Cholera

By:    Published: November 8, 2012

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In industrialized countries, cholera isn’t much of a threat any more. Countries that don’t have modern water treatment systems still struggle with this disease. However, natural disasters, like flooding from hurricanes, can expose people to contaminated water, which can lead to cholera outbreaks even in industrialized countries. Learn more about cholera and how it can be treated.

Definition

Cholera is a bacterial disease that causes severe dehydration and diarrhea. In most cases, cholera is spread through contaminated water. The infection, which is caused by the bacterium Vibrio cholerae, affects the small intestine. Even healthy people who are affected by cholera need to seek treatment immediately since the disease can be fatal within a matter of hours.

One of the unique aspects of cholera is that only about 1 in 10 people who become infected with the bacterium develop the symptoms of the disease. Instead, most people who come into contact with this bacterium never know that they’ve been infected. However, these people shed the bacterium in their stool for one to two weeks, which means that they can still infect others through contaminated water.

Symptoms

Cholera causes the following symptoms, many of which are related to the severe dehydration caused by the disease:

  • Watery diarrhea that begins suddenly
  • Diarrhea having a “fishy” odor
  • Diarrhea that is pale or milky in appearance
  • Abdominal cramps
  • Dry mouth
  • Dry skin
  • Glassy or sunken eyes
  • Low urine output
  • Rapid heart rate
  • Lethargy or unusual sleepiness
  • Nausea
  • Vomiting
  • Excessive thirst
  • Lack of tears
  • Irritability

The rapid dehydration caused by cholera may cause a loss of 10 percent or more of a person’s total body weight. In severe cases, the loss of minerals in the body can cause a major electrolyte imbalance that leads to hypovolemic shock, which can cause death in just minutes if left untreated.

Causes And Risk Factors

Although Vibrio cholerae is the bacterium that causes the cholera infection, it’s a toxin called CTX that is produced in the small intestine that makes this disease so dangerous. CTX interferes with the body’s sodium and chloride flow in the intestine, which leads to the rapid dehydration and sudden diarrhea.

An individual can contract cholera when exposed to any source that has been contaminated with Vibrio cholerae. This typically occurs when the source has been exposed to feces carrying the bacterium. The most common sources are:

  • Standing water
  • Public wells
  • Raw or undercooked seafood
  • Raw fruits and vegetables
  • Grains that have been contaminated after cooking

The following are considered to be the major risk factors for cholera:

  • Poor sanitary conditions: Areas without modern sewage and water treatment are more likely to have cholera outbreaks. Some areas which are known for cholera outbreaks are Africa, India, Asia, Mexico, South America and Central America. These conditions are also found in many refugee camps and areas affected by war or famine. Living in or traveling to these areas increases your risk of getting cholera (see: Traveler’s Diarrhea).
  • Household exposure: If you live with someone who has cholera, you are more likely to get the disease.
  • Eating raw or undercooked foods: This is especially true for fruits, vegetables and shellfish.
  • Having type O blood: Although doctors aren’t sure why, people with type O blood are twice as likely to develop cholera compared to people with other blood types.
  • Low stomach acid levels: Ordinary stomach acids often defend the body against cholera bacteria. If you have low levels of stomach acid, your body may have a harder time fighting off the disease. People with low stomach acid levels may include children, older adults and people who take antacids, H-2 blockers or proton pump inhibitors.

Prevention

If you go to an area where you know cholera is an issue, use these tips to help prevent the disease:

  • Drink only safe water, such as bottled water
  • Wash your hands frequently
  • Eat only food that’s been completely cooked
  • Avoid sushi or any raw or undercooked seafood
  • Eat only fruits and vegetables that you can peel yourself
  • Be cautious about consuming dairy products

In addition to these tips, some countries offer an oral cholera vaccine. Most travelers have a very low risk of contracting cholera so it’s not offered in the U.S. However, you can ask your doctor if you’re interested in the vaccine to get more information.

Treatment

The good news about cholera is that it is very easy to treat, and the treatment results are incredibly impressive. Without treatment, about half the people with cholera die, but with treatment that number drops to less than 1 percent.

The following are the key treatments for cholera:

  • Oral rehydration: A powder rehydration solution called Oral Rehydration Salts (ORS) can be taken in boiled or bottled water.
  • Intravenous fluids: In severe cases, an IV is needed to help a person rehydrate their body.
  • Antibiotics: The antibiotics tetracycline and doxycycline can reduce the amount and duration of diarrhea resulting from cholera.
  • Zinc supplements: According to some research, zinc can help children with cholera by shortening the duration of their diarrhea.

The most important thing to remember about cholera is that, if you suspect you may have the disease, you need to seek medical attention immediately. If you plan to travel to an area where cholera outbreaks are common, make sure you use the prevention tips above to reduce your risk of contracting the disease.

Sources:

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