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group_4_presentation_2_-_cholera [2020/02/28 21:36] baign |
group_4_presentation_2_-_cholera [2020/02/29 17:12] (current) hunteh2 |
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| ====== Cholera Discovery by John Snow ====== | ====== Cholera Discovery by John Snow ====== | ||
| - | <box 20% round left| >{{ :john_snow.jpg?200|}}</box|Figure 2: The OG Snow.> | + | <box 20% round left| >{{ :john_snow.jpg?200|}}</box|Figure 2: Image depicting John Snow, who discovered the transmission pathway of cholera.> |
| <box 20% round right| >{{ :john_snow_map.jpg?200|}}</box|Figure 3: Dot Map: Representing the number of cholera cases found.> | <box 20% round right| >{{ :john_snow_map.jpg?200|}}</box|Figure 3: Dot Map: Representing the number of cholera cases found.> | ||
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| ====== Signs & Symptoms ====== | ====== Signs & Symptoms ====== | ||
| - | <box 20% round left| >{{ :cholera_symptoms.jpg?200|}}</box|Figure 4: Symptoms.> | + | <box 20% round left| >{{ :cholera_symptoms.jpg?200|}}</box|Figure 4: Image depicting the common signs and symptoms of cholera.> |
| It can take between 12 hours to 5 days for a person to show symptoms after ingesting contaminated food or water, and __can kill within hours__ if left untreated (WHO, 2019). The main sign and symptom of cholera disease is watery diarrhea that generally contains flecks of pale and white material that are mucus and a number of gastrointestinal lining epithelial cells (Davis, 2018). These whitish substances are approximately the size of a piece of rice. Therefore, cholera related diarrhea is also known as rice-water stool. Many bacterial infections can lead to diarrhea. However, the volume of diarrhea caused by cholera disease is normally in vast amounts. For instance, a 154-pound adult suffering from cholera can discharge about 250 cc per kilogram or about 10 to 18 litres of diarrheal fluid over 24 hours (Davis, 2018). The amount of fluid discharging during diarrhea highly depends on the severity of the disease as such individuals with severe disease may excrete high levels of diarrheal fluid (Harris, 2012). Additionally, patients may also develop one or more of the common symptoms simultaneously. These symptoms include watery diarrhea, rice-water stools, fishy smell to stools, vomiting, and thirst due to dehydration (Harris, 2012). Most of the specified symptoms result from extreme dehydration and loss of body water. Individuals who suffer from more severe cases of the disease may also experience additional symptoms such as abdominal and rectal pain, fever, weight loss, little or no urine output, rapid heart rate, low blood pressure, loss of skin elasticity, muscle cramps, dry mucus membrane, restless and irritability appearing more in children, and severe vomiting, and shock (Davis, 2018). | It can take between 12 hours to 5 days for a person to show symptoms after ingesting contaminated food or water, and __can kill within hours__ if left untreated (WHO, 2019). The main sign and symptom of cholera disease is watery diarrhea that generally contains flecks of pale and white material that are mucus and a number of gastrointestinal lining epithelial cells (Davis, 2018). These whitish substances are approximately the size of a piece of rice. Therefore, cholera related diarrhea is also known as rice-water stool. Many bacterial infections can lead to diarrhea. However, the volume of diarrhea caused by cholera disease is normally in vast amounts. For instance, a 154-pound adult suffering from cholera can discharge about 250 cc per kilogram or about 10 to 18 litres of diarrheal fluid over 24 hours (Davis, 2018). The amount of fluid discharging during diarrhea highly depends on the severity of the disease as such individuals with severe disease may excrete high levels of diarrheal fluid (Harris, 2012). Additionally, patients may also develop one or more of the common symptoms simultaneously. These symptoms include watery diarrhea, rice-water stools, fishy smell to stools, vomiting, and thirst due to dehydration (Harris, 2012). Most of the specified symptoms result from extreme dehydration and loss of body water. Individuals who suffer from more severe cases of the disease may also experience additional symptoms such as abdominal and rectal pain, fever, weight loss, little or no urine output, rapid heart rate, low blood pressure, loss of skin elasticity, muscle cramps, dry mucus membrane, restless and irritability appearing more in children, and severe vomiting, and shock (Davis, 2018). | ||
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| ====== Cause ====== | ====== Cause ====== | ||
| - | <box 20% round right| >{{ :cholera_cause.png?200|}}</box|Figure 5: Cause.> | + | <box 20% round right| >{{ :cholera_cause.png?200|}}</box|Figure 5: Image depicting the cause of cholera and risk factors associated with the disease> |
| Cholera is caused by a bacterium known as //Vibrio cholerae//. There are different serogroups of //Vibrio cholerae//, but only two strains cause outbreaks - O1 and O139 (WHO, 2019). The deadly disease cholera is spread by drinking water or eating food contaminated with the //Vibrio cholerae// bacterium (CDC, 2018). The bacterium thrives in an environment of brackish water, i.e. water that is warm and salty. //Vibrio cholerae// produces a toxin in the small intestine, causing the deadly effects of cholera. | Cholera is caused by a bacterium known as //Vibrio cholerae//. There are different serogroups of //Vibrio cholerae//, but only two strains cause outbreaks - O1 and O139 (WHO, 2019). The deadly disease cholera is spread by drinking water or eating food contaminated with the //Vibrio cholerae// bacterium (CDC, 2018). The bacterium thrives in an environment of brackish water, i.e. water that is warm and salty. //Vibrio cholerae// produces a toxin in the small intestine, causing the deadly effects of cholera. | ||
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| ====== Mechanism ====== | ====== Mechanism ====== | ||
| - | <box 20% round left| >{{ :holy.jpg?200|}}</box|Figure 6: Image depicting //Vibrio cholerae// penetrating the mucus layer and colonizing on the intestinal mucosa.> | + | <box 20% round left| >{{ :holy.jpg?200|}}</box|Figure 6: Image depicting Vibrio cholerae penetrating the mucus layer and colonizing on the intestinal mucosa.> |
| <box 25% round right| >{{ :ahoy.png?250|}}</box|Figure 7: Image depicting cholera toxin entering the intestinal mucosa and setting off a chain of reactions that will eventually cause the symptoms of cholera.> | <box 25% round right| >{{ :ahoy.png?250|}}</box|Figure 7: Image depicting cholera toxin entering the intestinal mucosa and setting off a chain of reactions that will eventually cause the symptoms of cholera.> | ||
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| ====== Diagnosis ====== | ====== Diagnosis ====== | ||
| - | Cholera can be diagnosed through the findings of //Vibrio cholerae// serogroup O1 or O139 in stool samplings. Cary Blair media is ideal for the transport whereas the selective thiosulfate- citrate-bile salts agar (TCBS) is useful in the separation and recognition. In terms of epidemic settings commercially available rapid test kits are useful. In many countries where cholera is not uncommon, access to diagnostic laboratory testing is difficult. The Crystal VC dipstick rapid test allows for early warning to officials about an outbreak of cholera, although the sensitivity and specificity are not ideal. | + | Cholera can be diagnosed through the findings of //Vibrio cholerae// serogroup O1 or O139 in stool samplings. Cary Blair media is ideal for the transport whereas the selective thiosulfate- citrate-bile salts agar (TCBS) is useful in the separation and recognition. In terms of epidemic settings commercially available rapid test kits are useful. In many countries where cholera is not uncommon, access to diagnostic laboratory testing is difficult. The Crystal VC dipstick rapid test allows for early warning to officials about an outbreak of cholera, although the sensitivity and specificity are not ideal (CDC, 2018). |
| - | In countries that are not common to Cholera cases, WHO recommends using the following definition. In areas where cholera has not been declared, patients who are 2 years of age or older with acute watery diarrhea and severe dehydration. In areas where there is a declared outbreak, any person presenting with or dying from acute watery diarrhea. The use of crystal VC dipstick rapid tests can provide early warning of an outbreak to areas with limited or no lab testing. The sensitivity is not optimal therefore it is said to be confirmed using the traditional culture-based methods suitable for //Vibrio cholerae//. | + | In countries that are not common to Cholera cases, WHO recommends using the following definition. In areas where cholera has not been declared, patients who are 2 years of age or older with acute watery diarrhea and severe dehydration. In areas where there is a declared outbreak, any person presenting with or dying from acute watery diarrhea. The use of crystal VC dipstick rapid tests can provide early warning of an outbreak to areas with limited or no lab testing. The sensitivity is not optimal therefore it is said to be confirmed using the traditional culture-based methods suitable for //Vibrio cholerae// (CDC, 2018). |
| ====== Treatment ====== | ====== Treatment ====== | ||
| - | Those infected with cholera have mild diarrhea or little to no symptoms, the about 5-10% which are infected with //Vibrio cholerea// O1 may require treatment at a healthcare facility. This includes rehydration therapy which includes oral rehydration salts and intravenous fluids and electrolytes. In doing so, the fatalities reduce to well under 1% to all patients. Those with acute malnutrition also receive a low-osmolarity ORS solution to help regain the lost sodium which is not available in the generic rehydration therapy ( ReSoMal). ReSoMal does not contain the sufficient sodium content needed to replace the amount lost from cholera. | + | Those infected with cholera have mild diarrhea or little to no symptoms, the about 5-10% which are infected with //Vibrio cholerea// O1 may require treatment at a healthcare facility. This includes rehydration therapy which includes oral rehydration salts and intravenous fluids and electrolytes. In doing so, the fatalities reduce to well under 1% to all patients. Those with acute malnutrition also receive a low-osmolarity ORS solution to help regain the lost sodium which is not available in the generic rehydration therapy (ReSoMal). ReSoMal does not contain the sufficient sodium content needed to replace the amount lost from cholera. |
| Another viable option is the use of antibiotic treatment which is generally the use of antibiotics for children. Although hydration is the mainstay of cholera treatment, it can be used with the conjunction of antibiotics to those who are severely ill. It is particularly recommended for patients who are severely /moderately dehydrated and pass a large volume of stool. Generally, Doxycycline is the first line of treatment for adults while azithromycin is for children and pregnant women. Antibiotic use allows for reduces resource requirements, by decreasing the duration of diarrhea and stool volume it allows for rapid recovery and shorter inpatient stays which allow for optimal allocation of resources in an outbreak setting. There is so far insufficient data on examining the effect of antibiotics on the secondary transmission of cholera (CDC, 2018). | Another viable option is the use of antibiotic treatment which is generally the use of antibiotics for children. Although hydration is the mainstay of cholera treatment, it can be used with the conjunction of antibiotics to those who are severely ill. It is particularly recommended for patients who are severely /moderately dehydrated and pass a large volume of stool. Generally, Doxycycline is the first line of treatment for adults while azithromycin is for children and pregnant women. Antibiotic use allows for reduces resource requirements, by decreasing the duration of diarrhea and stool volume it allows for rapid recovery and shorter inpatient stays which allow for optimal allocation of resources in an outbreak setting. There is so far insufficient data on examining the effect of antibiotics on the secondary transmission of cholera (CDC, 2018). | ||
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| ====== Cholera Epidemiology and Disease Burden ====== | ====== Cholera Epidemiology and Disease Burden ====== | ||
| - | <box 35% round left| >{{ :cholera_cases.jpg?400|}}</box|Figure 8: Cases worldwide.> | + | <box 35% round left| >{{ :cholera_cases.jpg?400|}}</box|Figure 8: Image depicting the number of cholera cases worldwide each year from 1990-2016.> |
| Investigators have estimated that there are approximately 1.3 to 4 million cases and 21000 to 143000 deaths due to cholera per year worldwide (WHO, 2019). According to WHO reports, the number of cholera cases have been rising over the last few years which is mainly due to overpopulation and scare access to sanitation facilities and usable clean water (WHO, 2019). Studies indicate that the universal burden of cholera is rising specifically in developing countries. Cholera can be either endemic or non-endemic (epidemic) (Mohammad Ali, 2012). A cholera-endemic area is a region where cholera cases were detected during the last three years with verification of domestic and local transmission while non-endemic regions are areas and countries where cholera does not occur on a regular basis. With regards to statistics, approximately 2.8 million and about 91000 people suffer and die from cholera disease, respectively in endemic countries every year. Additionally, another 87000 cases and 2500 deaths developed in non-endemic countries (Mohammad Ali, 2012). It is worth mentioning that, many cholera cases are missed to be reported worldwide mainly due to limitations in surveillance systems and fear of negative effects on both trade and tourism (Mohammad Ali, 2012). | Investigators have estimated that there are approximately 1.3 to 4 million cases and 21000 to 143000 deaths due to cholera per year worldwide (WHO, 2019). According to WHO reports, the number of cholera cases have been rising over the last few years which is mainly due to overpopulation and scare access to sanitation facilities and usable clean water (WHO, 2019). Studies indicate that the universal burden of cholera is rising specifically in developing countries. Cholera can be either endemic or non-endemic (epidemic) (Mohammad Ali, 2012). A cholera-endemic area is a region where cholera cases were detected during the last three years with verification of domestic and local transmission while non-endemic regions are areas and countries where cholera does not occur on a regular basis. With regards to statistics, approximately 2.8 million and about 91000 people suffer and die from cholera disease, respectively in endemic countries every year. Additionally, another 87000 cases and 2500 deaths developed in non-endemic countries (Mohammad Ali, 2012). It is worth mentioning that, many cholera cases are missed to be reported worldwide mainly due to limitations in surveillance systems and fear of negative effects on both trade and tourism (Mohammad Ali, 2012). | ||
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| ====== Current Cholera Epidemic: The Civil War in Yemen ====== | ====== Current Cholera Epidemic: The Civil War in Yemen ====== | ||
| - | <box 25% round left| >{{ :cholera_yemen.jpg?300|}}</box|Figure 9: Cases in Yemen.> | + | <box 25% round left| >{{ :cholera_yemen.jpg?300|}}</box|Figure 9: Image depicting the incidence of cholera in Yemen.> |
| - | <box 25% round right| >{{ :yemen_kid.jpg?300|}}</box|Figure 10: Mother and child in Yemen.> | + | <box 25% round right| >{{ :yemen_kid.jpg?300|}}</box|Figure 10: Image depicting a mother and her child in war-torn Yemen.> |
| The civil war in Yemen has resulted in the world’s worst humanitarian crisis, causing a shattered health system in Yemen. The bombings have led to chronic shortages of supplies and staff, forcing half of the medical facilities to close since the civil war escalated (Doctors Without Borders, 2018). A lack of access to healthcare facilities and professionals has increased the spread of preventable infectious diseases, like cholera. The Yemeni population has become more vulnerable to deadly diseases. The recent cholera outbreak in Yemen is the world’s worst cholera epidemic, with roughly 10,000 suspected cases per week (WHO, 2018). Children under the age of five represent 25% of the suspected cholera cases in Yemen since January 2019 (WHO, 2019). According to the United Nations, the number of Yemenis with a suspected case of cholera passed one million in 2017 (United Nations, 2017). Yemenis suffering from malnutrition also suffer from a weakened immune system. Treating every patient that is starving is nearly impossible with the lack of healthcare infrastructure, staff, and supplies, further allowing Yemen to reach the state of a country-wide famine. | The civil war in Yemen has resulted in the world’s worst humanitarian crisis, causing a shattered health system in Yemen. The bombings have led to chronic shortages of supplies and staff, forcing half of the medical facilities to close since the civil war escalated (Doctors Without Borders, 2018). A lack of access to healthcare facilities and professionals has increased the spread of preventable infectious diseases, like cholera. The Yemeni population has become more vulnerable to deadly diseases. The recent cholera outbreak in Yemen is the world’s worst cholera epidemic, with roughly 10,000 suspected cases per week (WHO, 2018). Children under the age of five represent 25% of the suspected cholera cases in Yemen since January 2019 (WHO, 2019). According to the United Nations, the number of Yemenis with a suspected case of cholera passed one million in 2017 (United Nations, 2017). Yemenis suffering from malnutrition also suffer from a weakened immune system. Treating every patient that is starving is nearly impossible with the lack of healthcare infrastructure, staff, and supplies, further allowing Yemen to reach the state of a country-wide famine. | ||
