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. Modern sewage and water treatment have effectively eliminated cholera in most countries. It’s still a problem in parts of Asia, Latin America, Africa, and the Middle East. 

 

Epidemiological Outbreak 

As of 2015, the number of persons affected by cholera was projected to be 2.8 million, and the disease led to 95,000 annual fatalities (variance: 21,000–143,000). Developing countries are where this mostly happens. There may have been more than three million deaths annually during the beginning of the 1980s. Cholera started to spread in the war-torn nation of Yemen in October 2016. It was "the greatest cholera outbreak in the world," according to WHO. The cholera epidemics that occurred in Yemen from 2016 to 2021 and in Haiti in the 2010s, respectively, are recent large outbreaks. Yemen accounted for 93% of the recorded 923,037 cholera cases in 2019 (with 1911 deaths reported). Over 450,000 cases and over 900 fatalities were recorded globally between September 2019 and September 2020, but these figures are inflated by nations that report suspected cases (rather than laboratory-confirmed cases) and underreport by nations that do not report official cases (such as Bangladesh, India, and the Philippines). 

 

Causes 

Cholera is caused by the bacteria V. cholerae. The disease’s deadly effects are the result of cholera toxin (CTX), a strong toxin that’s produced in the small intestine by V. cholerae. It interferes with the normal flow of sodium and chloride, and it binds to the intestinal walls. When V. cholerae attaches to the walls of the small intestine, the body begins to secrete large amounts of water, leading to diarrhea and the rapid loss of fluids and salts. 

Sources of cholera infection include: 

• drinking contaminated water or eating food made with it, which are the primary sources of infection 

• eating raw or undercooked seafood, such as shellfish 

• eating raw fruits and vegetables 

Cholera is not usually transmitted from person to person through casual contact. 

 

Symptoms 

Most people with cholera have no symptoms at all or mild to moderate ones. According to the Centers for Disease Control and Prevention (CDC), only around 10 percent of Trusted Source people with cholera have severe symptoms. 

Symptoms of cholera may include: 

• Sudden onset of diarrhea. 

• Mild to severe dehydration. 

• High fever. 

• Weight loss. 

• Increased thirst. 

• Feeling of Nausea. 

• Vomiting. 

• A kind of bloating in the belly. 

• Blood pressure becomes low. 

• The elasticity of the skin is lost. 

• Develop cramps in the muscles. 

• A rapid increase in the heart rate. 

• Dryness in the mouth, nose, and eyelids. 

• Formation of blood or mucus or sometimes undigested materials in the stool. 

The dehydration associated with cholera is often severe and can cause signs and symptoms such as tiredness, moodiness, sunken eyes, dry mouth, shriveled skin, extreme thirst, reduced urine output, irregular heart rate and many more. Dehydration may cause the loss of minerals in the blood, which can result in an electrolyte imbalance. The first symptom of an electrolyte imbalance is severe muscle cramps. An electrolyte imbalance can eventually lead to shock. 

 

Risk Factors 

Anyone can potentially contract cholera, but a few factors may increase your risk. These risk factors also increase the likelihood that you’ll have a severe case: 

• Unclean surroundings. Places with poor sanitation and tainted water have cholera. 

• The risk is much higher if you are in close touch with people who are already suffering from cholera. 

• Low stomach acid levels. The cholera bacteria cannot survive in conditions that are quite acidic. 

• Blood of type O. Serious sickness is more likely to affect those with type O blood. This might be because type O blood has a greater sensitivity to CTX than other blood types, according to a 2016 study. 

• Consuming raw seafood. You run a higher risk of getting cholera if you consume seafood like shellfish that was harvested from contaminated water. 

 

Complications 

Cholera can be fatal. 

In severe situations, such as the 2010 outbreak in Haiti, death can occur in as little as 2 hours after the onset of symptoms. Even under typical circumstances, if cholera is left untreated, people can die of severe dehydration 6 to 12 hours after their symptoms start. 

Shock can also set in after a few hours or days. 

Severe dehydration and shock are the most serious complications of cholera. However, other problems may occur, such as: 

• low blood sugar 

• low potassium levels 

• kidney failure 

 

Prevention 

If you’re traveling to an area where cholera is widespread, your chances of contracting it will still be low if you: 

• wash your hands often 

• use bottled or boiled water to brush your teeth or prepare food 

• treat your water with a chlorine product or bleach, if you cannot boil it 

• avoid dairy 

• avoid raw shellfish and most other raw foods 

• only eat raw fruits and vegetables you can peel yourself 

If you still develop severe diarrhea after visiting an area with a high rate of cholera, see a doctor. 

 

Treatment 

Common methods for treating cholera include: 

• Oral rehydration salts, which are mixed with water 

• Other electrolyte solutions 

• Intravenous (IV) fluid rehydration 

• Zinc supplements 

• Antibiotics: Usually, doxycycline is recommended as a first-line treatment for adults (Doxycycline is usually avoided in pregnancy) and children. If resistance to doxycycline is documented, azithromycin and ciprofloxacin are alternative options. 

 

The most important part of Cholera treatment is preventing or reversing dehydration. And hence intravenous and oral hydration are both associated with greatly decreased mortality and remain the mainstay of treatment for cholera. 

 

Dr. Roshni Gautam 

Danphe Care