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CholeraCholera General InformationCholera is known to be an acute illness, the cause being an intestine infection with the bacteria called Vibrio cholerae. Transmission occurs directly through faecal-oral contamination and through contaminated food and water. The Cholera bacterium can also live in brackish rivers or coastal waters. Raw eaten shellfish was a source of the disease, and a few individuals in the United States have contacted it due to eating undercooked or raw shellfish from the Mexican Golf. Even if the disease was very rare in the industrialized nations in the last century, it is still common today in some parts of the world that include sub-Saharan Africa and the Indian subcontinent. The disease characterizes in its severest form with acute watery diarrhea which can lead to serious dehydration followed by kidney failure, and can finally lead to death. The number of the infected can rise very fast due to the extremely short period of incubation which is generally higher than two hours at least, being able to reach the maximum of five days. Usually, the pathogens remain in the faeces of the infected person between 7 to 14 days; during this period of time they are shed back into the nature or the environment from which they first infected the subject; this way, other individuals can become infected. Cholera is known to be an extremely virulent disease, which affects both adults and children. The infection can kill within hours a healthy adult. Individuals that have a lower immunity, as are the malnourished children or individuals infected with HIV present a great death risk if they become infected with the bacteria. In its severest forms, the disease is one of the fastest killing illnesses known to man, a healthy person being able to become hypotensive within one hour from the first symptoms. Infected patients can die after three hours if the treatment was not provided.Cholera SymptomsMost of the people exposed to Cholera bacterium do not become ill, and will never know that they have been infected. Yet, if they are infected, they shed the bacteria thorough their faeces for up to 14 days, and so, they can infect others. Most people who become sick due to the disease only experience mild diarrhea, which is often not easily distinguished from diarrhea caused by other problems. Usually one of ten people develops the typical symptoms and signs of the infection. If Cholera presents symptoms, the list containing them can get up to 38 symptoms, these being separated by the three stages existing in the evolution of the disease. First stage, which is the diarrheal stage contains watery diarrhea (which is painless but usually severe), rice-water stools and muscle cramps. In the second stage, which is the dehydration stage, the symptoms that we meet are dehydration, cold skin, sunken eyes, weak pulse, thirst, voice changes, reduced urine, shock, muscle cramps and muscle weakness. The last stage, which is the stage of recovery in case that death was not caused by the dehydration, triggers symptoms like mild diarrhea. However, patients who experience the most severe forms of this medical condition could experience severe diarrhea, shock, dehydration, watery diarrhea, loss of sodium, loss of potassium, loss of chloride, loss of bicarbonate, electrolyte imbalance, reduced urination, muscle weakness, muscle cramps, hypokalemia, hypotension, acidosis, shock and kidney failure. In general, children suffering with Cholera have the same symptoms and signs, but they can also experience fever, extreme drowsiness and even coma or convulsions.Cholera TreatmentIf Cholera affects patients from an unprepared community, from the number of infected cases, the average death rate can grow up to 50%, and that usually happens because there are no facilities of treatment, or due to the fact that the infected persons are treated too late. In contrast, a country that is well organized and has a plan of controlling the diarrheal diseases can, in conclusion, reduce the fatality in cases of infection with the bacteria to under 1%. Cholera can simply and successfully be treated by a replacement of the fluid lost thorough diarrhea, the replacement having to be done immediately. The replacement of the salts that are lost by the patient is also vital. A solution used worldwide in the treatment of diarrhea is an oral rehydration solution, which contains a mixture of sugar and salts that are prepackaged and have to be mixed with water and consumed in large amounts. During an epidemic, this treatment can be enough to cure 80-90% of the patients suffering from diarrhea. Patients who become severely dehydrated have to be given the fluids intravenously. If the re-hydration is prompt, less than 1% of the sufferers will die. In severe cases, the volume as well as the duration of diarrhea can be reduced with the help of an effective antibiotic. These drugs are also useful at reducing the vibrio excretion period. The antibiotic that is usually chosen in case of Cholera is tetracycline, but, in time, the bacteria is known to develop an increased resistance to the treatment. Other antibiotics that affect the bacteria are doxycyline, cotrimoxazole, erythromycine, chloramphenicol, and furazolidone. The antibiotics can be used in addition of re-hydration, as they are able to cut in half the length of this illness. Recent studies have shown that one dose of azithromycin in children or adults who suffer from severe Cholera is able to shorten the duration of the diarrhea and also decrease decreases vomiting. Complications to the treatment can occur. They are represented by pulmonary edema and renal failure. The pulmonary edema appears when the infected person receives more IV fluid than necessary, and especially if metabolic acidosis is not corrected. The latter is likely to occur if normal saline was used for re-hydration, without a parallel treatment with ORS. That only happens when the levels of IV fluid that are needed are exceeded. Renal failure usually happens due to the opposite comportment of the pulmonary edema. Renal failure occurs when not enough IV fluid is administrated and when the shock was not rapidly corrected. But this complication is less met due to the fact that severe dehydration can be rapidly corrected and guidelines are followed for maintaining normal hydration. However, left untreated, Cholera can quickly kill following the list of symptoms. This can happen with a speed that has paralyzed commerce and incited fear throughout history. Even if such reactions are not justified anymore, the disease continues to be considered deadly and very contagious threat by many, a threat that can easily spread worldwide with the use of international trade food. Ask your physician for further details. |
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