Reasonable Rascal
09-24-01, 05:00
Cholera
(Asiatic cholera or epidemic cholera)
Description: Vibrio Cholerae is a short, curved, motile, gram-negative, rod. It does not produce spores. Cholera is spread through unsanitary conditions--principally by the fecal/oral route i.e. feces contaminated food and water. All populations are susceptible, however, children are extremely vulnerable. Cholera is an Infection/infestation of the small intestine by the vibiros and the symptoms are the result of a toxin produced by the Cholera Vibrios. Cholera runs its course in 2 to 7 days.
Prophylaxis would be successful
Signs and Symptoms: Incubation is 6-72 hours. Signs and symptoms range from asymptomatic to severe with sudden onset. Symptoms can include, vomiting, headache, intestinal cramping with little or no fever. Early symptoms are swiftly followed by profuse watery diarrhea with 'rice water' appearance. Fluid losses can exceed 1 to 3 gallons (5 to 10 liters) per day. Without treatment, the patient may progress from severe dehydration to hypovolemia, acidosis, shock and death. Because of the overwhelming nature of the rapid fluid loss, death can occur within hours after onset. With intervention, mortality should not exceed 1%. Without intervention, mortality can be as high as 30% to 60%.
Clinical Diagnosis: If the patient has profuse 'rice water' diarrhea and dehydration then a diagnosis of Cholera may be confirmed by darkfield examination and by direct microscopic visual of darting vibrios.
Note: Nonpathogenic vibrios are widely distributed in estuaries and seafood. Therefore, isolation of vibrios from a patient with a mild diarrheal disease does not necessarily indicate Vibrio Cholerae!
War Engine: This agent has been investigated in the past as a biological weapon. Cholera does not easily spread from human to human, however, if used as a biological War Engine, major drinking water supplies would have to be heavily contaminated. Recent Cholera epidemics in South America, Africa and India have shown the devastating consequences of this disease.
Rehydration of the Cholera Patient
Note: Antibiotics will only shorten the duration of the fluid l0ss by killing the vibrios. Rehydration of the patient is the crucial lifesaving therapy. This is accomplished through the use of Oral Rehydration Salts (ORS) or I.V. therapy.
Oral Rehydration---Preferred
For Oral Rehydration: Oral Rehydration Salts (ORS)
ORS: (NaCl--3.5 g) + (KCl--1.5 g) + ( NaHCO3--2.5 g or trisodium citrate, 2.9 g) + (glucose-- 20.0 g.) This mixture is dissolved in 1 L (Quart) of water and taken orally in increments. Flavoring may be added.
Alternative:
One half (1/2) teaspoon of salt plus Eight (8) teaspoons of sugar dissolved in 1 L (quart) of water.
Note: Most patients absorb enough ORS solution to achieve rehydration even when they are vomiting. Vomiting usually subsides within 2-3 hours, as rehydration is achieved.
Note: A nasogastric tube can be used for ORS solution if the patient has signs of dehydration but cannot drink.
Note: Regular urinary output (every 3-4 hours) is a good sign that enough fluid is being absorbed.
Intravenous Rehydration
Warning! IV rehydration is invasive and should be performed by qualified responders!
FOR SEVERE DEHYDRATION: IV Therapy (Ringers Lactate)
Calculate for amount of IV: 100ml/kg (100ml (cc) of IV fluid per kilogram of body weight.
Weight: 1 kg = 2.2 pounds
Example: 60 pounds = 27 kg; 200 pounds = 90 kilograms
Amount: A severely dehydrated 90kg man would require: 90 X 100ml = 9000ml of IV fluid.
Rate: Ringer's Lactate--1 to 2ml/kg/min. until BP is normal and pulse is strong. Then calculate the remainder of IV fluid to infuse over a 3 to 5 hour period.
Note: Start IV fluid immediately to replace fluid deficit. Use Ringer's Lactate solution or, if not available, Normal Saline may be substituted.
Note: If the patient will tolerate, ORS solution can be administered concurrently (p.o.) even if the patient has an IV.
Notes on Rehydration:
Most patients absorb enough ORS solution to achieve rehydration even when they are vomiting. Vomiting usually subsides within 2-3 hours, as rehydration is achieved.
A nasogastric tube can be used for ORS solution if the patient has signs of dehydration but cannot drink.
Regular urinary output (every 3-4 hours) is a good sign that enough fluid is being absorbed.
CHILD: Treatment of Cholera with Antibiotics
Antibiotic Dosage
Doxycycline 6 mg / kg One time dose
or
2 mg /kg Every 12 hours (bid)
Take for 3 days (72 hours)
Tetracycline
Oxytet 12.5 mg/kg Every 6 hours (q6h)
Take for 3 days (72 hours)
Erythromycin 10 mg / kg Every 6 hours (q6h)
Take for 3 days (72 hours)
TMP/SMX TMP 5 mg /kg + SMX 25 mg / kg
Every 12 hours (bid)
Take for 3 days (72 hours)
Furazolidone 1.25 mg/kg Every 6 hours (q6h)
Take for 3 days (72 hours)
or
7 mg / kg One time dose
ADULT: Treatment of Cholera with Antibiotics
Antibiotic Dosage
Doxycycline 300 mg One time dose
or
100 mg twice a day (bid)
Take for 3 days (72 hours)
Tetracycline
Oxytet 500 mg Every 6 hours (q6h)
Take for 3 days (72 hours)
Ciprofloxacin 500 mg Every 12 hours (bid)
Take for 3 days (72 hours)
Erythromycin 500 mg Every 6 hours (q6h)
Take for 3 days (72 hours)
TMP/SMX TMP 160 mg + SMX 800 mg
Every 12 hours (bid)
Take for 3 days (72 hours)
Furazolidone 100mg Every 6 hours (q6h)
Take for 3 days (72 hours)
(Asiatic cholera or epidemic cholera)
Description: Vibrio Cholerae is a short, curved, motile, gram-negative, rod. It does not produce spores. Cholera is spread through unsanitary conditions--principally by the fecal/oral route i.e. feces contaminated food and water. All populations are susceptible, however, children are extremely vulnerable. Cholera is an Infection/infestation of the small intestine by the vibiros and the symptoms are the result of a toxin produced by the Cholera Vibrios. Cholera runs its course in 2 to 7 days.
Prophylaxis would be successful
Signs and Symptoms: Incubation is 6-72 hours. Signs and symptoms range from asymptomatic to severe with sudden onset. Symptoms can include, vomiting, headache, intestinal cramping with little or no fever. Early symptoms are swiftly followed by profuse watery diarrhea with 'rice water' appearance. Fluid losses can exceed 1 to 3 gallons (5 to 10 liters) per day. Without treatment, the patient may progress from severe dehydration to hypovolemia, acidosis, shock and death. Because of the overwhelming nature of the rapid fluid loss, death can occur within hours after onset. With intervention, mortality should not exceed 1%. Without intervention, mortality can be as high as 30% to 60%.
Clinical Diagnosis: If the patient has profuse 'rice water' diarrhea and dehydration then a diagnosis of Cholera may be confirmed by darkfield examination and by direct microscopic visual of darting vibrios.
Note: Nonpathogenic vibrios are widely distributed in estuaries and seafood. Therefore, isolation of vibrios from a patient with a mild diarrheal disease does not necessarily indicate Vibrio Cholerae!
War Engine: This agent has been investigated in the past as a biological weapon. Cholera does not easily spread from human to human, however, if used as a biological War Engine, major drinking water supplies would have to be heavily contaminated. Recent Cholera epidemics in South America, Africa and India have shown the devastating consequences of this disease.
Rehydration of the Cholera Patient
Note: Antibiotics will only shorten the duration of the fluid l0ss by killing the vibrios. Rehydration of the patient is the crucial lifesaving therapy. This is accomplished through the use of Oral Rehydration Salts (ORS) or I.V. therapy.
Oral Rehydration---Preferred
For Oral Rehydration: Oral Rehydration Salts (ORS)
ORS: (NaCl--3.5 g) + (KCl--1.5 g) + ( NaHCO3--2.5 g or trisodium citrate, 2.9 g) + (glucose-- 20.0 g.) This mixture is dissolved in 1 L (Quart) of water and taken orally in increments. Flavoring may be added.
Alternative:
One half (1/2) teaspoon of salt plus Eight (8) teaspoons of sugar dissolved in 1 L (quart) of water.
Note: Most patients absorb enough ORS solution to achieve rehydration even when they are vomiting. Vomiting usually subsides within 2-3 hours, as rehydration is achieved.
Note: A nasogastric tube can be used for ORS solution if the patient has signs of dehydration but cannot drink.
Note: Regular urinary output (every 3-4 hours) is a good sign that enough fluid is being absorbed.
Intravenous Rehydration
Warning! IV rehydration is invasive and should be performed by qualified responders!
FOR SEVERE DEHYDRATION: IV Therapy (Ringers Lactate)
Calculate for amount of IV: 100ml/kg (100ml (cc) of IV fluid per kilogram of body weight.
Weight: 1 kg = 2.2 pounds
Example: 60 pounds = 27 kg; 200 pounds = 90 kilograms
Amount: A severely dehydrated 90kg man would require: 90 X 100ml = 9000ml of IV fluid.
Rate: Ringer's Lactate--1 to 2ml/kg/min. until BP is normal and pulse is strong. Then calculate the remainder of IV fluid to infuse over a 3 to 5 hour period.
Note: Start IV fluid immediately to replace fluid deficit. Use Ringer's Lactate solution or, if not available, Normal Saline may be substituted.
Note: If the patient will tolerate, ORS solution can be administered concurrently (p.o.) even if the patient has an IV.
Notes on Rehydration:
Most patients absorb enough ORS solution to achieve rehydration even when they are vomiting. Vomiting usually subsides within 2-3 hours, as rehydration is achieved.
A nasogastric tube can be used for ORS solution if the patient has signs of dehydration but cannot drink.
Regular urinary output (every 3-4 hours) is a good sign that enough fluid is being absorbed.
CHILD: Treatment of Cholera with Antibiotics
Antibiotic Dosage
Doxycycline 6 mg / kg One time dose
or
2 mg /kg Every 12 hours (bid)
Take for 3 days (72 hours)
Tetracycline
Oxytet 12.5 mg/kg Every 6 hours (q6h)
Take for 3 days (72 hours)
Erythromycin 10 mg / kg Every 6 hours (q6h)
Take for 3 days (72 hours)
TMP/SMX TMP 5 mg /kg + SMX 25 mg / kg
Every 12 hours (bid)
Take for 3 days (72 hours)
Furazolidone 1.25 mg/kg Every 6 hours (q6h)
Take for 3 days (72 hours)
or
7 mg / kg One time dose
ADULT: Treatment of Cholera with Antibiotics
Antibiotic Dosage
Doxycycline 300 mg One time dose
or
100 mg twice a day (bid)
Take for 3 days (72 hours)
Tetracycline
Oxytet 500 mg Every 6 hours (q6h)
Take for 3 days (72 hours)
Ciprofloxacin 500 mg Every 12 hours (bid)
Take for 3 days (72 hours)
Erythromycin 500 mg Every 6 hours (q6h)
Take for 3 days (72 hours)
TMP/SMX TMP 160 mg + SMX 800 mg
Every 12 hours (bid)
Take for 3 days (72 hours)
Furazolidone 100mg Every 6 hours (q6h)
Take for 3 days (72 hours)