinguish from diarrhea caused by other problems. -The stool has a characteristic appearance: a nonbilious , gray, slightly cloudy fluid with flecks of mucus, no blood, and a somewhat fishy, inoffensive odor -It is frequently described as “rice-water” diarrhea. - An untreated person with cholera may produce 10 to 20 litres of diarrhea a day with fatal results

11. 2.stomach pains 3.Muscle cramps –Due to electrolyte imbalance

12. 5.Vomiting of clear fluid 4.Mild fever

13. 6.Decreased urinary output 7.Sunken eyes and cheeks ( sunken fontanelles in infants)

14. 8.Dry mucous membranes 9.Poor skin turgor (wrinkled hands)

15. 10.Tachycardia -rapid pulse 11.Postural hypotension (Orthostatic Hypotension.)

16. 12.Somnolence -(Sleepy) 13.Weakness

17. complications 1.Severe dehydration 2.Shock

18. 3.Renal failure - due to acute tubular necrosis. When the kidneys lose their ability to filter excess amounts of fluids, some electrolytes and waste build up in the body in people with cholera, often accompanied by shock.

19. 4.Low blood sugar (hypoglycemia  ) -low levels of blood sugar (glucose) which is the body’s primary energy source. This can happen when someone is too ill to eat. Children are at the greatest risk for this, causing unconsciousness, seizures and death .

20. 4.Low potassium levels (hypokalemia ) - Individuals with cholera lose many minerals, including potassium in their stools. Very low potassium levels interfere with nerve and heart functions and can be life-threatening.

21. Treatment Cholera demands immediate treatment because the disease can cause death within hours Rehydration  – The goal is to replace lost fluids and electrolytes using a simple rehydration solution, oral rehydration salts (ORS). Th ORS solution is available as a powder can be reconstituted in bold or bottled water. Without rehydration support half the individuals with cholera die. With medication a number of fatalities fall to less than 1 percent Intravenous fluids – During a cholera epidemic, the majority of people can be helped by oral rehydration alone, severely dehydrated people may also need intravenous fluids Antibiotics –  while antibiotics are not the necessary art of cholera treatment, some antibiotics may reduce the amount and duration of cholera caused diarrhea. A single dose of doxycycline ( Vibramycin , Monodox , Oracea ) or Azithromycin ( Zmax , Zithromax) can be helpful . Zinc supplements –  Research as shown that signs it may decrease and shorten the duration of diarrhea in children with cholera.

22. Prevention Cholera is rare in developed countries with a few cases related to travel outside to developing countries or regions that are contaminated and improperly cooked seafood. If you are traveling to a cholera-endemic area your risk of contracting the disease is extremely low if follow these precautions . Wash your hands with soap and water frequently , at least 14 seconds before rising, if soap and water aren’t available to use alcohol-based hand sanitizer Drink only safe water , including bottled, or boiled water. Hot beverages are generally safe and canned or bottled drinks are as well. Wipe the outside before you open them.

23. Eat foods that are completely cooked and hot. Avoid raw improperly cooked fish and seafood of any kind. Stick to first and vegetables you can peel yourself,  bananas, avocados and oranges. Do not eat grapes, salads and fruits that are not peeled, including berries. Avoid dairy foods,  which can be contaminated with pastured milk. Cholera vaccine  – for adults traveling to cholera- affected areas, the vaccine is now available in the US. The U.S food and Durg administration approved Vaxchora , a vaccine for prevention of cholera. It is a liquid does take by mouth 10 days before travel.

24. What is Typhoid Fever? Typhoid Fever is a lifethreatening illness caused by the bacterium Salmonella typhi from the family Enterobacteriacea . Clinically characterized by typical continuous fever for 3 to 4 weeks, relatively bradycardia with involvement of intestinal lymphoid tissues, reticuloendothelial system & gall bladder . It is transmitted through the ingestion of food or drink contaminated by the faeces or urine of infected people.

25. Modes of Transmission The disease is transmitted by “ faeco -oral route” or “urine–oral routes” either directly through hands soiled with faeces or urine or carriers or indirectly by ingestion of contaminated water, milk, food, or through flies. Contaminated ice, ice-creams, and milk products are a rich source of infection.

26. The bacteria itself only lives in humans and is carried through the blood stream and intestinal tract. Typhoid can be passed through animals, only through humans. Flies however, are known to help transmit the disease because when they land on human excrement, it remains on their appendages and can be transmitted when they land on something else.

27. Carriers of Typhoid Fever A carrier is usually a healthy person who survived the disease but in whom the bacteria are able to survive without causing further symptoms . Carriers continue to spread the disease through their excrement without realizing it . Carriers are treated with prolonged antibiotics. The term chronic carrier is reserved for those who excrete salmonella for an year or more.

28. Typhoid Mary It is believed that Mary Mallon never actually had the disease however , her mother had typhoid while pregnant with her. She infected 47 people and killed 3. She constantly changed her employment but the members of the household always got sick. She was forced into containment for two years and then released under the conditions that she could no longer be a cook. She assumed a false name and began cooking again and of course , infecting numerous people. She was forced into life-time containment where she died 26 years later of pneumonia.

29. Symptoms

30. Death occurred from the development of other complications such as:  Overwhelming infections  Pneumonia  Intestinal bleeding  Intestinal perforation  Kidney Failure  Peritonitis  Pancreatitis  Infections of the spine  meningitis  Inflammation of the heart muscle  Psychiatric problems Complications

31. Genera l: Supportive care includes Maintenance of adequate hydration. Antipyretics. Appropriate nutrition. Specific : Antimicrobial therapy is the mainstay treatment. Chloramphenicol , Ampicillin, Amoxicillin, Trimethoprim & Sulphamethoxazole , Fluroquinolones In case of quinolone resistance – Azithromycin, 3rd generation cephalosporins (ceftriaxone) Management of typhoid fever : Diet Fluids and electrolytes should be monitored and replaced diligently. Oral nutrition with a soft digestible diet is preferable in the absence of abdominal distension or ileus. Activity No specific limitations on activity are indicated. Rest is helpful, but mobility should be maintained if tolerable. The patient should be encouraged to stay home from work until recovery

32. Dysentery

33. What is dysentery? Dysentery is a type of infection that caused by bacteria. It is inflammation of the intestines and especially the colon. It leads to abdominal pain and frequent stools that contain blood and mucus. Dysentery is sometimes known as “travelers diarrhea”

34. Prevalence of dysentery Bacillary dysentery most common in western Europe & USA country. Amoebic dysentery most common in developing countries. Types of Dysentery

35. Etiology Dysentery can be caused by bacteria, protozoa, worms or even non-infectious agents. 1.Bacillary dysentery: 2.Amoebic dysentery: Entamoeba Shigella bacillus histolytica The four main Shigella species responsible for bacterial dysentery are S. sonnei , S. flexneri , S. boydii and S. dysenteriae and this disease is sometimes known as Shigellosis

36. Transmission Shigella infection is a major public health problem. It is happened when sanitation is poor. Overcrowding and poor hygiene are major risk factors for dysentery Dysentery is spread by means of fecal-oral transmission.

37. Other modes of transmission include ingestion of contaminated food or water, contact with a contaminated inanimate object, and certain mode of sexual contact. Vectors like the housefly can spread the disease by physically transporting infected feces

38. Symptoms of bacillary dysentery stomach ache, diarrhea, no blood or mucus in the feces, intense abdominal pain, fever, nausea, vomiting

39. Symptoms of amoebic dysentery abdominal pain, fever and chills , nausea and vomiting, watery diarrhea which can contain blood , mucus or pus, the painful passing of stools , fatigue , intermittent constipation

40. Treatment Bacillary dysentery Amoebic dysentery Rehydration By oral or IV By oral only Antimicrobial Ciprofloxacin Metronidazole Anti diarrheal Non preferable Preferable

41. Prevention A good standard of personal hygiene will prevent the transmission of dysentery. This means frequent handwashing , especially after using the toilet or after contact with someone who is infected with shigella . Hands should also be washed before handling and cooking food eating handling babies and feeding the young or elderly. To avoid spreading infection, personal items like towels or face clothe should not be shared. Travelers should avoid drinking tap water in countries known to have poor sanitation. Only drink properly sourced water, such as bottled water.