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Cholera

Overview

Cholera is an acute illness that involves intestinal infection caused by bacteria named Vibrio Cholera. It is a bacterial infection spread by drinking contaminated water. Cholera causes dehydration and severe diarrhea. Even if the cholera bacteria do not cause illness in everyone exposed, individuals pass the bacteria in their stool, contaminating food and water supplies. The infection is mild and asymptomatic in most cases. However, death may also occur within a few hours from complications if proper treatment is not provided in severe disease.

Causes

The bacterium Vibrio Cholera is present in contaminated food and water from where it can be transmitted to the population. This bacterium produces toxins in the intestine that releases water and create electrolyte imbalance in the body. This imbalance causes symptoms to appear.

The leading cause of cholera infection is contaminated water supply. The bacterium can be found in the following places:

Surface or Healthy Water: Large-scale cholera outbreaks are frequently caused by contaminated public wells. People who live in crowded conditions without appropriate sanitation are especially vulnerable.

Uncooked Seafood: Cholera bacteria can be spread by eating raw or undercooked seafood. The cholera cases in the United States have recently been linked to seafood from the Gulf of Mexico.

Raw Vegetables and Fruits: In cholera-affected areas, raw fruits and vegetables are a common cause of cholera infection due to uncomposted manure fertilizers or irrigation water containing raw sewage that may contaminate the fields.

Grains: In areas where cholera is prevalent, grains such as rice and millet can produce cholera bacteria if they are contaminated after cooking and stored at room temperature for many hours.

Signs and Symptoms

Most people with mild infections remain asymptomatic. But the person with severe disease may experience the following symptoms:

  • Diarrhea with watery stools
  • Nausea and Vomiting
  • Extreme Thirst
  • Dehydration
  • Leg cramps
  • Feeling restless and Irritated
  • Sunken eyes

Medical Practitioners check for the symptoms of dehydration such as dry mucous membrane, rapid heartbeat, and low blood pressure. Severe dehydration will lead to shock, coma, and death if left untreated.

Diagnosis

Symptoms like watery diarrhea are the primary indicator of cholera but can only be confirmed by a diagnostic test. The bacterium is isolated from the stool sample using selective media. It is considered a standard gold test for diagnosis. But rapid testing like stool dipsticks can help diagnose when the immediate stool culture is unavailable.

Stool Culture: Vibro Cholerae  Is isolated from the stool sample via selective media. Thiosulphate citrate bile salt (TCBS) is ideal for identifying the causative agent. Further biochemical tests are performed over the culture to confirm the diagnosis.

Rapid Test: Dipsticks can help identify the presence of Vibro Cholera but are not considered optimal. Fecal samples tested positive are then subjected to the culture-based diagnostic test for accurate identification.

Differential Diagnosis

Multiple pathogens such as Rotavirus, cryptosporidium, and Escherichia coli can cause watery diarrhea of sensitive nature and are difficult to distinguish from Cholera. The stool culture test is necessary for the confirmation of diagnosis.

Treatment

The treatment plan includes the following:

Rehydration: Electrolyte imbalance and dehydration leads to the loss of fluid. Hence, rehydration is considered the primary treatment. An appropriate amount of Oral Rehydrating Solution(ORS), IV fluids, and electrolytes are administered depending upon the patient’s condition.

Antibiotics: Antibiotics are administered to alleviate symptoms in severe cases. Doxycycline is the primary choice. But Azithromycin and Ciprofloxacin are prescribed if the patient is resistant to Doxycycline.

Zinc: Zinc supplements are given to reduce the volume and duration of stool, specifically in children.

Medications

Oral Rehydrating Solution is administered according to the patient’s fluid loss. Continuous monitoring of fluid levels is essential to determine the progression of the disease. IV solution such as Ringer’s Lactate is recommended for patients with severe volume depletion.

Antibiotics are given in patients with severe illnesses. Tetracyclines are considered the first-line treatment in most countries. Fluoroquinolones and macrolides are alternatives in case of resistance.

Complications

Cholera is a disease that can become fatal due to the rapid loss of large amounts of fluids and electrolytes. People who do not receive cholera treatment might die from dehydration and shock hours to days after symptoms occur. Although shock and extreme dehydration are the most severe complications of cholera, other issues can occur, including:

Hypoglycemia ( Low Blood Sugar): Due to loss of appetite, low levels of sugar in blood might occur in individuals, which may cause seizures and unconsciousness.

Hypokalemia ( Low Potassium Level): Rapid loss of minerals from the body may result in low potassium levels, affecting the heart and nerve functioning.

Kidney Failure: Excess fluids, electrolytes, and wastes build up in the body when the kidneys lose their filtering abilities, posing a potentially life-threatening condition.

Prevention

The following preventive measures will control the transmission of Cholera:

  • Developing and maintaining a proper sanitation system.
  • Ensure that drinking water is clean and free from pollutants by boiling it.
  • Washing hands multiple times a day will prevent the transmission of disease.
  • Cook the food properly before eating.

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