Cholera - Causes, Symptoms and Treatment
Alternative Names: Asiatic Cholera or Epidemic Cholera
Cholera is an acute enterotoxin - mediated gastrointestinal infection caused by the gram-negative bacillus Vibrio cholerae. It produces profuse diarrhea, vomiting, massive fluid and electrolyte loss and, possibly. hypovolemic shock, metabolic acidosis, and death. A similar bacterium, vibrio parahaemolyticus, causes food poisoning.
Cholera occurs more frequently during the warmer month and is most prevalent among lower socioeconomic groups. In India, it's common among children's of ages 1 - 5 years, but in other endemic areas, it's equally distributed among all age groups. This disease is most common in Africa, southern and Southeast Asia, and the Middle East, although outbreaks have occurred in japan, Australia, and Europe.
Humans are the only hosts and victims of V. cholerae, a motile, aerobic microbe. It's transmitted through food and water contaminated with fecal material from carriers or people with active infections.
In the United States, cholera has been virtually eliminated by modern sewage and water treatment systems. However, as the transportation system has improved a lot - so, nowadays more persons travel from United States to other parts of Latin America, Africa, or Asia where epidemic cholera is very common. So, in this way U.S. travelers may be exposed to the cholera bacterium. In addition, travelers may bring contaminated seafood back to the United States.
Cholera Signs and symptoms
After an incubation period ranging from several hours to 5 days, cholera produces acute, painless, profuse, watery diarrhea and effortless vomiting (without preceding nausea), As diarrhea worsens, the stools contain white flecks of mucus (ricewater stools). Because of massive fluid and electrolyte losses from diarrhea and vomiting (fluid loss in adults may reach 1 L/hour), cholera causes intense thirst, weakness, loss of skin turgor, wrinkled skin, sunken eyes, pinched facial expression, muscle cramps (especially in the extremities), cyanosis, oliguria, tachycardia, tachypnea, thready or absent peripheral pulses, falling blood pressure, fever, and inaudible, hypoactive bowel sounds.
Patients usually remain oriented but apathetic, although small children may become stuporous or develop seizures, If complications don't occur, the symptoms subside and the patient recovers within a week. But if treatment is delayed or inadequate, cholera may lead to metabolic acidosis, uremia and, possibly, coma and death. About 3% of patients who recover continue to carry V. cholerae in the gallbladder; however, most patients are free from the infection after about 2 weeks.
A culture of V. cholerae from feces or vomitus indicates cholera; however, definitive diagnosis requires agglutination and other clear reactions to group- and type-specific antisera.
A dark-field microscopic examination of fresh feces showing rapidly moving bacilli (like shooting stars) allows for a quick, tentative diagnosis. Immunofluorescence also allows rapid diagnosis. Diagnosis must rule out Escherichia coli infection, salmonellosis, and shigellosis.
Even with prompt diagnosis and treatment, cholera can lead to fatal results in upto 2% of children and in adults - fatal rare is reduced to 1%. However, untreated cholera may be fatal in as many as 50% of patients. Cholera infection confers only transient immunity.
Improved sanitation and the administration of cholera vaccine to travelers in endemic areas can control this disease. Unfortunately, the vaccine now available confers only 60% to 80% immunity and is effective for only 3 to 6 months. Consequently, vaccination is impractical for residents of endemic areas.
Treatment requires rapid intravenous infusion of large amounts (50 to 100 ml/minute) of isotonic saline solution, alternating with isotonic sodium bicarbonate or sodium lactate. Potassium replacement may be added to the intravenous solution. Antibiotic therapy has not proved successful in shortening the course of infection, but in severe cases doxycycline has been prescribed.
When intravenous infusions have corrected hypovolemia, fluid infusion decreases to quantities sufficient to maintain normal pulse and skin turgor or to replace fluid loss through diarrhea. An oral glucoseelectrolyte solution can substitute for intravenous infusions. In mild cholera, oral fluid replacement is adequate. If symptoms persist despite fluid and electrolyte replacement, treatment includes tetracycline.
Some Prevention Tips against Cholera
A cholera patient requires enteric precautions, supportive care, and close observation during the acute phase.
1) Advise anyone traveling to an endemic area to boil all drinking water and avoid eating uncooked vegetables and unpeeled fruits. If the doctor orders a cholera vaccine, tell the patient that he'll need a booster 3 to 6 months later for continuing protection.
2) Wear a gown and gloves when handling feces-contaminated articles or when a danger of contaminating clothing exists, and wash your hands after leaving the patient's room.
3) Protect the patient's family by administering oral tetracycline, if ordered.
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