A case of vibrio cholera

Hanifa1, Christina Rajathi2, Subadhra Devi3, Maha Lakshmi3

1Isolation ICU Staff Nurse, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

2Nursing Incharge, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

3Nurse Educator Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

4Nursing Superintendent, Kauvery Hospital, Cantonment, Trichy, Tamil Nadu

Abstract

Vibrio cholera is the causative agent of cholera, a highly contagious diarrheal disease affecting millions worldwide each year. Cholera is a major health problem, primarily in countries with poor sanitary conditions and regions affected by natural disasters where access to safe drinking water is limited. We aim to summarize the current understanding of the evolution of virulence and pathogenesis of Vibrio Cholerae as well as provide an overview of the immune response against this pathogen. We highlight that Vibrio Cholerae has a remarkable ability to adapt to evolution which is a global concern because it increases the risk of cholera outbreaks and spread of the disease to new regions, making its control even more challenging. Furthermore, Vibrio. Cholerae is a major public health concern due to its potential to cause pandemics. Since 1817, there have been seven cholera pandemics, with the seventh beginning in 1961and continuing until today. In 2015 the estimated annual incident of cholera was 1.3-4 million cases, resulting in 21000-143000 deaths. cholera is preventable and treatable disease and several strategies can be used to control it in 2017 the global task force for cholera control proposed an ambitious plan to endemic cholera in 20 countries and reduced cholera deaths by 90% by 2030 the plan called “ENDING CHOLERA: A global roadmap to 2030,” focuses on strengthening public health systems, improving drinking water, sanitation, and hand hygiene conditions, making oral rehydration treatments more accessible and increasing vaccination coverage.

Background

Cholera is an acute diarrheal illness caused by the bacteria vibrio cholera. It spreads through contaminated water or food and can cause severe dehydration and even death if untreated.

Causative organism vibrio cholera bacteria gram negative comma shaped has a flagellum for movement toxin – producing cholera toxin (CT) is the main cause of water diarrhea. mode of transmission fecal oral route contaminated water or food poor sanitation areas, overcrowded camps or after natural disasters. Incubation period usually 2 hr to 5 days’ signs and symptoms profuse watery diarrhea (described as rice water stool) vomiting rapid dehydration sunken eyes dry mouth low blood pressure muscle cramps shock (if not treated). Diagnosis stool sample culture (detects vibrio cholera ) rapid diagnostic tests clinical symptoms and outbreak history .Treatment rehydration therapy ORS ( oral rehydration therapy) , IV fluids for severe cases (ringer lactate), antibiotics doxycycline (adults), azithromycin (children/ pregnant women ), zinc supplements( especially in children) Prevention safe drinking water, proper sanitation, hand washing, boil or treat water, cholera vaccines (dukoral shanchol) ,Nursing diagnosis fluid volume deficit related to excessive fluid loss from diarrhea and vomiting . Goal: maintain hydration, prevent complications like shock, educate on hygiene and safe practices, monitor vital signs and hydration status, administer ORS /IVF as prescribed record input and output, educate patient/ family on hand hygiene and water safety ensure environmental cleanliness.

Case Presentation

A 67- years- old male with no reported co-morbidities presented to the emergency room complaining of watery loose stools – multiple episodes more than 10-15 episodes. Followed by generalized weakness and fatigue, hypo gastric pain with abdomen distension, absent urine output for the past 24 hours. On presentation the patient exhibited tachycardia, severe hypovolemia and hypotension. Initially blood investigation and culture were taken and started with IV fluids for rehydration and broad-spectrum antibiotics and other supportive medicine and then the patient transferred to the critical care unit for further management.

Complication

  • Severe hypovolemia and ischemia
  • Disseminated vascular coagulation
  • Acute pancreatitis
  • Use of anti-coagulopathy or coagulopathy

Social History: No h/o of smoking alcohol or drug addiction.

Allergies: No history for drug food environmental allergies

Past Medical History: Nil

Travel History: He did not travel from his hometown to any other district or state or country

Physical Examination

Vitals signs temp-96’F, BP 100/60mmhg HR;130/min, SPO2;97% in room air, RR-20/min pain score 7/10,

GCS; 15/15

Circulation: all peripheral pulse + capillary refill was more than 3 seconds

Investigations

Patient had abdomen pain CT abdomen (17-05.2025) taken that shows bilateral contracted kidneys, dilated fluid filled small and large bowel loops with right inguinal hernia no obvious evidence of obstruction at present, prostatomegaly.

Culture aerobic stool (18.05.2025); vibrio cholera (probable)

Patient had abdomen distension and had pain (6/10), and did not pass stool for 2 days in view of that CT abdomen and pelvis done on (24.05.2025) it showed large hematoma in the paraaortic region adjacent to head of pancreas with surrounding inflammatory change

Advice CT Angio to R/O pseudo aneurysm / direct extravasations of contrast bilateral medial renal disease

Moderate ascites, right inguinal hernia, mild prostomegaly, bilateral pleural effusion with collapse of bilateral lower lobes, and no evidence of pneumoperitoneum / bowel obstruction.

Multislice CECT – Abdomen and Pelvis CECT (24.05.2025)

Large hematoma in the Para aortic region adjacent to the head of pancreas causing compression and displacement of the adjacent GDA and its branches. No obvious evidence of direct extravasation of contrast /pseudoaneurysm. Bilateral renal simple cysts, moderate ascites with diffuse abdominal wall edema, right inguinal hernia with mild prostomegaly. Bilateral pleural effusion with collapse of bilateral lower lobes.

DOPPLER: Acute deep vein thrombosis extending from left brachial vein to innominate vein and IJV

Blood culture aerobic and anaerobic: Sterile (22.05.2025)

Investigation

Potassium3.09 mmol/L
Magnesium1.20 mg/dL
Bicarbonate24
Sodium130 mmol/L
Chloride97 mmol/L
Hemoglobin9.0 g/dl
Packed Cell Volume (PCV)29.9 %
Platelet Count627000 cells/µl
Urea Serum10 mg/dL
Creatinine0.50 mg/dL
Hemoglobin7.8 g/dl
Absolute Eosinophil Count (AEC)140 cells/µl
Total RBC Count3.58 10^9/cmm
Lymphocyte14.2 %
Monocyte12.9 %
Basophil0.7 %
Absolute Monocyte Count (AMC)950 cells/µl
Total WBC Count7380 Cells/Cumm
Aspartate Aminotransferase (AST/SGOT)251.4 U/L
Direct Bilirubin0.38 mg/dL
Alanine Aminotransferase (ALT/SGPT)174.0 U/L
Indirect Bilirubin0.55 mg/dL
Absolute Neutrophil Count (ANC)11680 cells/µl
Test (PT)17.5 Seconds
INR1.55 .
Control (PT)11.4 Seconds
Troponin I (Quantitative)0.12 ng/mL
Total Bilirubin0.77 mg/dL
AnGap17 mEq/L
Procalcitonin1.73
CA++(7.4)1.19 mmol/L
02Sat96.9 %
Phosphorous10.4 mg/dL
CA++(7.4)1.11 mmol/L
CA 19-9108.83 U/mL

The patient was treated with IV fluids and Electrolytes were corrected and there was HB drop 4 PRBC transfused and endoscopy done for HB drop nil GI bleed, patient required BIPAP post endoscopy and weaned and he was on O2mask with 4-6 lit O2, IV antibiotics and antifungal and analgesics, proton pump inhibitors stabilized patient. There was improvement and shifted to ward.

Management

Non Pharmacological

  • Nebulization
  • Chest physiotherapy
  • Incentive spirometry
  • Ambulation

Skilled Nursing Interventions

1) Fluid and electrolyte replacement

  • Initiate iv fluid therapy immediately (ringers lactate) in moderate to serve dehydration
  • Monitor input output hourly
  • Administer ORS if patient is able to drink
  • Monitor for signs of hypovolemia hypokalemia and metabolic acidosis

2) Monitor vital signs and dehydration status

  • Check vital signs every 15-30 min during acute phase
  • Assess for sunken eyes dry mucous membranes poor skin turgor decreased urine output.

3) Administer antibiotics as prescribed

  • Administer tetracycline, doxycycline or azithromycin as ordered.
  • Watch for adverse effects and response

4) Infection control and isolation

  • Use PPE and follow enteric precautions
  • Isolate patient if needed to prevent spread
  • Proper disposal of faces hand hygiene and disinfection of contaminated items

5) Nutritional support

  • Encourage light easily digestible foods once vomiting stops
  • Maintain nutritional intake to support immune function and recovery.
  • Educate on zinc supplementation in children

6) Health education

  • Teach about safe water consumption, hand hygiene, food sanitation
  • Educate family on signs of dehydration and when to seek help
  • Emphasize the importance of a complete antibiotic course and ORS use.

Conclusion

Vibrio cholerae infection remains a significant public health concern, especially in areas with poor sanitation and limited access to clean water. This case study highlights the importance of early diagnosis, prompt rehydration therapy, and appropriate antibiotic use in managing cholera effectively. Nursing care plays a vital role in monitoring fluid balance, educating patients and families on hygiene practices, and preventing further transmission. Strengthening public health infrastructure, promoting oral rehydration therapy, and ensuring community awareness are key strategies to reduce cholera-related morbidity and mortality. Continued vigilance and health education are essential in controlling outbreaks and improving patient outcomes.

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