cholera


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Related to cholera: dysentery, tuberculosis, typhoid

Cholera

 

Definition

Cholera is an acute infectious disease characterized by watery diarrhea that is caused by the bacterium Vibrio cholerae, first identified by Robert Koch in 1883 during a cholera outbreak in Egypt. The name of the disease comes from a Greek word meaning "flow of bile."
Cholera is spread by eating food or drinking water contaminated with the bacterium. Although cholera was a public health problem in the United States and Europe a hundred years ago, modern sanitation and the treatment of drinking water have virtually eliminated the disease in developed countries. Cholera outbreaks, however, still occur from time to time in less developed countries, particularly following such natural disasters as the tsunami that struck countries surrounding the Indian Ocean in December 2004. In these areas cholera is still the most feared epidemic diarrheal disease because people can die within hours of infection from dehydration due to the loss of water from the body through the bowels.
V. cholerae is a gram-negative aerobic bacillus, or rod-shaped bacterium. It has two major biotypes: classic and El Tor. El Tor is the biotype responsible for most of the cholera outbreaks reported from 1961 through the early 2000s.

Description

Cholera is spread by eating food or drinking water that has been contaminated with cholera bacteria. Contamination usually occurs when human feces from a person who has the disease seeps into a community water supply. Fruits and vegetables can also be contaminated in areas where crops are fertilized with human feces. Cholera bacteria also live in warm, brackish water and can infect persons who eat raw or undercooked seafood obtained from such waters. Cholera is rarely transmitted directly from one person to another.
Cholera often occurs in outbreaks or epidemics; seven pandemics (countrywide or worldwide epidemics) of cholera have been recorded between 1817 and 2003. The World Health Organization (WHO) estimates that during any cholera epidemic, approximately 0.2-1% of the local population will contract the disease. Anyone can get cholera, but infants, children, and the elderly are more likely to die from the disease because they become dehydrated faster than adults. There is no particular season in which cholera is more likely to occur.
Because of an extensive system of sewage and water treatment in the United States, Canada, Europe, Japan, and Australia, cholera is generally not a concern for visitors and residents of these countries. Between 1995 and 2000, 61 cases of cholera in American citizens were reported to the Centers for Disease Control and Prevention (CDC); only 24 represented infections acquired in the United States. People visiting or living in other parts of the world, particularly on the Indian subcontinent and in parts of Africa and South America, should be aware of the potential for contracting cholera and practice prevention. Fortunately, the disease is both preventable and treatable.

Causes and symptoms

Because V. cholerae is sensitive to acid, most cholera-causing bacteria die in the acidic environment of the stomach. However, when a person has ingested food or water containing large amounts of cholera bacteria, some will survive to infect the intestines. As would be expected, antacid usage or the use of any medication that blocks acid production in the stomach would allow more bacteria to survive and cause infection.
In the small intestine, the rapidly multiplying bacteria produce a toxin that causes a large volume of water and electrolytes to be secreted into the bowels and then to be abruptly eliminated in the form of watery diarrhea. Vomiting may also occur. 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 fontanelle (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.
Some people are at greater risk of having a severe case of cholera if they become infected:
  • People taking proton pump inhibitors, histamine blockers, or antacids to control acid indigestion. As noted earlier, V. cholerae is sensitive to stomach acid.
  • People who have had chronic gastritis caused by infection with Helicobacter pylori.
  • People who have had a partial gastrectomy (surgical removal of a portion of the stomach).

Diagnosis

Rapid diagnosis of cholera can be made by examining a fresh stool sample under the microscope for the presence of V. cholerae bacteria. Cholera can also be diagnosed by culturing a stool sample in the laboratory to isolate the cholera-causing bacteria. In addition, a blood test may reveal the presence of antibodies against the cholera bacteria. In areas where cholera occurs often, however, patients are usually treated for diarrhea and vomiting symptoms as if they had cholera without laboratory confirmation.

Treatment

The key to treating cholera lies in preventing dehydration by replacing the fluids and electrolytes lost through diarrhea and vomiting. The discovery that rehydration can be accomplished orally revolutionized the treatment of cholera and other, similar diseases by making this simple, cost-effective treatment widely available throughout the world. The World Health Organization has developed an inexpensive oral replacement fluid containing appropriate amounts of water, sugar, and salts that is used worldwide. In cases of severe dehydration, replacement fluids must be given intravenously. Patients should be encouraged to drink when they can keep liquids down and eat when their appetite returns. Recovery generally takes three to six days.
Adults may be given the antibiotic tetracycline to shorten the duration of the illness and reduce fluid loss. The World Health Organization recommends this antibiotic treatment only in cases of severe dehydration. If antibiotics are overused, the cholera bacteria organism may become resistant to the drug, making the antibiotic ineffective in treating even severe cases of cholera. Tetracycline is not given to children whose permanent teeth have not come in because it can cause the teeth to become permanently discolored.
Other antibiotics that may be given to speed up the clearance of V. cholerae from the body include ciprofloxacin and erythromycin.
A possible complementary or alternative treatment for fluid loss caused by cholera is a plant-derived compound, an extract made from the tree bark of Croton lechleri, the Sangre de grado tree found in the South American rain forest. Researchers at a hospital research institute in California report that the extract appears to work by preventing the loss of chloride and other electrolytes from the body.

Prognosis

Today, cholera is a very treatable disease. Patients with milder cases of cholera usually recover on their own in three to six days without additional complications. They may eliminate the bacteria in their feces for up to two weeks. Chronic carriers of the disease are rare. With prompt fluid and electrolyte replacement, the death rate in patients with severe cholera is less than 1%. Untreated, the death rate can be greater than 50%. The difficulty in treating severe cholera does not lie in not knowing how to treat it but rather in getting medical care to the sick in underdeveloped areas of the world where medical resources are limited.

Prevention

The best form of cholera prevention is to establish good sanitation and waste treatment systems. In the absence of adequate sewage treatment, the following guidelines should be followed to reduce the possibility of infection:
  • Boil it. Drink and brush teeth only with water that has been boiled or treated with chlorine or iodine tablets. Safe drinks include coffee and tea made with boiling water or carbonated bottled water and carbonated soft drinks.
  • Cook it. Eat only thoroughly cooked foods, and eat them while they are still hot. Avoid eating food from street vendors.
  • Peel it. Eat only fruit or nuts with a thick intact skin or shell that is removed immediately before eating.
  • Forget it. Do not eat raw foods such as oysters or ceviche. Avoid salads and raw vegetables. Do not use untreated ice cubes in otherwise safe drinks.
  • Stay out of it. Do not swim or fish in polluted water.
Preventive measures following natural disasters include guaranteeing the purity of community drinking water, either by large-scale chlorination and boiling, or by bringing in bottled or purified water from the outside. Other important preventive measures at the community level include provision for the safe disposal of human feces and good food hygiene.
Because cholera is one of the few infectious diseases that can be spread by human remains (through fecal matter leaking from corpses into the water supply), emergency workers who handle human remains are at increased risk of infection. It is considered preferable to bury corpses rather than to cremate them, however, and to allow survivors time to conduct appropriate burial ceremonies or rituals. The remains should be disinfected prior to burial, and buried at least 90 feet (30 m) away from sources of drinking water.
A cholera vaccine exists that can be given to travelers and residents of areas where cholera is known to be active, but the vaccine is not highly effective. It provides only 25-50% immunity, and then only for a period of about six months. The vaccine is never given to infants under six months of age. The Centers for Disease Control and Prevention do not currently recommend cholera vaccination for travelers. Residents of cholera-plagued areas should discuss the value of the vaccine with their doctor.
A newer cholera vaccine known as Peru-15 underwent phase II trials in the summer of 2003. As of mid-2004, the manufacturer is planning phase III trials in a developing country and in travelers. Peru-15 is classified as a single-dose recombinant vaccine.

Resources

Books

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Bacterial Diseases." Section 13, Chapter 157. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Periodicals

Altman, Lawrence K., MD, and Denise Grady. "Water Is Key to Averting Epidemics Along Coasts." New York Times December 30, 2004.
Fischer, H., T. E. Machen, J. H. Widdicombe, et al. "A Novel Extract SB-300 from the Stem Bark Latex of Croton lechleri Inhibits CFTR-Mediated Chloride Secretion in Human Colonic Epithelial Cells." Journal of Ethnopharmacology 93 (August 2004): 351-357.
Handa, Sajeev. "Cholera." eMedicine. [cited March 21, 2003]. http://www.emedicine.com/med/topic351.htm.
Jones, T. "Peru-15 (AVANT)." Current Opinion in Investigational Drugs 5 (August 2004): 887-891.

Organizations

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.
Infectious Diseases Society of America (IDSA). 66 Canal Center Plaza, Suite 600, Alexandria, VA 22314. (703) 299-0200. Fax: (703) 299-0204. http://www.idsociety.org.
World Health Organization (WHO). http://www.who.int/en/.

Other

World Health Organization Fact Sheet. "Cholera." Fact sheet No. 107, March 2000. http://www.who.int/mediacentre/factsheets/fs107/en/.
World Health Organization Fact Sheet. "Flooding and Communicable Diseases Fact Sheet: Risk Assessment and Preventive Measures." December 2004. http://www.who.int/hac/techguidance/ems/flood_cds/en/index.html.

Key terms

Antibody — A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.
Bacillus — A rod-shaped bacterium. The organism that causes cholera is a gram-negative bacillus.
Biotype — A variant strain of a bacterial species with distinctive physiological characteristics.
Electrolytes — Salts and minerals that ionize in body fluids. Common human electrolytes are sodium, chloride, potassium, and calcium. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost all major biochemical reactions in the body.
Pandemic — A widespread epidemic that affects whole countries or the entire world. There have been seven cholera pandemics since 1817.
Toxin — A poison. In the case of cholera, a poison secreted as a byproduct of the growth of the cholera bacteria in the small intestine.

cholera

 [kol´er-ah]
an acute infectious enteritis endemic and epidemic in Asia, caused by Vibrio cholerae, marked by severe diarrhea and vomiting, with extreme fluid and electrolyte depletion, and by muscle cramps and prostration. Called also Asiatic cholera.

Immunization and modern methods of sanitation have all but eliminated cholera epidemics in the United States and Europe, but they are still a danger in many other parts of the world, such as in India and many tropical regions. Travelers to cholera-ridden areas should protect themselves by vaccination, but this does not provide complete immunity. The local drinking water should be boiled; uncooked foods should be avoided; food should be protected from flies; and fruits and vegetables should be peeled with their rinds discarded.
Transmission. Vibrio cholerae is carried in the cholera victim's feces, urine, and vomitus, and is transmitted to others in contaminated water or food. Once it has reached the intestines, the intestinal lining becomes inflamed and the passages distended with a thin, watery fluid.
Symptoms. Symptoms begin to appear at any time from a few hours to 5 days after contact; the usual incubation period is 3 days. When the disease is at its peak, diarrhea and vomiting occur with such frequency and abundance that dehydration results very rapidly. The skin is cyanotic and shriveled, the eyes are sunken and the voice is feeble. There may be painful muscular cramps throughout the body.
Treatment. Because alkaline substances are lost in the vomitus and feces, acidosis as well as dehydration must be combated. The fluids and electrolytes are replaced either orally or by administration of a water, glucose, and electrolyte solution. Acid intoxication may require intravenous administration of sodium bicarbonate. Guidelines for cholera control are available from the World Health Organization.
Asiatic cholera see cholera.
cholera infan´tum a noncontagious diarrhea occurring in infants; formerly common in the summer months.
pancreatic cholera a condition marked by profuse watery diarrhea, hypokalemia, and usually achlorhydria, and due to an islet-cell tumor (other than beta cell) of the pancreas.

chol·er·a

(kol'er-ă),
An acute epidemic infectious disease caused by the bacterium Vibrio cholerae. A soluble toxin elaborated in the intestinal tract by the bacterium activates the adenylate cylase of the mucosa, causing active secretion of an isotonic fluid resulting in profuse watery diarrhea, extreme loss of fluid and electrolytes, and dehydration and collapse, but no gross morphologic change in the intestinal mucosa. Synonym(s): Asiatic cholera
[L. a bilious disease, fr. G. cholē, bile]

cholera

/chol·era/ (kol´er-ah) Asiatic c.; an acute infectious disease endemic and epidemic in Asia, caused by Vibrio cholerae, marked by severe diarrhea with extreme fluid and electrolyte depletion, and by vomiting, muscle cramps, and prostration.
Asiatic cholera  see cholera.
pancreatic cholera  a condition marked by profuse watery diarrhea, hypokalemia, and usually achlorhydria, and due to an islet-cell tumor (other than beta cell) of the pancreas.

cholera

(kŏl′ər-ə)
n.
1. An acute infectious disease of the small intestine, caused by the bacterium Vibrio cholerae and characterized by profuse watery diarrhea, vomiting, muscle cramps, severe dehydration, and depletion of electrolytes. Also called Asiatic cholera.
2. Either of two unrelated diseases of domestic animals, fowl cholera or classical swine fever (hog cholera), that are often marked by severe diarrhea.

chol′e·ra′ic (-ə-rā′ĭk) adj.
chol′e·roid′ (-ə-roid′) adj.

cholera

[kol′ərə]
Etymology: Gk, chole + rhein, to flow
an acute bacterial infection of the small intestine, characterized by severe watery diarrhea and vomiting, muscular cramps, dehydration, and depletion of electrolytes. The disease is spread by water and food that have been contaminated by feces of persons previously infected. The symptoms are caused by Cholera toxin, which is produced by the infecting organism, Vibrio cholerae. The profuse, watery diarrhea, as much as a liter an hour, depletes the body of fluids and electrolytes. Complications include circulatory collapse, cyanosis, destruction of kidney tissue, and metabolic acidosis. The rate of mortality is as high as 50% if the infection remains untreated. Treatment includes, first and foremost, replacement of fluids and electrolytes (oral rehydration therapy) or IV fluids and, second, the administration of antibiotics. A cholera vaccine is available for people traveling to areas where the infection is endemic but is of limited effacacy. Other preventive measures include drinking only water that has been boiled or decontaminated by iodine or commercially bottled water and eating only cooked foods. See also Vibrio cholerae, vibrio gastroenteritis.

cholera

Infectious disease A severe form of gastroenteritis, caused by V cholera, often acquired through contaminated water supplies; cholera may be seasonal in developing regions–eg, Africa, Asia, South America Clinical Copious watery stools, abdominal colic and eventual collapse from dehydration Management Aggressive hydration. See Bengal cholera, Cholera toxin, WHO solution.

chol·er·a

(kol'ĕr-ă)
An acute epidemic infectious disease caused by the bacterium Vibrio cholerae, occurring primarily in Asia. A toxin elaborated by the bacterium activates the adenylate cyclase of the mucosa, causing active secretion of an isotonic fluid resulting in watery diarrhea, loss of fluid and electrolytes, and dehydration and collapse, but no gross morphologic change in the intestinal mucosa.
[L. a bilious disease, fr. G. cholē, bile]

cholera

A highly infectious disease caused by the organism Vibrio cholerae , usually acquired in contaminated food or drinking water. 1–3 days after infection there is profuse watery diarrhoea and vomiting and severe, often fatal, dehydration from fluid loss. Timely and effective fluid replacement is life-saving.

cholera

a serious human disease caused by gut infection of the bacterium Vibrio cholerae that results in severe diarrhoea, vomiting and abdominal cramps. Up to 15 litres per day of fluid may be lost from the gut, resulting in extreme dehydration and even death. Treatment is effected by replacement of the lost body fluids and salts. Cholera is endemic in certain Third World countries, occurring more often where natural resistance of the host is impaired, particularly by malnutrition.

cholera,

n bacterial infection of the small intestine caused by the
Vibrio cholerae. Symptoms include vomiting, diarrhea, dehydration, and electrolyte imbalance. Can be fatal in up to half of cases if left untreated.

chol·er·a

(kol'ĕr-ă)
An acute epidemic infectious disease caused by the bacterium Vibrio cholerae that causes profuse watery diarrhea, extreme loss of fluid and electrolytes, and dehydration and collapse.
[L. a bilious disease, fr. G. cholē, bile]

cholera (kôl´erə),

n an acute bacterial infection of the small intestine characterized by severe diarrhea and vomiting, muscular cramps, dehydration, and depletion of electrolytes. The disease is spread by water and food that have been contaminated by feces of infected persons. The cholera vibrio produce an exotoxin, cholera toxin (choleragen), that stimulates the secretion of electrolytes and water into the small intestine, draining body fluids and weakening the patient. A vaccine is available.

Patient discussion about cholera

Q. Can Cholera outbreak here in the U.S? I looked for information about Cholera and couldn’t find much…

A. You can find any information in wikipedia. here is a link about Cholera :
http://en.wikipedia.org/wiki/Cholera
and here is all the info about Cholera outbreaks in the world:
http://www.who.int/cholera/en/

More discussions about cholera
References in periodicals archive ?
Accra, Shawwal 4, 1435, Jul 31, 2014, SPA -- The death toll from cholera outbreak in Ghana's capital, Accra, has risen from five to 15 out of over 850 reported cases, health officials said Wednesday.
The findings are significant because, until now, researchers had not identified the early strains of cholera, a water-borne pathogen.
Nicholas Muraguri, Director of Medical Services in the Ministry of Health said the government will deploy technical personnel, medicine and water treatment chemicals to Nairobi, HomaBay and Migori counties affected by cholera.
KAMPALA: The UN children's agency says 29 people have died in South Sudan's latest cholera outbreak.
Characteristics of cholera case-patients and controls during outbreak in Juba County, South Sudan, 2014 Characteristic Case-patients, Controls, no.
Omer Sluieman Adam, the chairman of the council, approved Tuesday the statement of the Federal Ministry of Health on the precautions taken by the ministry to prevent leak of cholera into the Sudan presented by the ministry's State Minister.
Muscat: Cholera is very rare in Oman and therefore Omanis do not need to panic, an official from World Health Organisation's (WHO's) office in Oman said.
CENEVRE (CyHAN)- The humanitarian agencies warned that heavy rains will worsen the Cholera epidemic in Iraq which had infected more than 2200 people since September.
October 15, 2015 (JUBA) - More than 800,000 children in South Sudan marked on Thursday the annual World Handwashing Day by washing their hands with soap and clean water in a symbolic show of how the practice was essential in fighting cholera.
BASRA, Iraq, Oct 9 (KUNA) -- Forty five infections with the cholera disease were registered in the southern Iraqi city of Basra, Health officials said Friday.
Greek health authorities urged the public to take health precautions on Friday after a suspected cholera case was discovered on Kos island, a tourist destination and entry point for migrants from the Middle East and Asia.
An outbreak of cholera that started in Haiti three years ago has now spread to South America's mainland, and is heading north towards the US.