Cholera – causes, symptoms, treatment and prevention. What do we know about cholera epidemics?

Cholera is a disease caused by a bacterium (Vibrio cholerae) that resembles a comma. The disease usually occurs as an epidemic, usually in low-sanitary countries with wars and natural disasters, usually in tropical regions. However, the disease rarely occurs all over the world, which is related to the migration of people.

What is cholera?

Cholera is a digestive disease that is contagious in nature. It is a global threat to public health and a major factor in the lack of social development. It is caused by a bacterium that looks like a comma—a strain of the comma cholera . Microbes enter the human body with food or water. They cope very well in a humid environment, as evidenced by the cholera epidemic that took place in flood-affected Haiti.

Cholera is a very dangerous acute disease characterized by abdominal pain and vomiting. Along with its development, skin wrinkling and a change in the timbre of the voice begin to appear. If untreated, it leads to death in over half of the cases. Therefore, it is important to give the patient antibiotics and replenish electrolytes as soon as possible.

The bacterium that causes cholera – cholera comma, we can divide into the so-called. serogroups:

1. serogroup 01 – it includes bacteria of great epidemiological importance, secreting eneterotoxins called choleragen; Two biotypes of toxicogenic strains are distinguished: El Tor and classical, each of which includes two serotypes: Inaba and Ogawa,
2. serogroup 0139 – this is an equally toxic strain of bacteria, related to the El Tor strain,
3. serogroup: no – 01 and no – 0139 – this serogroup includes other strains of Vibrio cholerae which cause milder cholera.

Damn – causes of formation – cholera is caused by:

The cholera comma is responsible for the formation of cholera. It is not a foreign bacterium, as all its genetic varieties have been researched for many years. This bacterium was first identified by Robert Koch in 1883. Then it was possible to identify two serological types of this microorganism: 01 and 0139. In most people, the infection is caused by type 01, which occurs in two varieties: classical and El Tor.

Cholera produces enterotoxin , which in turn damages the water and electrolyte balance in the small intestine, which is responsible for the main symptoms of the disease. The sources of bacteria are: patients with symptomatic cholera and vectors. The bacteria can be located outside the human body on the surface of crustaceans, algae or other marine animals. Cholera infection occurs through dirty hands and flies, but mainly from surface water contaminated with faeces. Food products that have previously been in contact with contaminated water (eg fruit) and “seafood” (crabs, shrimps, mussels) play an important role. Infection is also possible through objects belonging to the sick person.

Temperature can limit the development of cholera in water bodies, so infection is more common in warm climates. Global warming in particular creates favorable conditions for the growth of bacteria. It is worth mentioning that bacteria, in addition to the above-mentioned sources of bacteria, can also multiply in dairy products.

The infection with the comma cholera occurs:

1. by the fecal-oral route,
2. as a result of consuming contaminated water and food (directly or indirectly) – the sick person’s vomit, the carrier or the sick person’s faeces.

Cholera, after getting into the gastrointestinal tract, in most cases dies in the acidic environment of the stomach. However, some of them survive and begin to colonize the mucosa of the small intestine. Bacteria multiply in the intestine and secrete choleragen , which disrupts the transport of ions and leads to diarrhea and, consequently, dehydration of the body.

The main factors that increase the risk of cholera spreading are:

1. lack of hygiene when preparing meals;
2. lack of personal hygiene;
3. poor sanitary and hygienic conditions in places with a high density of people;
4. lack of proper water and sewage infrastructure;
5. eating undercooked dishes;
6. a warm climate zone conducive to the development of cholera commas;

The most vulnerable to cholera infection are: malnourished; patients with AIDS; with low immunity; traveling to or living in tropical countries; staying in the immediate vicinity of a cholera patient; blood group 0 who have a full-blown cholera; not caring about personal hygiene; having is acid gastritis.

Although cholera is mainly found in tropical regions, there has recently been a trend towards increasing cholera cases elsewhere where it should not occur. A case of cholera has also been recorded in Poland. Then the bacterium was detected in the Czerniakowskie Lake. Therefore, it can be assumed that global warming will affect the more frequent growth of pathogenic bacteria in an increasingly larger area.

The symptoms of cholera

Cholera develops within 5 days of consuming contaminated food or water, and most infections are mild in nature. In its acute form, the disease begins with diarrhea that is not accompanied by abdominal pain or pressure on the stool. The stools very quickly become watery-rice and are excreted from the body in very large amounts. In addition, diarrhea is accompanied by intense vomiting (no nausea). The course of the disease is fever-free and relatively quickly leads to significant dehydration and electrolyte disturbances, and eventually death. The daily loss of water can sometimes be greater than 20 liters. Mortality in untreated form is 30%.

Summary of the characteristic symptoms for a typical form of cholera:

1. development of acidosis (in the absence of intervention leads to death),
2. the occurrence of watery diarrhea with the addition of mucus, which is excreted effortlessly in the amount of up to a dozen liters a day (diarrhea is not accompanied by abdominal pain and fever),
3. vomiting,
4. excessive drying of the mucous membranes and skin – the cheeks become sunken (Hippocrates face) and the voice becomes hoarse,
5. muscle spasms,
6. sometimes vascular collapse (due to significant water loss and decreased plasma volume).

The patient’s death occurs due to the lack of proper treatment. The mortality of untreated people may be as high as 50% of cases, while in the case of people undergoing medical treatment, this number is approx. 1%. It is very important that people who have traveled to tropical zones and experience diarrhea upon return contact a doctor as soon as possible!

Diagnosis of cholera

In the diagnosis of cholera, a microbiological test is used, during which cholera commas are isolated from feces, vomit or rectal swabs. In addition, a retrospective test is performed to determine the level of vibroid and antitoxic antibodies. It is also possible to perform molecular tests that detect bacterial DNA in a clinical sample.

Treatment of cholera

Treatment of cholera is mainly symptomatic , characterized by a large intake of fluids and minerals. Losing a large amount of fluid in a short time is dangerous to the patient’s life, therefore dehydration should be prevented. In mild cholera, the patient may be rehydrated orally, but in advanced cases it is necessary to administer intravenous fluids. The World Health Organization recommends administering a special mixture, which includes: sodium chloride, sodium citrate, potassium chloride, and also glucose. All ingredients should be mixed in one liter of water – such a mixture provides the right proportions of electrolytes and nutrients.

Treatment of cholera should take place in a hospital setting. Antibiotic therapy, mainly consisting of tetracyclines , is often implemented . They are widely used because they eliminate many pathogenic bacteria. The advantage of tetracyclines is also the speed with which they reach every organ in the human body, including the nervous system. They show especially high efficiency in the less advanced form of cholera. Then they reduce the volume and frequency of diarrhea, thus avoiding significant dehydration of the patient.

Another preparation used in the treatment of cholera is ciprofloxacin , which, however, causes many side effects, e.g. diarrhea, vomiting, nausea. Treatment of cholera should not be limited to an infected person. All persons from the patient’s environment who may have become infected with cholera, e.g. using the same toilet, should be under the supervision of a doctor and be tested for the presence of cholera.

If cholera treatment is introduced too late to inhibit dehydration, the kidneys may become severely impaired, which can damage them permanently. Complications in the course of cholera usually appear in the severe course of the disease or in people with impaired immune system.

In the course of this disease, numerous uncoordinated movements are observed in the patient, which may consequently lead to visual disturbances. It is also common to increase the patient’s sleepiness and progressive dementia, which is the result of low sugar in the serum.

What is the prognosis for cholera?

Failure to make a diagnosis quickly leads to the death of the patient, even within a few hours. Therefore, if cholera is suspected, you should contact a doctor as soon as possible, who will decide on further actions.

How to prevent cholera?

1. In the prevention of cholera, it is important to neutralize the source of the infection, so to do this:

• the patient’s home should be disinfected with agents containing chlorine compounds,
• hospitalize all cholera sufferers until they obtain three consecutive negative microbiological test results,
• isolate the patient from the environment and people who ate meals with them and used the same toilet in the five days preceding the onset of the disease symptoms.

2. You should only drink boiled water and baked / cooked food.

3. People traveling to tropical countries who want to eat fruit and vegetables should first wash them in boiled water.

4. People going to tropical countries should think about vaccinations before traveling.

5. Follow the rules of personal hygiene.