What Is Cholera?
Cholera is an acute bacterial infection that spreads by drinking contaminated water. It causes watery and loose stools, severe loss of body electrolytes, and dehydration, which can be fatal. If left untreated, it rapidly progresses to dehydration and death within hours, commonly in infants and children. People who survive this infection have long-term immunity against this bacteria.
What Causes Cholera?
Vibrio cholerae bacteria is the microorganism causing cholera which was identified by the German bacteriologist Robert Koch in 1883. These bacteria live in damp and moist clothes and soil and are present in the stools of infected people. Diarrhea is triggered by the poison produced by toxic strains of cholera. This toxin interferes with the exchange of sodium and chloride in the intestinal walls, which makes the body release excess amounts of water. This leads to watery stools, fluid, and mineral loss. People get infected by drinking contaminated water and eating raw shellfish and uncooked fruits and vegetables. This results in the spread of cholera.
The Life Cycle of Cholera Bacteria:
This bacterium has two distinct life cycles:
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Life cycle in the environment: Cholera bacteria are found naturally in coastal waters. In the water, they attach to microscopic crustaceans and travel with them.
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Life cycle in people: On ingesting contaminated water, not all humans show signs of infection, but they shed the bacteria in their stools. These feces can contaminate food and water supplies, which is how cholera spreads.
How Is Cholera Spread or Transmitted?
Cholera bacteria are transmitted through fecal matter, primarily entering water bodies, and contaminating food or water from infected individuals. This transmission is more prevalent in underdeveloped regions with insufficient water infrastructure and sanitation systems. Cholera is not typically transmitted directly from person to person.
Cholera outbreaks often arise in conditions of war, poverty, or natural disasters, forcing people into crowded and unsanitary living conditions. Administering oral rehydration salts is a straightforward method to prevent dehydration and reduce mortality in cholera patients.
What Are the Symptoms of Cholera?
Mild cholera cases often present with no noticeable symptoms, making individuals unaware of the bacterial infection. Despite the absence of symptoms, these individuals remain contagious, posing a risk of contaminating water for up to two weeks. While most cholera cases result in mild symptoms, only 1 in 10 adults progress to severe symptoms.
Adult Symptoms:
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Diarrhea: Sudden onset of loose and frequent stools called rice water stools, leading to significant fluid loss. Stools exhibit a distinctive rice-water appearance, appearing pale and milky.
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Nausea and Vomiting: Nausea is the uneasy sensation of wanting to vomit, and vomiting results in the forceful removal of stomach content through the mouth, causing loss of fluid.
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Dehydration: Rapid onset within hours of diarrhea and vomiting. Severe dehydration, defined as a loss of 10 percent or more of total body weight, manifests with signs such as irritability, fatigue, sunken eyes, severe thirst, dry mouth, dry skin, absence of urine output, and hypotension.
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Electrolyte Imbalance: Loss of minerals due to dehydration can result in:
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Muscle Cramps: Caused by the depletion of salts (sodium, chloride, and potassium).
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Shock: Hypotension resulting from a reduction in blood volume, leading to decreased oxygen circulation. Untreated shock can be fatal.
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Child Symptoms:
Children exhibit symptoms similar to adults, but their vulnerability to dehydration is higher, and progression to hypovolemic shock occurs more rapidly than in adults. Signs of shock in children include seizures, altered consciousness, and coma. It is crucial to note and promptly address these symptoms in children for effective management and prevention of complications.
How Is Cholera Diagnosed?
Cholera is usually diagnosed based on the signs and symptoms in endemic areas. To confirm the diagnosis, cholera bacteria are identified in the stool sample. For quick diagnosis, a rapid cholera dipstick test is available.
How Is Cholera Treated?
The goal of the treatment is the adequate replacement of fluids and salts lost during diarrhea.
Oral Rehydration Solution (ORS):
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A simple and globally recognized solution composed of sugar and salts mixed with water.
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Administered in large amounts to replenish lost fluids and electrolytes.
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Widely used worldwide to manage and alleviate the symptoms of diarrhea.
Intravenous Fluids:
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Necessary in severe cases of cholera where dehydration is profound.
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Administered directly into the bloodstream to rapidly restore fluid balance.
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Helps in preventing complications associated with severe cholera.
Antibiotics:
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While not the primary focus, antibiotics play a role in cholera treatment.
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Reduce the length and severity of the illness.
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Rehydration remains paramount, with antibiotics serving as a supplementary measure.
Zinc Supplements:
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Aid in fluid retention and help prevent dehydration and related complications.
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A supportive measure to enhance the overall effectiveness of treatment.
What Are the Complications of Cholera?
The infection can become fatal if not properly treated within hours. The other less severe complications of cholera include:
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Hypoglycemia (low blood sugar) - The blood sugar levels fall dangerously, which can result in seizures, loss of consciousness, and death in children.
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Hypokalemia (low potassium levels) - As large amounts of minerals, such as potassium, are lost in stools, it results in hypokalemia. This can also cause fatal complications as it interferes with heart and nerve functioning.
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Kidney failure - In shock, the kidneys are unable to filter out waste, which results in the buildup of excess fluids, electrolytes, and wastes in the body. This can also be fatal.
How to Prevent Cholera?
The Following preventive measures can prevent cholera.
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Hand Hygiene: Regularly and thoroughly wash the hands with soap and water, especially before cooking, handling food, and after using the toilet.
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Safe Food Choices: Properly wash the fruits and vegetables before consuming.
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Dairy Awareness: Take ice creams and certain dairy foods with caution, as they are often prone to contamination.
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Water Consumption: Consume only bottled water or water that has been boiled or disinfected to mitigate waterborne risks.
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Food Preparation: Cook food thoroughly, avoiding eating raw and improperly cooked food to ensure it is safe for consumption.
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Street Food Caution: Minimize risks by refraining from consuming foods from street vendors, particularly in high-risk areas.
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Vaccination: The cholera vaccine, known as Vaxchora, is given in liquid form, usually taken by mouth approximately 10 days before visiting areas where there is a risk of cholera. This vaccine works by creating immunity to the bacteria that cause cholera, lowering the likelihood of infection and lessening the severity of symptoms.
Conclusion
Cholera occurs due to improper sanitation and lack of hygiene. Proper sanitation facilities and ensuring the water bodies are not contaminated with human waste are important. Adopting community-level awareness programs on hygiene and sanitation can help people aware of the spread of cholera and its health implications. Measures should be taken even from home, adopting proper hand washing, ensuring uncontaminated and safe drinking water, and proper sanitation facilities. Always rush to the nearest nursing home and take proper management of symptoms, if you suspect cholera.
