Introduction

This article delves into the world of cholera, an abrupt illness caused by consuming contaminated food or water harbouring Vibrio cholerae bacteria. Harmful organisms in the small intestine produce a toxin called choleragen that sticks to the intestine. This toxin triggers the release of a substance that leads to a significant release of electrolytes and water.² This faeco-oral transmitted disease triggers severe diarrhoea and dehydration, and can even be fatal. Join us as we explore the impact of this bacterial infection, often affecting regions lacking modern sanitation and clean water system.¹ Undeveloped nations and refugee camps, in addition to parts of the Middle East, Asia, South America, and Africa are some examples.¹

Signs and Symptoms of Cholera

Out of 10 infected people, 1 person will develop severe symptoms that are listed below^:3 

• Watery diarrhoea/rice-water-like stools 
• Cramps in the leg muscles
• Feeling of uneasiness
• Feeling dehydrated
• Nausea³
• Passing very less amount of urine¹ 

When there is a case of profuse water-like diarrhoea, then additional signs are examined in such individuals: 

• Heart rate becomes rapid
• Skin loses its elastic nature 
• Mucosa becomes dry
• Blood pressure drops³

A person who has developed profuse diarrhoea implies that the amount of an infectious agent called Vibrio cholerae has reached greater numbers inside the patient’s body. This has the potential to infect others.³

When to See a Doctor

It is observed that after consumption of contaminated food, a person takes 12 hours to even upto 5 days to develop severe symptoms. 

Therefore, anyone who experiences any of the above-mentioned symptoms should immediately visit the doctor. Some early symptoms might fade within a few days. Early diagnosis and onset of administering medications can prevent a patient’s life.¹ 

You may have come across news pieces that in the rural areas of economically poor countries, cholera is a common disease. The reason for this may be the lack of proper water sanitation, compromised sewage disposal and hygiene issues. In such places, the food and water are usually infected with Vibrio cholerae bacteria, consumption of which leads to diarrhoea and other symptoms. They typically take 2–3 days to manifest.

Dr. Siddharth Gupta, B.A.M.S, M.D (Ayu)

Causes of Cholera

The main causative agent of cholera is Vibrio cholerae (V. cholerae) bacteria, which is responsible for the infection and its transmission through contaminated water and food sources.  

• The infection spreads when contaminated faeces enter the water system.
• Improperly sanitized water puts people at risk when using it for drinking, cooking, and washing.
• Consumption of food or water contaminated with V. cholerae leads to bacterial multiplication in the small intestines and causes fluid secretion, resulting in diarrhoea.
• Cholera usually does not spread directly from person to person, but there can be occasional cases of transmission.
• Practising good hand hygiene is important to prevent infection.
• V. cholerae bacteria can also be found in salty rivers and coastal waters.
• Rare cases of cholera have been associated with consuming raw or undercooked shellfish.¹ 

Vibrio cholerae bacteria, being the causal microbe for cholera, are transferred from infected to healthy individuals through their faeces. V. cholerae grows within people when they consume food, water, or both that is infected with the bacteria. The small intestines then may release fluid as a result of the bacteria, which results in diarrhoea.

Dr. Rajeev Singh, BAMS

Risk Factors for Cholera

Exploring the factors that increase susceptibility to cholera:

• People who are much more likely to be exposed to cholera include healthcare employees treating cholera patients, and tourists in a place of active cholera transmission who cannot or do not always comply with secure meals and water precautions and private hygiene measures.⁴
• A person who has profuse diarrhoea has the potential to infect nearby people if the faecal matter of such a patient is not discarded carefully and other things are contaminated with it.³

Diagnosis of Cholera

After examining the patient for several signs and symptoms, a confirmatory test is required to declare and outline the degree of cholera infection. 

• Stool sample examination: The patient would be asked to collect their stools into a cup/bag which can be sent into the laboratory for checking the presence of V. cholerae.¹
• Rapid test: In many areas, there are no labs to perform stool examination. Hence, there are rapid dipstick tests which can indicate a cholera case instantly.¹

Treatment of Cholera

When someone contracts cholera their focus should be on preventing dehydration. Since the body fluids are constantly being lost, the water intake must compensate for the loss. 

• Therapy of rehydration: Drink Oral Rehydration Solution at regular intervals. Also, if dehydration is at a severe stage go to the doctor for instant administration of I.V fluids.⁵
• Antibiotic treatment: Since 1964, antibiotics are prescribed in conjunction with rehydration therapy. 

• A study found that antibiotics can reduce stool volume, shorten the duration of diarrhoea, and decrease the duration of positive bacterial culture.
• Antibiotics are prescription medicines and should be taken according to the doctor’s instructions. ⁶
• Treatment with zinc: Administering zinc supplements is found to lessen the severity of diarrhoea in children.
• Children who were given zinc supplements experienced 8 hours less of diarrhoea and had 10% less diarrhoea stool compared to those who did not receive the supplementation.⁷

Prevention of cholera

Bacteria causing cholera are not contagious, however, preventive measures can be undertaken to avoid contracting the infection from another person.¹ 

There are 5 fundamental cholera preventive steps as per Centres for Disease Control and Prevention (CDC)⁸: 

1. Be sure you drink and use clean water

• Always use clean, boiled water for drinking and cooking purposes.
• Water used for brushing teeth, for cooking food must be at least boiled for a minute or it must be treated using chlorine tablets.

2. Clean hands frequently with soap and water

• Hand-washing hygiene should be followed and children should be supervised by an adult. It is very important to thoroughly clean hands using soap and water before having food and post visiting the washroom.

3. Make use of toilets

• Toilet hygiene must be followed and they should be sanitized regularly.  

4. Simmer it, make it, remove the peel, or discard it

• Food that is taken from the sea should be cooked properly; after fruits and vegetables are brought, clean them. 
• Consume only freshly made home-cooked meals.

5. Keep it clean

• Utensils used for preparing food and toilets after use should be kept clean by deploying soap and water. The bathroom area and washing clothes area should be 100 feet away from each other.
• After all the cleaning has been done, discard the dirty water and wash your hands properly.

Complications of Cholera

Cholera can cause excessive diarrhoea and vomiting, resulting in the loss of important substances in the body.

• Electrolytes
• Fluids
• Sodium
• Potassium

Insufficient levels of these substances can lead to dehydration and various symptoms:

• Dryness in eyes, nose, and mouth
• Increased heart rate
• Potassium levels falls (hypokalaemia)
• Low blood pressure (hypotension)
• Reduced elasticity of the skin

If left untreated, severe dehydration caused by cholera can lead to serious complications:

• Kidney failure
• Shock
• Coma
• Death.^1,3

Research facts about cholera

• In 2020, a total of 323,369 cases and 857 deaths were reported from 24 countries.⁹
• Millions across the world get cholera infection every year.¹
• Cholera outbreaks are commonly seen in warmer climates.¹
• Salty rivers and coastal area water is the habitat for cholera-causing bacteria.¹
• With well-timed rehydration therapy, more than 99% affected will recover. That is why rehydration is the most vital treatment for cholera. ⁵

Disclaimer: The information included on this site is for educational purposes only and is not intended to be a substitute for medical treatment by a healthcare professional. Because of unique individual needs, the reader should consult their physician to determine the appropriateness of the information for the reader’s situation.

FAQs

Reference

1. Cholera: Symptoms, Causes, Treatment & Prevention [Internet]. Available from: https://my.clevelandclinic.org/health/diseases/16636-cholera

2. Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic Vibrios – Medical Microbiology – NCBI Bookshelf [Internet]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK8407/

3. Illness and Symptoms | Cholera | CDC [Internet]. Available from: https://www.cdc.gov/cholera/illness.html

4. Sources of Infection & Risk Factors | Cholera | CDC [Internet]. Available from: https://www.cdc.gov/cholera/infection-sources.html

5. Rehydration Therapy | Treatment | Cholera | CDC [Internet]. Available from: https://www.cdc.gov/cholera/treatment/rehydration-therapy.html

6. Antibiotic Treatment | Treatment | Cholera | CDC [Internet]. Available from: https://www.cdc.gov/cholera/treatment/antibiotic-treatment.html

7. Zinc Treatment | Treatment | Cholera | CDC [Internet]. Available from: https://www.cdc.gov/cholera/treatment/zinc-treatment.html

8. Five Basic Cholera Prevention Steps | Cholera | CDC [Internet]. Available from: https://www.cdc.gov/cholera/preventionsteps.html

9. Cholera [Internet]. Available from: https://www.who.int/news-room/fact-sheets/detail/cholera