Cholera

Cause

Cholera is caused by eating food or drinking water that is contaminated with the cholera bacterium (Vibrio cholerae). This bacterium produces a toxin (enterotoxin), which stimulates the intestinal wall to produce large amounts of moisture. Malnourished people are much more susceptible to having this disease. People can also be infected via contact with feces or vomit from a patient. Under poor sanitary conditions, these bacteria can survive well and spread. This can especially occur after disasters and in wartime, when large quantities of people live together in camps with inadequate sanitary facilities.

Symptoms

After infection, it takes one to five days before the first symptoms occur. It starts with vomiting, diarrhea and abdominal pain. The stools come in large quantities (sometimes up to forty times per day) and is watery. The moisture loss is huge and a life-threatening situation may occur. During epidemics, there are also lots of milder cases. Depending on the nutritional status at the time of the onset of the disease, the mortality rate can be as much as seventy-five percent.

Diagnosis

The diagnosis of cholera is made on the basis of physical examination and identification of the bacterium concerned. A stool sample or a smear of the rectum is sent to a laboratory where a culture is developed. The diagnosis is confirmed when the cholera bacterium has been identified by microscopic examination of the stool sample.

Treatment

The treatment includes administration of oral rehydration fluid to stop dehydration and optionally antibiotics. If the patient cannot take the fluid, an infusion is required. Since 2004, a vaccine is available against cholera. This vaccine prevents about eighty-five percent of cholera infections. Given the small chance of getting cholera, there is basically no indication for travellers to take this vaccine prior to the trip. Exceptions are people going to work in a refugee camp and likely may not have boiled or bottled water available.

Prognosis

Cholera can have a very serious course and lead to death within hours. However, with rapid and appropriate treatment, the risk of death is low, about one percent. The severity of the disease is highly dependent on the health and nutritional status. However, the disease usually has a mild course.

Considerations

• Cholera is especially contracted in areas at risk, such as refugee camps. Try to avoid these places.
• Pay attention to hygiene, use bottled or boiled water, wash hands regularly with water and soap, don’t eat raw food (fish, salad), peel fruits and don’t buy any food or drink along the street.
• Most important when cholera is suspected, is to ensure that the patient receives plenty of fluid and salts. This is best done with ORS (Oral Rehydration Solution). This is available almost everywhere and can also be made by yourself. Do this by dissolving eight teaspoons of sugar and one teaspoon of salt in one liter of clean water. Drink a lot of this (liters) in case of severe diarrhea.

Facts

• The cholera bacterium was discovered in 1883 by the German doctor Robert Koch.
• The term ‘cholera’ is derived from the Greek word kholérā. That was an indication for various types of abdominal symptoms and diseases of the digestive organs, including the ‘real’ cholera.
• The worldwide prevalence of cholera is 0.04%.
• The disease is most common in infants and the elderly, who are physically more vulnerable.