Cholera: Causes,Diagnosis, and Treatment

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Cholera overview

 

Cholera is an infectious disease that causes severe watery diarrhea, which can lead to dehydration and even death if untreated. It is caused by eating food or drinking water contaminated with a bacterium called Vibrio cholerae.

Cholera was prevalent in the U.S. in the 1800s, before modern water and sewage treatment systems eliminated its spread by contaminated water. Only about 10 cases of cholera are reported each year in the U.S. and half of these are acquired abroad. Rarely, contaminated seafood has caused cholera outbreaks in the U.S. However, cholera outbreaks are still a serious problem in other parts of the world. The World Health Organization reports that there are 1.3 million to 4 million cases each year.
 

The disease is most common in places with poor sanitation, crowding, war, and famine. Common locations include parts of Africa, south Asia, and Latin America. If you are traveling to one of those areas, knowing the following cholera facts can help protect you and your family.

The extremely short incubation period of cholera pertaining to a few hours to five days with average of 3 days has marked its deadly threat to those infected to it; considering that its mild form causes no symptoms at all. That is why it could result to severe dehydration, coma and death if left untreated.

The initial clinical manifestations of an individual infected with cholera are:

  1. Acute colicky pain of the abdomen
  2. Mild diarrhea with yellowish colored stools
  3. Headache and vomiting
  4. Fever, which may or may not be present
  5. Marked mental depression

Later on, if not treated right away it could get worse to more profuse watery diarrhea (grayish white or rice water colored stools), vomiting and severe or violent leg cramps – leading to mild up to severe dehydration.

Symptoms of dehydration may be manifested by:
Mild Dehydration Moderate Dehydration Severe Dehydration
Somewhat dry mucous membranes

Pale, cool skin on arms & legs
Slight tachycardia
Increased capillary refill
Anxiety
Dry mucous membranes

Poor skin turgor
Cool truncal skin
Sunken fontanel/eyes
Rapid, thread pulse
Supine hypotension
Increased thirst
Restlessness, confusion, or irritability
Dry, cracked mucous membranes

Very poor skin turgor
Cold, mottled, or cyanotic skin
Sunken fontanel/ eyes
Marked tachycardia & hypotension
Narrowed pulse pressure
Delayed capillary refill
Unconsciousnes

According to World Health Organization, there are 48 countries that had been affected by cholera in the past 3 years. The continents of Africa, Americas (Haiti), Asia, and Oceania were the ones which are mostly affected by this infection. Nevertheless, it has occurred an overwhelming 52% increase of reported cases last 2009 to 2010 in the countries globally and which did not spared 45% of lives from 32 countries with reported cases of deaths.

In May 2011, the re-emergence of its cases pushed through a more integrated and comprehensive management utilizing strong surveillance, early detection and control, and prevention strategies.

Cholera Causes

Vibrio cholerae, the bacterium that causes cholera, is usually found in food or water contaminated by feces from a person with the infection. Common sources include:

  • Municipal water supplies
  • Ice made from municipal water
  • Foods and drinks sold by street vendors
  • Vegetables grown with water containing human wastes
  • Raw or under cooked fish and seafood caught in waters polluted with sewage

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhea. It is not likely you will catch cholera just from casual contact with an infected person.

Cholera Diagnosis

A doctor may suspect cholera if a patient has severe watery diarrhea, vomiting, and rapid dehydration, especially if they have recently traveled to a place that has a recent history of cholera, or poor sanitation, or if they have recently consumed shellfish.

A stool sample will be sent to a laboratory for testing, but if cholera is suspected, the patient must begin treatment even before the results come back.

Cholera Treatment

It is normally dehydration that leads to death from cholera, so the most important treatment is to give oral hydration solution (ORS), also known as oral rehydration therapy (ORT).

The treatment consists of large volumes of water mixed with a blend of sugar and salts.

Prepackaged mixtures are commercially available, but widespread distribution in developing countries is limited by cost, so homemade ORS recipes are often used, with common household ingredients.

Severe cases of cholera require intravenous fluid replacement. An adult weighing 70 kilograms will need at least 7 liters of intravenous fluids.

Antibiotics can shorten the duration of the illness, but the WHO does not recommend the mass use of antibiotics for cholera, because of the growing risk of bacterial resistance.

Anti-diarrheal medicines are not used because they prevent the bacteria from being flushed out of the body.

Prevention

  1. Provision or assisting the community to access to potable and clean water resource i.e. boiling water if not sure to be clean
  2. Teaching the community on proper sanitation practices, handling and preserving food
  3. Educating them of the importance of hand washing before handling or eating food, and after defecating
  4. Proper detection of cases as part of rigid surveillance.
(WHO Standard case definition) Cholera case is suspected if:
  1. n an area where the disease is not known to be present, a patient aged 5 years or more develops severe dehydration or dies from acute watery diarrhoea;
  2. in an area where there is a cholera epidemic, a patient aged 5 years or more develops acute watery diarrhoea, with or without vomiting.

Cholera Management and Control

Infants
  • Emphasize to mother to continue breastfeed the baby
  • If the baby is exclusively breastfeeding, give ORS or 100 to 200ml clean water in addition to breast milk
  • If the baby is not exclusively breastfeeding, teach the mother to give food based fluids like rice water and soups or ORS
  • Encourage the mother to give frequent small sips of clean water or ORS from a cup; the child vomits, tell to wait for at least 10 minutes and continue slowly
    • Rehydration is the main goal to compensate for the fluid loss from diarrhea and vomiting.
    • Clients are encouraged to take more fluids as much as possible or are given with ORS to replace electrolyte losses.
    • Children: 20ml/kg body weight per hour
    • Adult: 1000ml per hour, if necessary
    • If moderate to severe dehydration ensues, intravenous infusion with normal saline or Lactate ringer’s solution is main priority.
    • Administration of antibiotic is done to reduce the volume and duration of diarrhea. Meanwhile, Zinc supplement is given to children to reduce the duration of diarrhea and to minimize its successive episodes.
    • Parenteral vaccines and mass chemoprophylaxis are not recommended by WHO for its high rates of severe adverse reactions. The available Oral Cholera Vaccine (OCV) in the market is only limited but best suitable for travellers aging 2 years old and above.

References:

 1.Critical Care Nursing Made Incredibly Easy 3rd Edition. (2012). Lippincott Williams & Wilkins.
2.National Center for Infectious Diseases, Center for Disease Control. Defeating Cholera: Clinical Presentation and Management. Retrieved last July 24, 2012 from www.cdc.gov Health Organization.
3.Prevention and Control of Cholera Outbreaks: WHO Policy and Recommendations. Retrieved last July 24, 2012 from http://www.who.int

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