Cholera is an acute intestinal illness caused by a particular strain of the Vibrio cholerae bacterium. Usually, the disorder is mild, but in approximately one case in 10, cholera produces profuse watery diarrhea, vomiting, and leg cramps. These, in turn, cause a rapidloss of body fluids and salts and result in dehydration and shock that, if left untreated, can be fatal. A person may contract cholera by eating food or drinking water that has been contaminated by body wastes or vomit from infected individuals, as well as by eating raw shellfish from waters infested with cholera bacteria. However, it is not spread through casual contact with an infected person. Epidemics are likely to occur in areas where there is inadequate sewage and water sanitation. In recent years, cholera epidemics have been occurring continuously in parts of Africa, Asia, and South and Central America. (Even where sanitation is normally adequate, cholera is likely to follow after a disaster such an an earthquake or flood.) However, Americans who visit these places are at very low risk of getting the disease if they observe simple dietary precautions .
Diagnostic Studies And Procedures
Diagnosis is based on laboratory identification of the cholera organism in a fresh sample of the patient’s stool.
Emergency treatment consists of immediate rehydration therapy to replace fluids and salts lost through diarrhea.When patients are severly dehydrated, they will be given intravenous fluids in rapid succession until the body’s fluid volume, blood pressure, and pulse return to normal. Persons who are only moderately affected usually respond well to an oral rehydration solution. The standard formula calls for 20 grams of glucose, 3.5 grams of sodium chloride, 1.5 grams of potassium, and 2.9 grams of trisodium citrate or 2.5 grams of sodium bicarbonate per liter of sterile water. Although most cholera patients will recover completely with rehydration alone, the addition of antibiotic treatment reduces the volume and duration of diarrhea. Tetracycline, taken orally every 6 hours for 72 hours, kills the bacteria and usually ends diarrhea within 48 hours. An alternative is a single dose of doxycycline, considered almost as effective as tetracycline. Immunization is sometimes recommended for people traveling to areas where cholera is widespread, but public health officials generally advise against it. Only 50 percent of those who receive cholera vaccine develop immunity against the disease, and even then, it lasts only a few months. Still, some local authorities in countries where cholera is endemic may require that travelers present proof of having been vaccinated. In such cases, a single dose of vaccine is sufficient to satisfy the requirements. In any event, cholera vaccination should definitely be avoided during pregnancy.
There are no alternative treatments for cholera, although some may alleviate symptoms. For example, relaxation exercises can be helpful in overcoming exhaustion from fluid loss. Some herbs that contain tannins, such as tormentil root and witch hazel, taken as teas, are also helpful in controlling diarrhea.
Prevention is the best self treatment for cholera. A simple rule to follow is: “Boil it, cook it, peel it, or forget it.” The Centers for Disease Control and Prevention (CDC) makes the following recommendations for travelers to places where cholera is endemic:
- Drink only water that has been boiled or treated with chlorine or iodine. Other safe beverages include tea or coffee made with boiled water, and carbonated bottled beverages served without ice unless the water to make it has been boiled.
- Eat only vegetables and other foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself. Avoid fresh salads.
- Avoid undercooked or raw fish or shellfish, including ceviche.
Other Causes of Cholera like Symptoms
Diarrhea is a symptom of most types of food poisoning, including salmonella and Escherichia coli infection (a common cause of traveler’s diarrhea).