Cholera

Fadillah Alma Putra

 Physiology and Structure
• gram-negative, facultatively anaerobic, fermentative rods
• All species of Vibrio require sodium chloride (NaCl) for growth
• Vibrios tolerate a wide range of pH (e.g., pH of 6.5 to 9.0) but are
susceptible to stomach acids.
• Most vibrios have polar flagella (important for motility), as well as
various pili that are important for virulence
• The interest in this classification scheme is more than academic—V.
cholerae O1 and O139 produce cholera toxin and are associated
with epidemics of cholera
• Three serotypes are recognized: Inaba, Ogawa, and Hikojima
• Two biotypes of V. cholerae O1 are recognized: Classical and El Tor
thiosulfate-citrate-bile-sucrose (TCBS) agar
• V. cholerae are able to adhere to the mucosal cell
layer by means of (1) the TCP encoded by the tcp
gene complex and (2) chemotaxis proteins
encoded by the cep genes
• zonnula occludens toxin and accessory cholera
enterotoxin
• zonnula occludens toxin loosens the tight
junctions (zonnula occludens) of the small
intestine mucosa, leading to increased intestinal
permeability, and the enterotoxin produces
increased fluid secretion
 Epidemiology
• Vibrio species, including V. cholerae, grow naturally in
estuarine and marine environments worldwide
• Pathogenic vibrios can also flourish in waters with
chitinous shellfish (e.g., oxysters, clams, mussels)
• Cholera is spread by contaminated water and food
rather than direct person-to-person spread because a
high inoculum (e.g., more than 108 organisms) is
required to establish infection in a person with normal
gastric acidity
• Cholera is usually seen in communities with poor
sanitation
 Clinical Disease
• 2 to 3 days after ingestion of the bacteria, with the abrupt
onset of watery diarrhea and vomiting
• feces-streaked stool specimens become colorless and
odorless, free of protein, and speckled with mucus (“rice-
water” stools).
• resulting severe fluid and electrolyte loss can lead to
dehydration, painful muscle cramps, metabolic acidosis
(bicarbonate loss), and hypokalemia and hypovolemic
shock (potassium loss), with cardiac arrhythmia and renal
failure
• Extraintestinal infections, such as septicemia, particularly in
patients with liver disease or hematologic malignancies
 Treatment
1. fluid and electrolyte replacement
2. A single dose of azithromycin is currently the
drug of choice for children and adults
3. A single dose of doxycycline or ciprofloxacin
in nonpregnant adults can be used as
alternative therapy
4. Obat antidiare >> Loperamid, bismut
subsalisilat, atalpugit, racecadotril
 Prevention
• Pemberian ASI
• Pemberian makanan pendamping ASI
• Menggunakan air bersih yang cukup
• Mencuci tangan
• Menggunakan jamban
• Membuang tinja bayi dengan benar
• Pemberian imunisasi campak