cholera

What is Cholera and ICD 10 Codes for Cholera?

What is Cholera?

 The word cholera have been originated from a latin word choler which denotes bile. Cholera is an acute intestinal infectious disease caused by a gram -ve(negative) comma shaped bacterium, vibrio cholera which is a facultative anaerobe (survives either with or without oxygen)  with a flagellum at one end. Usually contaminated through food and water. In aerobic conditions, it synthesizes ATP as energy molecule by respiration. During anaerobic conditions, it undergoes fermentation. 

Cholera is acute infection of the bowel due to Vibrio cholera that presents with diarrhea, cramps and vomiting leads to dehydration. electrolyte imbalance and death.

ICD 10 CM Codes for Cholera:

Cholera due to vibrio cholerae 01 biovar cholerae(Classical cholera) – A00.0

cholera due to vibrio cholerae 01 biovar eltor     ( Cholera eltor)        – A00.1

Cholera, unspecified- A00.9

 

                                      

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Epidemiology:

     Cholera can be epidemic or endemic. It affects 1.3-4 million people all over the world.  Nearly 1,00,00 deaths occurs worldwide in 90s. Over the last century cholera deaths have been declined, due to improved sanitation.

Etiology/Risk factors:

  • Cholera is caused by a gram -ve curve shaped facultative anaerobe bacterium called vibrio cholerae.
  • Contaminated food and water.
  • Poor sanitary conditions.
  • Eating Raw or undercooked shell-fish.
  • Eating unwashed fruits,vegetables and seafood.
  • Hypochlorhydria, low levels of stomach acid is a risk factor of cholera.
  • Blood group – O people are at high risk of severe condition.

Pathophysiology:

    Vibrio cholera releases an enterotoxin, which attaches to the mucous membrane of the intestinal epithelial cells.
                         
                 Enterotoxin activates Adenylate cyclase in the epithelial cells
                                                                 ⇓
                  Specifically  binds to GTPase enzyme and Inhibits its activity
                                                                     
                 Inhibts the convertion (inactivation) of GTP to GDP                  
                                                                      
                  Activation of Adenylyl cyclase by active G-protein(GTP)
                                            ⇓
                  Production of large amounts of cyclic AMP 
                                            ⇓
                  Activation of protein kinase-A and cellular response
                                            ⇓
                   Opening of calcium channels in Intestinal membrane
                                             
                    Release of calcium ions into the Intestinal cells
                                            ⇓
                    Increased water loss from the intestinal cells causing Diarrhea
 

Signs and symptoms:

  • Watery stools, diarrhea
  • Dehydration
  • Low blood pressure
  • Thirst
  • Rapid heart rate
  • Weakness
  • Loss of skin elasticity
  • Shock
  • Vomiting
  • Decreased urinary output
  • Dry mucous membrane
  • Mild fever
  • Sunken eyes and cheeks
  • Stomach pain
  • Leg cramps
  • Rapid weight loss

                                         

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Diagnosis

  • Collection and Examining stools
  • Rapid Diagnostic  tests
  • Collection of vomitus
  • Dark field microscopy
  • Identification by Polymerase Chain Reaction  
  • Isolation by TCBS (Thiosulfate citrate- bile salts Agar) media
  • Cary blair transport medium

Treatment

  • Oral Rehydration Salts
  • Zinc capsules
  • Antibiotics
  • Doxycycline
  • Azithromycin

 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

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