ACUTE GASTROENTERITIS AND CHOLERA

SESSION 29
•.
 LEARNING OBJECTIVES
• Define acute gastroenteritis and cholera
• Describe the epidemiology of acute
gastroenteritis and cholera
• Describe the clinical features of acute
gastroenteritis and cholera
• Describe the treatment of acute gastroenteritis
and cholera
• Describe the prevention and control of acute
gastroenteritis and cholera
 DEFINITION
Acute Gastroenteritis
• Is a clinical syndrome that causes irritation
and inflammation of the stomach and
intestines (the GIT) and presents with
diarrhoea(more than 3 motions in 24hrs)
other associated symptoms are nausea
crampy abdominal pain and vomiting.
 causes
• Viruses such as rotavirus, enterovirus, norovirus and
bacteria such as Escherichia coli.
• Other organisms such as Isospora and
Cryptosporidium, and enterotoxins of Escherichia coli
may also cause acute diarrhoea.
• In patients with immunosuppression e.g. HIV, these
organisms may cause chronic diarrhoea.
• Bacillary dysentery, paratyphoid fever, food poisoning,
cholera, Campylobacter infection and giardiasis may
also present as gastroenteritis
Other common causes of gastroenteritis

Gastroenteritis that is not contagious to

others can be caused by :-
• Chemical toxins, most often found in
seafood, food allergies, heavy metals,
antibiotics, and other medications.
 Common gastroenteritis symptoms
• Low grade fever to 37.7 C
• Nausea with or without vomiting
• Mild-to-moderate diarrhea
• Crampy painful abdominal bloating (The cramps may come in cycles,
increasing in severity until a loose bowel movement occurs and the pain
resolves somewhat.)
• Escherichia coli infection causes:
– Profuse watery diarrhoea with mucous but no blood .
– No fever
– The onset is acute and progress rapidly to severe diarrhoea
– The fluid balance in children is more easily disturbed than in adults
because of rapid fluid turnover
– Dehydration rapidly occurs and may be severe
 More serious symptoms of
gastroenteritis

• Blood in vomit or stool

• Vomiting more than 48 hours
• Fever higher than (40 C)
• Swollen abdomen or abdominal pain
• Dehydration - weakness, lightheadedness,
decreased urination, dry skin, dry mouth and
lack of sweat and tears .
 Treatment of acute gastroenteritis

• The first choice is to correct dehydration by using oral

rehydration solution (ORS) or intravenous fluid
• Replacement in severe dehydration depends on the
severity of dehydration and applies to both adults
and children.
• Oral antibiotics are given when there is blood in stool
or after result of stool microscopy and/or stool
culture.
 Treatment of acute gastroenteritis

• Specific issues in treatment for children

include:
– Give Zinc and vitamin A to children below five years of age.
– Continue feeding and give extra meals on recovery to
improve catch up growth.
– Continue and increase breastfeeding.
– If there is fever, look for the cause and treat.
– Teach the mother on how to reconstitute oral rehydration
solution and give it to the child.
– Educate her about diarrhoea prevention.
 Prevention and Control of Acute
Gastroenteritis
• Prevent malnutrition in weaning period.
• Encourage breast feeding and avoid bottle feeding.
Controls of diarrhoeal diseases (CDD) programmes aim at:-
 Use of Oral rehydration solution (ORS) to reduce diarrhoea-related deaths
 Improve water sanitation
 Improve weaning practices and nutrition of children
 Immunisation

 Antenatal care to reduce low birth weight

 Practice proper hand washing
 DEFINITON

• Cholera: An acute infectious disease that

causes severe watery diarrhea, which can lead
to dehydration and even death if untreated.
• It is caused by eating food or drinking water
contaminated with a bacterium called Vibrio
cholerae.
 OVERVIEW
• Vibrio cholerae, the bacterium that causes cholera, is usually found
in food or water contaminated by faeces from a person with the
infection. Common sources include:
• Contaminated water
• Contaminated Foods and drinks sold by street vendors
• Vegetables grown with water containing human wastes
• Raw or undercooked fish and seafood caught in waters polluted with
sewage
• When a person consumes these the bacteria release a toxin in the
intestines that produces severe diarrhea.
• It is not likely you get cholera from casual contact with an infected
person
 epidemiology
• Sub-strains of Vibrio cholerae are sensitive to gastric acid
therefore a large number of organisms have to be ingested
to cause a disease.
• Therefore cholera has a very high infective dose.
• Even in severe epidemic only 1-2% of infected persons
developed severe cholera disease.
• For every clinical case of cholera there may be 50-100 more
asymptomatic carriers.
• Fatality rate of untreated severe cholera exceeds 50% but
with adequate rehydration this can be brought to below 1%.
 epidemiology
• Transmission is through faecal –oral route but almost all
cholera infections are water-borne.
• Vibrio cholera can live in water for 2 weeks and prefer
brackish (salty) water.
• In sea water, the vibrios may survive for longer period and
multiply in shellfish such as crab and shrimp.
• Vibrios also readily multiply in certain foods such as milk and
boiled rice.
• Carriers excrete vibrios in small numbers than the patients
but pose the greatest danger to the community.
 
 Clinical features
• The incubation period is 2-3 days
• The syndrome of cholera is caused by water and electrolyte loss and
developing in 3 stages as described below:
First stage: Last for 3-12 hours
• Characterized by profuse watery stool
• Soon faecal matter disappears from the stool which comprises
almost clear fluid with flakes of mucous, giving them the classical
rice-water appearance
• The patient then starts vomiting
• At first, food is vomited but soon only ‘rice-water’ is vomited
• Severe cramps in the abdomen and limbs develop from loss of
electrolytes
 Clinical features
Second stage:- There is collapse from dehydration
• The body becomes cold, the skin dry and inelastic
• The blood pressure is low or unrecordable; the pulse is
rapid and feeble
• Patient develop anuria and may die of hypovolaemic
shock
Third stage: This is a stage of recovery, either spontaneously or with
treatment
• The diarrhoea decreases
• The patient is able to take fluids and general condition
rapidly improves 
 treatment
• Admit and isolation is important vomitus and stool
are infectious these should be properly deposited in
pit latrine or a septic tank system
• Hospital equipment should be cleaned with
disinfectant .
• Patients can be on ‘Cholera bed’ with central hole
through which the continuous stool can pass into a
bucket and fluid loss be measured .
 treatment
• The essential treatment is by appropriate and timely
rehydration
• Those who can drink will ingest the volume of
glucose/electrolyte solution needed for rehydration
and maintenance.
• Use ORS or appropriate IV fluids so as to replace the
necessary electrolytes.
• Patients in shock or too weak to drink require
intravenous fluids until they can take in oral fluids.
 treatment
 Antimicrobial agents have been shown to shorten the
period of diarrhoea and the amount of fluid loss.
 Drugs to be used includes;-Tetracycline 2g single
dose and doxycycline but the increasing occurrence
of resistant strains limits their usefulness.
 Erythromycin and Cotrimoxazole can also be used in
children less than 8 year of age in whom tetracycline
cannot be given.
 diagnosis
• The diagnosis of cholera is made on clinical grounds.
• Do not refer the patient but send rectal swab or stool
specimen in transport medium (Cary Blair transport
medium).
 Prevention and control
• Public notification
• Proper hand wash before and after visiting patients.
• Chlorination of water in large scale and boiling drinking water.
• Milk products should be pasteurized and uncooked food should
be avoided or washed in safe water.
• Handling of leftovers against contamination .
• Markets and food premises should be inspected.
• Improvement of sanitation facilities e.g. proper excreta and
refuse disposal .
• Tetracycline can be given to contacts.
 Prevention and control
In an outbreak of the following should be done:-
• Open temporary place for managing patients.
• Public notification.
• Chlorination of water supply
• Take stool specimen for culture
• Do not refer suspected cases
• Prepare large amount of rehydration fluids
• Rehydrate as many patients as possible with ORS
• Give intravenous fluid to patients in shock .
• Give health education to public .