Introduction- Cholera Infection

Cholera is an infectious diarrheal disease cause’s severe watery diarrhea, which can lead to dehydration and if left untreated death can occur.

Cholera is caused by drinking water or eating food that are contaminated with a bacterium called Vibrio cholerae.

Cholera is an acute diarrheal infection that caused intestine illness by exposure to Vibrio cholerae bacteria. 

Cholera is an infection of the small intestine by causative agent bacterium Vibrio cholera that causes acute diarrhoeal illness.

 Most of infected symptoms of cholera may range mild to severe.

Cholera infection is extremely virulent disease that can cause severe acute watery diarrhoea cases. It occur frequent in adults as well as children, both are affected.

 

Who gets Cholera?

Cholera is an infection of the small intestine by bacterium Vibrio cholerae.It is an acute intestinal, diarrhoeal infection caused by ingestion of contaminated food or water with the bacterium Vibrio cholerae.A person can infected with cholera by drinking water or eating food contaminated with the cholera bacterium.Mild symptoms of cholera infection usually successfully treated with oral rehydration solution. In severity cases need rapid treatment requirement with intravenous fluids and antibiotics. If Cholera Left untreated, it can be fatal.

Epidemiology Triad

Agent– The causative agent of cholera is bacterium Vibrio cholerae. The bacterium Vibrio cholerae present in the stool and vomits of cases and carries.

Period of communicability of cholera infection depends of the case and type of carrier.

Case/ carrier                              Period of communicability

Case                                                   7-10 days

Convalescent carrier                   2-3 weeks

Chronic carrier                             from month to years

Convalescent carrier – Who have recovered from their illness but remain capable of transmitting to others.

Host factor – Affect both sexes, all ages, more in children

Incidence of cholera infection found to be higher among low socio- economic groups.

Environmental factor  – Poor environmental sanitation, contaminated water, contaminated food, poor personal hygiene

Individual living in places with unsafe drinking water, poor sanitation, and inadequate hygiene are at the highest risk for cholera infection.

Risk Factors of Cholera

1. Poor sanitation

2. Contaminated drinking water

3. Eating raw shellfish

4. Poverty

Causes of Cholera

Cholera toxin

Cholera is caused by bacteria called Vibrio cholerae. V. cholerae bacteria produced Cholera toxin  known as CTX in small intestine.

CTX binds to intestinal walls and interferes with the normal flow of sodium and chloride. When the bacteria attaches to the small intestine’s walls, body begins to secrete large amounts of water that lead to diarrhea and the rapid loss of fluids and salts.

Mode of Transmission

Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation.

The bacterium cholera is sheds in infected person feces (poop). It usually found in water or in foods that have been contaminated by feces (poop) from a person infected with cholera bacteria.

The key source of the infection by contamination usually the feces of an infected person that contaminates water or food.

1. Infection occur and transmitted in places where inadequate water treatment, poor sanitation, inadequate hygiene, contaminated environment; water, food and drinks, hand, flies.

2. Drinking water or consuming eating food contaminated with bacteria cholera.

3. Spread in areas where inadequate treatment of sewage and drinking water.

4. Transmitted person to person –  transferred by infected fecal matter entering in mouth or ingested water or food contaminated or contaminated hand with bacteria Vibrio cholerae.

5. Spread mostly by unsafe water and unsafe food that contaminated with human feces containing the bacteria

6. Undercooked seafood

Clinical Manifestation

Cholera infection symptoms can appear ranges mild to severe. 

Primary symptoms are sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet. Cholera cause Dehydration skin can turn to bluish. Symptoms start within  two hours to five days after exposure to bacteria.               

1. Watery diarrhoea

2. Vomiting

3. Dehydration

4. Sunken eyes

5. Hollow cheeks

6. Anterior abdominal wall is sunken

7. Loss of skin elasticity/ decreased skin turgor

8. Shallow, rapid respiration

9. Abdominal pain

10. Low blood Pressure

11. Oliguria

12. Metabolic acidosis

Laboratory Diagnosis

1. Stool examination – collected sample by rubber catheter or rectal swab

2. Rapid Dipstick test  – To determine the presence of bacteria V. cholerae

3. By checking of water for vibrio-cholerae by taking water sample

4. By checking food sample

Treatment of Cholera

Cholera infection cause loss of fluid due to diarrhoea, lead to  dehydration, it can be of mild form or of severe form.

Majority of person treated successfully, prompt administration of oral rehydration solution (ORS).

Severely dehydrated patients can risk of shock and require the rapid administration of intravenous fluids and antibiotics.

Mild Dehydration

1. Restless and thirsty

Prompt administration of oral rehydration solution (ORS), mixed with 1 liter of water and drunk in large amounts. 

ORS  contain electrolytes; sodium chloride, sodium bicarbonate, potassium chloride, glucose which maintain or balance the body fluids and electrolytes .

Severe Dehydration

1. Appears drowsy, cold, sweaty or in coma

2. Pulse will be feeble or sometime not palpable

3. Low blood pressure

4. Skin elasticity decreases and on pinching, the skin retracts very slowly

5. Tongue very dry, anterior fontanelle sunken and urine ouput is very less

6. Fluid deficit/ body weight loss

Severe dehydration patient require rapid treatment with intravenous fluids and antibiotics.

Antibiotics–  Tetracycline, Trimethoprim and sulfamethoxazole, Furazolidone, Doxycycline

Prevention and Control of Cholera

1. Early diagnosis

2. Safe drinking water

3. Hygienic food

4. Proper disposal of excreta

5. Handwashing

6. Disinfectant and sanitation – patient’s stool, patients vomit, contamination items, contamination areas

7. Chemoprophylaxis– administration of medication to prevent disease or infection such as Tetracycline, Doxycycline

8. Immunization 

1. Oral cholera vaccines – The oral vaccines are generally of two forms: inactivated and attenuated oral vaccine

Live, attenuated oral vaccine – Single-dose cholera vaccine, “Vaxchora” for adults 18 – 64 years old for those traveling to an area where cholera is common.

For best protection against cholera infection, vaccine should be given at least 10 days before travel to a cholera-affected area.

Inactivated or non-live cholera oral vaccines, “Dukoral”

2. Injected cholera vaccines – Effective and preventing cholera for people living where cholera is common or contaminated environment.

Cholera Complications

1. Severe diarrhea

2. ShocK

3. Hypoglycemia

4. Low potassium levels

Shock and severe diarrhea are the most serious complications of cholera.

Also, Checkout here the clinical manifestation of Bacillary dysentery and Amoebic dysentery.