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home - Colon - Colonic Infection - Cholera Treatment Written by Dr Sebastian Zeki
Knowledge

Recognises the range of important inflammatory conditions of the
intestine other than inflammatory bowel disease
Knows the range of potential aetiologies including infection and
ischaemia
Understands how diverticular disease can give rise to complications mini-CEX, SCE 1
Knows how diseases can affect the peritoneum and how such
conditions can present both in the acute and chronic situation
Knows the range of both acute and chronic intestinal infections and
their various presentations
Knows the means of investigations of infectious diseases and
understands the principles and use of antimicrobial therapy

Skills
Makes a full clinical assessment of patients presenting with infective
and inflammatory conditions
Recognises the potential urgency of the clinical situation. Selects
appropriate investigations and treatments

Behaviours
Manages patients with inflammatory and infective conditions carefully,
competently and sympathetically.

Cholera Treatment

TreatmentAntibiotic therapy is usually not necessary.Antibiotics can reduce the volume of diarrhoea by 50% and the duration of Vibrio excretion to 1 day.Give tetracycline or doxycycline when vomiting stops.Use erythromycin/ azithromycin for pregnant women and children.Use fluoroquinolones or azithromycin if resistance.Zinc supplementation reduces the stool output and duration of diarrhea among children with cholera. Laboratory diagnosis of choleraStool can contains curved G-ve rods.Dark field microscopy shows mobile rods which appear like "shooting stars" - motility stopped with specific antisera.Other tests include ELISA or PCR stool. > 10 % dehydrationIntravenous volume repletion Ringer's lactateDextrose-containing solutions should not be used for volume repletion. < 10 % dehydrationOral rehydration — (uses Na glucose co-transporterCommercially available ORS per liter of water contains:2.6 g NaCl;2.9 g trisodium citrate;1.5 g KCl;13.5 g glucose OHS containing rice (esp L-histidine containing rice) or cereal as the carbohydrate source may be best Incubation: Hours to 5 days Most infections are asymptomatic Clinical Presentations:Rice water stools- diarrhoea lasts up to 6 days.Vomiting.Abdominal cramps.Fever uncommon. Mortality — Up to 50-70%. Children and pregnant women particularly at riskDeath can be very rapid from first signs of illness Ingestion of contaminated food or water.V. cholerae colonizes arthropods and flies-potential vectors and hosts. Environmental persistence related to exopolysaccharide (from vps genes) extracellular matrix biofilm develo-ment Sensitive to gastric acid, and killed at pH <2.4. Protection from killing by:1. Protection within food, 2. Low gastric acidity of a compro-mised host3. Rapid gastric emptying4. Large inoculum size. pH Transmission PreventionAntibiotic prophylaxis is recommended only if an av. of 1 household member in a family of 5 are ill after the 1st case.Community chemotherapy is not effective.-Oral, killed whole-cell vaccine given with the nontoxic B subunit of cholera toxin (rBS-WC, Dukoral) is WHO recommended.-Oral live, attenuated vaccine strain (CVD 103-HgR, Mutacol) also exists. Cholera Transmission, Diagnosis and Treatment Colony formation: Plate stool or rectal swabs onto enteric bacteria growth inibitory media: thiosulfate citrate bile salts-sucrose (TCBS) agar or tellurite taurocho-late gelatin agar (TTGA) -TTGA: Flat with a black center and are surrounded by a gelatinase cloudy halo in the agar.-TCBS: Ferments sucrose, and produces large, yellow, smooth and opaque colonies.Subtyoe V. cholerae as O1 and O139 strains with specific antiseraSerology not useful Vaccines Written by Dr Sebastian Zeki

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