what is Cholera

 

 

Cholera

Cholera is an infectious disease caused by the bacteria Vibrio cholerae. People typically acquire cholera from contaminated water.

Most people with cholera have few or no symptoms, but some will experience severe diarrhea and dehydration.

In severe cases, immediate treatment is necessary because death can occur within hours. This can happen even if you were healthy before you contracted cholera.

 

Cholera is an acute diarrheal illness caused by infection of the intestine with Vibrio cholera bacteria. People can get sick when they swallow food or water contaminated with cholera bacteria. The infection is often mild or without symptoms, but can sometimes be severe and life-threatening.

 

Causes

A bacterium called Vibrio cholerae causes cholera infection. The deadly effects of the disease are the result of a toxin the bacteria produces in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).

Cholera bacteria might not cause illness in all people who are exposed to them, but they still pass the bacteria in their stool, which can contaminate food and water supplies.

Contaminated water supplies are the main source of cholera infection. The bacterium can be found in:

·         Surface or well water. Contaminated public wells are frequent sources of large-scale cholera outbreaks. People living in crowded conditions without adequate sanitation are especially at risk.

·         Seafood. Eating raw or undercooked seafood, especially shellfish that comes from certain places can expose you to cholera bacteria.

·         Raw fruits and vegetables. Raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where there's cholera. In developing countries, un composted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the field.

·         Grains. In regions where cholera is widespread, grains such as rice and millet that are contaminated after cooking and kept at room temperature for several hours can grow cholera bacteria.

 

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Symptoms

Most people exposed to the cholera bacterium (Vibrio cholerae) don't become ill and don't know they've been infected. But because they shed cholera bacteria in their stool for seven to 14 days, they can still infect others through contaminated water.

Most cases of cholera that cause symptoms cause mild or moderate diarrhea that's often hard to tell apart from diarrhea caused by other problems. Others develop more-serious signs and symptoms of cholera, usually within a few days of infection.

Symptoms of cholera infection can include:

·         Diarrhea. Cholera-related diarrhea comes on suddenly and can quickly cause dangerous fluid loss — as much as a quart (about 1 liter) an hour. Diarrhea due to cholera often has a pale, milky appearance that resembles water in which rice has been rinsed.

·         Nausea and vomiting. Vomiting occurs especially in the early stages of cholera and can last for hours.

·         Dehydration. Dehydration can develop within hours after cholera symptoms start and range from mild to severe. A loss of 10% or more of body weight indicates severe dehydration.

Signs and symptoms of cholera dehydration include irritability, fatigue, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a fold, little or no urinating, low blood pressure, and an irregular heartbeat.

Dehydration can lead to a rapid loss of minerals in your blood that maintain the balance of fluids in your body. This is called an electrolyte imbalance.

 

Electrolyte imbalance

An electrolyte imbalance can lead to serious signs and symptoms such as:

·         Muscle cramps. These result from the rapid loss of salts such as sodium, chloride and potassium.

·         Shock. This is one of the most serious complications of dehydration. It occurs when low blood volume causes a drop in blood pressure and a drop in the amount of oxygen in your body. If untreated, severe hypovolemic shock can cause death in minutes.

 

 

Diagnosis and Detection

It is almost impossible to distinguish a single patient with cholera from a patient infected by another pathogen that causes acute watery diarrhea without testing a stool sample. A review of clinical features of multiple patients who are part of a suspected outbreak of acute watery diarrhea can be helpful in identifying cholera because of the rapid spread of the disease.

While management of patients with acute watery diarrhea is similar regardless of the illness, it is important to identify cholera because of the potential for a widespread outbreak.

How to Diagnose

Isolation and identification of Vibrio cholerae serogroup O1 or O139 by culture of a stool specimen remains the gold standard for the laboratory diagnosis of cholera.

Cary Blair media is ideal for transport, and the selective thiosulfate–citrate–bile salts agar (TCBS) is ideal for isolation and identification. Reagents for serogrouping Vibrio cholerae isolates are available in all state health department laboratories in the U.S. Commercially available rapid test kits are useful in epidemic settings but do not yield an isolate for antimicrobial susceptibility testing and subtyping, and should not be used for routine diagnosis.

Cholera treatment

Common methods for treating cholera include:

• oral rehydration salts, which are mixed with water
• Other electrolyte solution
• Intravenous (IV) Fluid rehydration
• antibiotics
• zinc supplements

These treatments add to the liquid in the body and rehydrate it. They also help reduce the Length of time you have diarrhea.

 

Five Basic Cholera Prevention Steps

To prevent cholera, you should wash your hands often and take steps to ensure your food and water are safe for use. Following these simple steps greatly reduces your risk of getting cholera in areas where cholera is spreading:

1. Be sure you drink and use safe water.

·         Use bottled water to brush your teeth, wash and prepare food, and make ice or beverages.

·         If bottled water is not available, use water that has been properly boiled, chlorinated, or filtered using a filter that can remove bacteria.

·         Use bottled water with unbroken seals.

Water from pipes, drinks sold in cups or bags, and ice may not be safe.

If you think your water may not be safe—treat it with a chlorine product, boil it, treat with bleach, or filter it.

Treat with Chlorine Product

·         Treat your water with one of the locally available chlorine treatment products and follow the label instructions.

Or Boil it

·         If a chlorine treatment product is not available, boiling is an effective way to make water safe. Bring your water to a rolling boil for 1 minute. Note: Boiled water is at risk for re-contamination if not stored and used safely.

Or Treat with Bleach

·         If you cannot boil water, treat water with household bleach. Add 8 drops of household bleach for every 1 gallon of water (or 2 drops of household bleach for every 1 liter of water) and wait 30 minutes before drinking.

Or Filter It

·         If filtering, use a device with a pore size less than or equal to 0.3 microns and treat the water with a disinfectant such as chlorine, chlorine dioxide, or iodine.

·         Always store your treated water in a clean, covered container.

2. Wash your hands often with soap and safe water.

·         Before, during, and after preparing food.

·         Before and after eating food or feeding your children.

·         After using the toilet.

·         After cleaning your child’s bottom.

·         After taking care of someone who is sick with diarrhea.

If you don’t have access to soap and water, use an alcohol-based hand rub with at least 60% alcohol.

 

3. Use toilets

·         Use toilets or safely managed sanitation facilities to get rid of feces (poop). This includes disposal of children’s poop.

·         Wash hands with soap and safe water after going to the bathroom.

If you don’t have access to a toilet:

·         Poop at least 30 meters (98 feet) away from any body of water (including wells) and then bury your poop.

·         Dispose of plastic bags containing poop in latrines or at collection points if available, or bury it in the ground.

·         Do not put plastic bags in chemical toilets.

·         Dig new latrines or temporary pit toilets at least a half-meter (1.6 feet) deep and at least 30 meters (100 feet) away from any body of water.

4. Boil it, cook it, peel it, or leave it.

·         Cook food well, keep it covered, eat it hot, and peel fruits and vegetables.

·         Eat foods that have been thoroughly cooked and are still hot and steaming. Be sure to cook seafood, especially shellfish, until it is very hot all the way through.

·         Avoid raw vegetables and fruits that cannot be peeled.

5. Clean up safely.

·         Clean food preparation areas and kitchenware with soap and treated water and let dry completely before reuse.

·         Bathe and wash clothes or diapers 30 meters (100 feet) away from drinking water sources.

·         Clean and disinfect toilets and surfaces contaminated with poop: clean the surface with a soap solution to remove solids; then disinfect using a solution of 1 part household bleach to 9 parts water.

·         When finished cleaning, safely dispose of soapy water and dirty rags. Wash hands again with soap and safe water after cleaning and disinfecting.

How Family Members Can Prevent Infection

• Drink and use safe water
• Cook food thoroughly
• Wash hands with soap and safe water after caring for the patients, and especially after handling poop
• Remove and wash any bedding or clothing that may have had contact with diarrhea, preferably in a washing machine using warm or hot water. Usual machine detergents are sufficient; bleach is not necessary.
• Use a flush toilet or approved septic system; double bag soiled materials (items contaminated with poop) when throwing them away.
• Use any household disinfectant or a bleach solution made up of 1 part bleach to 9 parts water to clean any area that may have contact with poop, including the patient’s bathroom, bedpan, as soon as possible after being soiled.
• When possible, use rubber gloves when cleaning any room or surface that may have had contact with the patient’s poop.
• Patients with cholera should not swim until their symptoms have been gone for 2 weeks.
• If another household member starts having diarrhea, give them oral rehydration solution (ORS) and go to a healthcare provider immediately.
• While caring for persons who are sick with cholera, do not serve food or drink to anyone outside of the household.
• Any visitors should be very careful to avoid touching contaminated surfaces and should wash hands thoroughly before leaving and again when they arrive at their next destination.