Cholera is an infectious disease characterized by primary cholera symptoms like diarrhea and nausea. Read about Cholera treatment and prevention at Meri Sehat.

Cholera

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Syed Intisar Hussain

Overview

Cholera is caused by the bacterium V. cholera, and it is an infectious disease that causes severe watery diarrhea leading to severe dehydration. Cholera is fatal if left untreated. The main cause of cholera is food and water contaminated with bacteria.

Cholera was prevalent in the United States in the 1800s. However, the spread was eliminated when modern sanitization, sewerage systems, and water took over. Only 10% of cases of cholera are reported in the US every year, and about half of them are acquired by citizens during their travels<a href="#accordion">[1]</a>. While seafood contamination has rarely caused cholera in the US, outbreaks are still serious in other parts of the world (Asia, Africa, and the Middle East). For example, according to the World Health Organization, at least 1.3 to 4 million cases are reported every year.

The disease is common in places with areas of poor sanitation and crowding. The most common locations are Africa, South Asia, and Latin America. If you are planning to travel to one of these areas, follow the cholera travel advisory or facts to protect yourself and your family.

&nbsp;

Signs And Symptoms

People with cholera usually don&rsquo;t have any symptoms at all or they are of a mild to moderate nature. According to the CDC (Centers for Disease Control and Prevention), only 10% of people have severe symptoms of cholera<a href="#accordion">[2]</a>.

Most people are unaware of the presence of Vibrio cholerae, as they do not exhibit any symptoms. However, they are carriers and shed the cholera bacteria in their stool for fourteen days. Carriers and shedders can potentially infect others through contaminated sewage.&nbsp;

The symptoms of cholera in most people are mild to moderate diarrhea which is not easily distinguishable from regular diarrhea. However, other people develop more serious signs and symptoms of cholera, and they start a few days after the infection.

The following are the symptoms of cholera: 
&nbsp;

<ul>
	<li>Diarrhea:&nbsp;Diarrhea due to cholera has a sudden onset and can cause severe dehydration due to loss of fluids. You can lose as much as 1 liter of fluid per hour from your body. Furthermore, diarrhea linked with cholera is usually pale and milky, resembling rice water.</li>
	<li>
	Nausea And Vomiting:&nbsp;Vomiting due to cholera lasts a few hours and occurs during the early stages of the bacterial infection.
	</li>
	<li>
	<a href="http://merisehat.pk/disease/dehydration">Dehydration</a>:&nbsp;People affected by cholera can develop dehydration within hours of being infected by cholera. The symptoms start as mild, but can quickly become severe. If you have lost more than 10% body weight, that indicates severe dehydration.
	</li>
</ul>

&nbsp;

<h5>Signs And Symptoms Of Severe Cholera Dehydration</h5>

The signs and symptoms of cholera dehydration are fatigue, irritability, xerostomia (dry mouth), sunken eyes, extreme thirst, and dry and shriveled skin which bounces back very slowly when it is pinched into a fold. Those affected have little to no urination, irregular heartbeat, tachycardia, and low blood pressure.

Dehydration due to cholera can cause a rapid loss of minerals in your blood, which are essential for the maintenance of fluids in your body. This is commonly known as electrolyte imbalance.

&nbsp;

<h5>What Is Electrolyte Imbalance?</h5>

Electrolyte imbalance can cause serious signs and symptoms, which can also lead to death.

<ul>
	<li>Muscle Cramps:&nbsp;Cholera patients get muscle cramps because of the loss of salts, sodium, potassium, and chloride.</li>
	<li>
	Shock:&nbsp;One of the most serious complications of dehydration is shock and it occurs when the blood pressure drops, in addition to a drop in the amount of oxygen in your body. If left untreated, it can cause hypovolemic shock and death within minutes.
	</li>
</ul>

&nbsp;

The following symptoms are associated with severe dehydration in cholera:

<ul>
	<li>Sunken eyes</li>
	<li>Dry mouth</li>
	<li>Mood swings</li>
	<li>Feeling extremely thirsty</li>
	<li>Reduced urine output</li>
	<li>Low BP</li>
	<li><a href="https://merisehat.pk/disease/heart-burn-58">Irregular heart rate</a></li>
</ul>

Muscle cramps are the first symptom of electrolyte imbalance and can eventually cause shock.

&nbsp;

<h5>Cholera Symptoms In Children</h5>

The symptoms of cholera in children are the same as in adults. They may also experience the following:

<ul>
	<li>Fever</li>
	<li>Drowsiness</li>
	<li>Convulsions</li>
	<li>Coma&nbsp; 
	&nbsp;</li>
</ul>

<h5>What Happens When The Symptoms Appear?</h5>

The majority of the people who get exposed to cholera, do not get ill and in most cases, they never find out about the exposure. WHO says that symptomatic people usually develop symptoms 12 hours to 5 days after the ingestion of the bacteria.

After the contraction of the bacteria, you will continue to shed it in your stool for one to ten days, even if you don&rsquo;t have any symptoms<a href="#accordion">[4]</a>.

&nbsp;

Causes

Vibrio cholera bacterium causes cholera and has deadly effects. The bacteria produce toxins in the small intestine, which results in the disease. Moreover, the body secretes great amounts of water, which leads to diarrhea and rapid fluid loss. Electrolytes are also lost.

Although cholera may not cause any illness in those who are exposed, the bacteria can still pass from the stool into the water and food, contaminating it.&nbsp;The main source of cholera is contaminated water.

The bacterium is found in the following sources: 
&nbsp;

<h5>Well Water</h5>

Public wells that are contaminated are a frequent source of cholera outbreaks on a larger scale. People who live in crowded areas, especially in slums with inadequate sanitation are at risk. 
&nbsp;

<h5>Seafood</h5>

When people eat raw and undercooked seafood, especially shellfish, it can expose them to cholera bacteria. In the United States, most cases of cholera are due to seafood, especially in regions of the Gulf and Mexico. Cholera is also very common in Pakistan, especially in Karachi, despite the urbanization. It is mostly caused by eating undercooked seafood. 
&nbsp;

<h5>Raw Vegetables And Fruits</h5>

Raw fruits and vegetables frequently cause cholera, especially in Pakistan where it is served at restaurants and weddings<a href="#accordion">[3]</a>. In most developing countries, the non-composted fertilization manure and irrigation water comprising raw sewage contaminate the field.&nbsp; 
&nbsp;

<h5>Grains</h5>

In regions where cholera is common, grains such as rice and millet can grow cholera if they are contaminated by the cholera water.

&nbsp;

Diagnosis

The signs and symptoms of cholera are unmistakable where it is common, but the diagnosis is only confirmed after testing stool samples. In remote areas, doctors use rapid cholera dipstick tests to enable doctors to confirm the diagnosis. Furthermore, quick confirmation of the disease can help prevent death rates during the beginning of an outbreak. It can also help in earlier public health interventions to control outbreaks. 
&nbsp;

Most people are susceptible to cholera, except infants breastfed by mothers who have had cholera before. However, some of these factors can make you susceptible to the disease and cause symptoms. 
&nbsp;

<ul>
	<li>Poor Sanitation</li>
</ul>

Cholera is very common in places with poor sanitation, which also includes the difficult maintenance of safe water supplies. These conditions are very common in refugee camps and developing countries.

<ul>
	<li>Stomach Acid</li>
</ul>

Cholera does not survive in an acidic environment and an ordinary <a href="https://merisehat.pk/disease/food-poisoning">stomach</a> acts as a defense against cholera. However, children will have low levels of acids. Moreover, adults who take antacids, H2 receptor blockers, or PPPs lack this protection and are at a greater risk of cholera.

<ul>
	<li>Exposure</li>
</ul>

If you live with someone who has the disease, you are prone to exposure.

<ul>
	<li>Blood Type O</li>
</ul>

Although it isn&rsquo;t clear why, people with O blood type are more likely to develop cholera compared to other blood groups. 
&nbsp;

Cholera has a vaccine, approved by the CDC and World Health Organization. However, specific guidelines need to be followed before giving the vaccine.

You can protect yourself and your family from cholera by drinking only boiled, filtered, or chemically disinfected water. Make sure that you use these categories of water for the following purposes:

<ul>
	<li>For making food and drinks</li>
	<li>To drink</li>
	<li>To make ice</li>
	<li>For brushing your teeth</li>
	<li>To wash your hands and face</li>
	<li>To prepare food, wash dishes, utensils, and vegetables or fruits 
	&nbsp;</li>
</ul>

You can boil the water for one minute to disinfect it, or for three minutes if you require higher elevations. Filtering the water is also an option or you can use a commercial disinfectant. It is best to avoid the following and other raw foods:

<ul>
	<li>Fruits and vegetables that are not peeled</li>
	<li>Milk and milk products that are not pasteurized</li>
	<li>Fish that are raw or undercooked</li>
	<li>Fish from the tropical reefs that might be contaminated 
	&nbsp;</li>
</ul>

If you develop any of the severe symptoms of cholera (e.g., watery diarrhea, vomiting, and dehydration) after eating raw, undercooked fish or traveling to a country with a cholera epidemic, get immediate medical help. Cholera is treatable. However, dehydration can start very quickly, and getting treatment is important.

The mainstay treatment of cholera is hydration, and it depends on how severe the symptoms are. Treatment may comprise intravenous solutions for replacing the fluid loss. However, antibiotics are not a treatment for mild cases, but taking them can reduce the duration of diarrhea and bacterial excretion. It helps in preventing the spread of the disease. 
&nbsp;

Key Points

<ul>
	<li>Cholera is a bacterial disease caused by Vibrio Cholera and is spread through contaminated food and water.</li>
	<li>It is an acute bacterial infection.</li>
	<li>Cholera can cause severe diarrhoea and dehydration, which requires immediate treatment. Otherwise, it can be fatal.</li>
	<li>Modernisation&nbsp;of sewage systems and water treatment have reduced cholera in industrialised&nbsp;countries.</li>
	<li>Cholera is a notification priority disease in Pakistan and any presenting cases should be notified to the concerned authorities immediately to prevent outbreaks. 
	&nbsp;</li>
</ul>

[1] Newton, A.E., Heiman, K.E., Schmitz, A., Török, T., Apostolou, A., Hanson, H., Gounder, P., Bohm, S., Kurkjian, K., Parsons, M. and Talkington, D., 2011.

[2] Colwell, R.R., 1996. Global climate and infectious disease: the cholera paradigm. Science, 274(5295), pp.2025-2031.

[3] Sheikh, A., Khan, A., Malik, T. and Fisher-Hoch, S.P., 1997. Cholera in a developing megacity; Karachi, Pakistan. Epidemiology & Infection, 119(3), pp.287-292.

[4] Keen, M.F. and Bujalski, L., 1992. The diagnosis and treatment of cholera. The Nurse Practitioner, 17(12), pp.53-56.

[5] Dureab, F., Jahn, A., Krisam, J., Dureab, A., Zain, O., Al-Awlaqi, S. and Müller, O., 2019. Risk factors associated with the recent cholera outbreak in Yemen: a case-control study. Epidemiology and Health, 41.

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