What is cholera?

Cholera is an acute intestinal infection caused by ingestion of food or water contaminated with the bacterium Vibrio cholerae. It has a short incubation period and produces an enterotoxin that causes a copious, painless, watery diarrhoea that can quickly lead to severe dehydration and death if treatment is not promptly given.

Most of the cases are asymptomatic although the bacterium is still present in their feces for 7-14 days.

When illness does occur, about 80-90% of episodes are of mild or moderate severity and are difficult to distinguish clinically from other types of acute diarrhoea. Less than 20% of ill persons develop typical cholera with signs of moderate or severe dehydration.

What are the symptoms of Cholera?

Could be asymptomatic.

Most symptomatic cases of cholera cause mild or moderate diarrhea that’s often hard to distinguish from diarrhea caused by other problems.

Incidence : 1/10 infected patients.

Symptoms of cholera includes:

1. Abdominal cramps
2. Dry mucus membranes or mouth
3. Dry skin
4. Excessive thirst
5. Glassy or sunken eyes
6. Lack of tears
7. Lethargy
8. Low urine output
9. Nausea
10. Rapid dehydration
11. Rapid pulse (heart rate)
12. Sunken “soft spots” (fontanelles) in infants
13. Unusual sleepiness or tiredness
14. Vomiting
15. Headache
16. Watery diarrhea that has fishy odour and rice-water stool character.

How about children. What are the signs and symptoms of cholera in children?

In general, children with cholera have the same signs and symptoms adults do, but they may also experience:

• Extreme drowsiness or even coma
• Fever
• Convulsions

How does cholera spread?

Cholera spreads with :

1. Contaminated water supply
2. Raw selfish
3. Uncooked vegetables and fruits

What are the sources of infection for cholera??

The most common sources of cholera infection include:

• Surface or well water. Cholera bacteria can lie dormant in water for long periods, and contaminated public wells are frequent sources of large-scale cholera outbreaks. Cholera epidemics are most likely to occur in communities without adequate sanitation and in areas affected by natural disasters or war. People living in crowded refugee camps are especially at risk of cholera.
• Seafood. Eating raw or undercooked seafood, especially shellfish, that originates from certain locations can expose you to cholera bacteria.
• Raw fruits and vegetables. Raw, unpeeled fruits and vegetables are a frequent source of cholera infection in areas where cholera is endemic. In developing nations, uncomposted manure fertilizers or irrigation water containing raw sewage can contaminate produce in the field.
• Grains. In regions where cholera is widespread, grains such as rice and millet that are contaminated after cooking and allowed to remain at room temperature for several hours become a medium for the growth of cholera bacteria.

Bacteria produce strong toxin Although V. cholerae is the source of cholera infection, the deadly effects of the disease are the result of a potent toxin, called CTX, that the bacteria produce in the small intestine. CTX binds to the intestinal walls, where it interferes with the normal flow of sodium and chloride. This causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes).

What are the risk factors and its complications?

Everyone is susceptible to cholera, with the exception of infants who derive immunity from nursing mothers who have previously had cholera.

Risk factors for cholera include:

• 1. Malnutrition.
  2. Reduced or non existent stomach acid ex: gastrectomy,under antacid treatment,children and older adult who has lower than normal stomach acid levels.
  3. Household exposure. If one of the family members infected, there is a high possibility that the  whole family will be infected.
  4. Decrease immunity as in under corticosteroid treatment and AIDS patient.
  5. Type O blood.
  6. Raw or undercooked shellfish.

Complications:

1. Low blood sugar ( hypoglycaemia )
2. Low potassium level ( hypokalemia ) – it interferes with heart and nerve functions—life threatening.
3. Kidney failure.

Test and Diagnosis

Stool and swab samples are collected in the acute stage of the disease.

Rapid cholera dipstick tests is currently available to confirm diagnosis of cholera.

In epidemic situations a clinical diagnosis is made by taking a history of symptoms from the patient and by a brief examination only. Treatment is usually started without or before confirmation by laboratory analysis of specimens.

Management of Cholera:

1. Rehydration. Restore fluid via ORS or IV fluids( in severe cases ).
2. Antibiotics. Azithromycin helps shorten diarrhea duration and decreases vomiting.
3. Zinc supplement. It can reduce duration of diarrhea in children.

Prevention:

1. Wash hands.
2. Avoid untreated water.
3. Eat completely cooked and hot food.
4. Avoid eating raw food like sushi.
5. Be careful with foods and vegetables.
6. Be careful with unpasterized milk.
7. Avoid food and beverages from street vendors.
8. Cholera vaccine. Oral cholera vaccine 1.5 ml per dosage for both adults and children basic immunity: take 2 dosages, and the 2^nd dosage is taken 2 weeks after the first dosage.

You can download Cholera.ppt or cholera poster here!

Malay language version of cholera poster is available here!

Unable to download?

Download here:

1.Cholera.ppt

2.Cholera poster.

3.Cholera poster : Bahasa melayu.