What Is Cholera: Get the Facts

Cholera is a very dangerous disease, which is caused by the bacterium called Vibrio cholerae. Someone infected with cholera experiences painless and watery diarrhea. Due to continuous diarrhea, one is likely to develop dehydration which can result in death. Many people who get cholera happen to consume the bacterium through food or water contaminated with the organism. The symptoms of this disease are very mild; however, after experiencing copious diarrhea for about a week, one may become weak due to dehydration. Untreated cholera can become fatal within hours, even in healthy people.

Causes of Cholera

A gram-negative bacterium called Vibrio cholerae is the cause of cholera infection. However, what makes the disease so fatal is the toxin called CTX, which the bacterium produces once it is in the small intestines. CTX binds to the walls of your intestines and interferes with the normal flow of both chloride and sodium ions. As a result of the altered flow of ions in the intestinal wall, the intestines retain excess water, which is then released in the form of watery diarrhea. Continuous diarrhea leads to the rapid loss of body salts and fluids.

The major sources of Vibrio cholerae are:

• Environment: Vibrio cholerae is mostly found in coastal water. It naturally occurs and is attached to small crustaceans known as copepods. The copepods host the bacteria and travel with it, spreading it to different parts of the world. The tiny crustaceans travel in search of algae and plankton, which are their common food. Plankton grows in warm temperature waters while algae grow in waters rich in urea due to agricultural sewerage runoffs. 

• Vibrio Cholerae in Humans: Humans can sometimes ingest the bacterium without it ever infecting them. The bacteria are instead passed through the stool. However, when human feces contaminate food or water supply, the bacteria breed there, forming millions of cholera bacteria. With millions of bacteria found in bodies of water, one glass of water is enough to make one ill.

Other common sources of Vibrio cholerae you should know are:

• Seafood: If you consume undercooked or raw seafood such as shellfish, you increase your risk of getting cholera. Shellfish or any other types of seafood that cause cholera mainly come from locations with a cholera epidemic.

• Well Water: According to research, cholera bacteria can lie on surface water for a long time, contaminating public wells and lead to a cholera outbreak.

• Raw Vegetables and Fruits: In areas where cholera is endemic, the consumption of raw vegetables and fruits can be a major source of cholera infection.

It is important to note that cholera cannot be transmitted through person-to-person contact.

Signs and Symptoms

The signs and symptoms of cholera can begin a few hours or up to five days after ingesting the cholera bacteria. The major symptom of cholera disease is the production of watery diarrhea that has some flecks that look like rice. The flecks resembling rice are formed from gastrointestinal epithelial cells and mucus. The volume of diarrhea of an adult can be very high, resulting in the passage of watery stools about 10-18 liters within a 24-hour period. Other major signs and symptoms of cholera include:

• Increased heartbeat
• Low blood pressure
• Watery diarrhea
• Stools with fishy odor
• Stool that looks like water with flecks of rice
• Thirst
• Muscle cramps
• Shock
• Nausea
• Vomiting
• Reduced skin elasticity
• Restlessness and tiredness
• Dry mucosal membranes of the nose, mouth, throat, and eyelids.

Other symptoms that can be found in people with cholera in its severe stage include:

• Fever
• Seizures
• Weight loss
• Shock
• Abdominal or rectal pain
• Severe vomiting and dehydration
• Coma in children
• Death

Diagnosis

The major diagnosis of cholera is through its symptoms. Your doctor may look at symptoms such as severe vomiting and diarrhea, which are accompanied by rapid dehydration. Such symptoms, especially when linked to recent consumption of shellfish, can help your doctor in the diagnosis. There are also laboratory tests that can be used to diagnose cholera. They include:

• Gram stain test
• Darkfield microscopy
• Rapid dipstick test

Treatment

Upon the diagnosis of cholera, it is important to immediately treat it since it can cause death within hours. Below are the recommended treatment options for cholera:

• Rehydration: The major aim of rehydration in cholera treatment is to replace the fluids and electrolytes lost through diarrhea and vomiting. Rehydration is achieved through the administration of oral rehydration salts (ORS). Without rehydration, it has been found that 50 percent of people infected with cholera die. Oral rehydration salts are usually found in powder form, which can be dissolved in water to become effective. According to statistics, oral rehydration has reduced the death rate of people infected with cholera to 1 percent.

• Antibiotics: Antibiotics are not the main treatment for cholera, but they are used to reduce the duration and amount of cholera-causing diarrhea. Examples of antibiotics used to treat cholera are doxycycline, azithromycin, erythromycin, and tetracyclines.

• Zinc Supplements: These are mainly used to decrease or shorten the duration of diarrhea. Zinc supplements are mainly effective in children infected with cholera.

• Intravenous Fluids: These are mainly administered to severely dehydrated individuals. In case of a cholera outbreak, oral rehydration alone cannot help, since some cases can become severe.

Bottom Line

Cholera is a very dangerous disease, which can cause death within hours of infection. To help you understand more about cholera, here are some basic facts about it:

• Cholera is an acute infection of the gastrointestinal tract that is caused by Vibrio cholerae bacteria. The infection leads to watery diarrhea, which when left untreated, can lead to severe dehydration and death.
• There are more than 150,000 deaths in the world every year as a result of cholera. According to WHO, there are about 3.5 million cases of cholera every year.
• About 81 percent of cholera cases are successfully treated with oral rehydration therapy. However, serious dehydration cases have been treated with intravenous fluids and antibiotics to reduce the diarrhea period.
• 80 percent of cholera patients have moderate or mild diarrhea. About 75 percent of people with cholera usually never develop symptoms.
• The areas with a high risk of cholera infection include areas with poor sanitation and limited access to clean drinking water such as refugee camps.
• Safe and effective oral vaccines are available to control or prevent cholera. The vaccines have been found to provide about 65 percent protection against cholera in cholera-endemic areas.
• Cholera can be prevented through the use of treated or clean water and proper sanitation. Oral cholera vaccines can also be used to control cholera.
• In the case of a cholera outbreak, it is important to offer rapid access to treatment. Prompt treatment helps to reduce deaths caused by cholera. You can also prevent the spread of the disease through the provision of clean water, proper sanitation, and education aimed at improving hygiene when handling food.
• Quarantine is no longer used as a preventive measure for cholera in many developing countries today.
• Surveillance is very important to identify areas with many cases of cholera. This will help in undertaking effective control and preventive measures.