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Cholera Disease - Symptoms & Vaccine

Cholera is also called Asiatic cholera and epidemic cholera. It's an acute, enterotoxin-mediated GI infection caused by the gram-negative rod Vibrio cholerae. Cholera produces profuse diarrhea, vomiting, and fluid and electrolyte losses. A similar bacterium, Vibrio parahaemolyticus, causes food poisoning.

Cholera is native to the Ganges delta in the Indian subcontinent. Pandemics have affected the United States Gulf Coast of Louisiana and Texas and Latin and Central America. Southeast Asia has also had outbreaks. It usually occurs during the warmer months and is most prevalent in coastal areas among lower socioeconomic groups. In India, cholera is especially common among children ages 1 to 5, but in other endemic areas, it's equally distributed among all age groups.

Even with prompt diagnosis and treatment, cholera can be rapidly fatal because of difficulty with fluid replacement. Cholera infection confers only transient immunity. About 3% of patients who recover continue to carry y. cholerae in the gall bladder; however, most patients are free from the infection after about 2 weeks.

Causes

Humans are the only documented hosts and victims of V. cholerae, a motile, aerobic rod bacterium. The disease is transmitted directly through food and
water contaminated with fecal material from carriers or people with active infections. Cholera is a toxin mediated disease affecting the small intestine that results in watery diarrhea.

Signs and symptoms

Symptoms begin to appear between one and three days after the contaminated food or water has been ingested.

Most cases of cholera are mild, but about one in 20 patients experience severe, potentially life-threatening symptoms. In severe cases, fluids can be lost through diarrhea and vomiting at the rate of one quart per hour. This can produce a dangerous state of dehydration unless the lost fluids and electrolytes are rapidly replaced.

Signs of dehydration include intense thirst, little or no urine output, dry skin and mouth, an absence of tears, glassy or sunken eyes, muscle cramps, weakness, and rapid heart rate. The soft spot on an infant's head will appear to be sunken or drawn in. Dehydration occurs most rapidly in the very young and the very old because they have fewer fluid reserves. A doctor should be consulted immediately any time signs of severe dehydration occur. Immediate replacement of the lost fluids and electrolytes is necessary to prevent kidney failure, coma , and death

Diagnostic tests

Many diseases cause diarrhea, but if it is violent with watery stools, the doctor will treat you immediately. To make a definite diagnosis, the stools have to be examined to detect the cholera bacteria.

Diagnosis must rule out Escherichia coli infection, salmonella infection, and shigellosis.

Treatment

Travelers to endemic areas can receive the cholera vaccine. Vaccination is impractical for residents of endemic areas due to cost at this time. Only an improvement in sanitation can control the disease.

When the patient has cholera, he requires rehydration by oral fluids containing sodium at 90 mmol/L to replace losses in the stool. For severe dehydration, often accompanied by acidosis, I.V. fluid is preferred, particularly Ringer's lactate, to replace losses. Total fluid deficit in severely dehydrated patients can be replaced in the first 4 hours of therapy; half within the first hour. Oral rehydration of electrolytes, particularly potassium, is safer than by the I.V. route. Thirst and urine output guide fluid replacement. The patient also may receive calcium and magnesium replacements in the I.V. solution.

After the I.V. infusions have corrected hypovolemia, the patient only needs fluid infusions sufficient to maintain normal pulse rate and skin turgor or to replace fluid lost through diarrhea. An oral glucose-electrolyte solution can be substituted for I. V. infusions.

In mild cholera, the patient only needs early oral fluid replacement. A patient who is suspected of having cholera can receive a single dose of doxycycline or tetracycline. However, with the emergence of bacterial strains that resist traditional antibiotic therapy, he's likely to receive ciprofloxacin or erythromycin instead. Antibiotic therapy shortens the duration of diarrhea, diminishing fluid and electrolyte losses.

Prevention

Two vaccines are available that give short-term, limited protection against cholera bacteria. Neither is currently available in the U.S. Booster doses are given regularly for people who remain in an area where cholera is a risk.

  • Travelers should always take precautions with food and drinking water, even if vaccinated.
  • When outbreaks of cholera occur, efforts should be directed toward establishing clean water, food, and sanitation, because vaccination is not very effective in managing outbreaks.
  • Choose food that's been thoroughly cooked and is served piping hot. Cholera bacteria can survive on room temperature food for up to five days and aren't destroyed by freezing. It's best to avoid street food, but if you do buy from local vendors, make sure your meal is cooked in your presence and served hot.
  • Avoid ice cubes in drinks, unless you can be sure they were made from 'safe water'! Ice cream from doubtful sources may also be contaminated.


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