1. Vibrio Cholera Prof.Dr. Fhim Shaltout Professor of Meat Hygiene
Faculty of Veterinary Medicne
Benha University, Egypt.

2. Vibrio Cholera

4. Introduction
Cholera is an infection in the small intestine caused by the bacterium Vibrio cholerae. The main symptoms are profuse, watery diarrhea and vomiting. Transmission occurs primarily by drinking water or eating food that has been contaminated by the feces of an infected person, including one with no apparent symptoms.

5. Vibrio cholerae.
The Bacteria that causes Cholera

6. Identification Gram-negative rods. Curves or Comma shaped.
Non-spore forming
Highly motile-single polar flagella
Associated with salt water
Oxidase positive
Tolerate alkaline conditions to pH9.0
Readily cultivated, Simple nutritional requirements.
Facultative anaerobe

7. The disease Acute infectious disease is often fatal
characterized by severe vomiting, diarrhoea, and collapse

8. Cholerae Afflicted Areas 2000

9. Causes and Transmission
Caused By: Vibrio cholerae
Indirect transmission
Vehicle borne
Reaches water through:
Vomiting
Diarrhoea
Carriers active or passive
Produces toxins in small intestines that cause severe diarrhoea and dehydration

10. Infection Through: Contaminated water Contaminated food
Eating with unwashed hands
Also house flies and other insects

11. Conditions that lead to infection

12. Symptoms
The primary symptoms of cholera are profuse, painless diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, one to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have a fishy odor.
An untreated person with cholera may produce 10 to 20 liters (3 to 5 US gal) of diarrhea a day with fatal results. For every symptomatic person, 3 to 100 people get the infection but remain asymptomatic.
Cholera has been nicknamed the "blue death" due to a patient's skin turning a bluish-gray hue from extreme loss of fluids.

13. Typical Rice Water Diarrhea

14. Symptoms
If the severe diarrhea is not treated with intravenous rehydration, it can result in life-threatening dehydration and electrolyte imbalances. The typical symptoms of dehydration include low blood pressure, poor skin turgor (wrinkled hands), sunken eyes, and a rapid pulse.
A person with severe dehydration due to cholera - note the sunken eyes and decreased skin turgor which produces wrinkled hands

15. Life Cycle Host drinks water Bacteria moves through the stomach
Reach the intestine & produce flagella
Propel through mucus of the sm. intestine
Produce toxin causing diarrhea
Feces carry new bacteria into drinking water

16. Life Cycle

17. Stages of Cholera Start to recover Mild to severe diarrhoea
Vomiting
Muscle cramps
Sudden onset and watery, painless diarrhea
Stool has a characteristic “rice water” appearance (gray, slightly cloudy with bits of mucus, and a slightly sweaty odor)
Start to recover
Mild to severe diarrhoea
Shock and dehydration
Loss of important minerals and electrolytes
Intense thirst
Reduced urination
Muscle cramps/weakness
Stage 2
Dehydration, Thirst and Shock
Cold Skin, sunken Eyes, weak pulse and feint high-pitched voice
Reduced urine
Muscle cramps and Muscle weakness

18. Treatment Oral Rehydration Therapy (ORT)
Solution of salts and sugars, taken by the mouth
Also homemade solutions (water, sugar, table salt, baking soda, and fruit)
Sometimes intravenous

19. Anti biotics Tetracycline Shortens the course of the disease
Weaken the symptoms.

20. Bacteriological Diagnosis
Specimens: stool, vomitus.
Stained smear
Culture: alkaline peptone water of agar plate, and TCBS agar plate.
Quick immunological methods: immunofluorescent “ball” test; PCR.

21. Prevention/Risk Behavior
Squatter camps
Bad hygiene
Unsafe preparation of food
Drinking contaminated water
To bathe / swim in contaminated water

22. Prevention Immunization Boiling water, covering food Education
Personal and domestic hygiene
Prevention of contamination of water supplies
Improvement of sewage systems
Access to health care

23. Food safty
For shellfish in the shell, either a) boil until the shells open and continue boiling for 5 more minutes, or b) steam until the shells open and then continue cooking for 9 more minutes.
Do not eat those shellfish that do not open during cooking. Boil shucked oysters at least 3 minutes, or fry them in oil for at least 10 minutes at 375°F (190°C), while keeping the pieces well separated.

24. Cholera
Although cholera may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. In developed countries, due to nearly universal advanced water treatment and sanitation practices, cholera is no longer a major health threat.

25. The End