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Cholera : Symptoms, Causes, Treatment, Prevention and Diagnosis

Overview

One of the many bacterial diseases spread through contaminated water is cholera. The main symptom of the disease is diarrhea and dehydration. Left untreated, it can be fatal for all, including healthy people. 

Modern sewage and water treatment systems have almost eliminated cholera in most industrialized countries. However, you can find Cholera patients in countries such as Africa, Southeast Asia, and Haiti. The people of poverty-stricken, war-zone, and natural disasters live in crowded and inadequate conditions. Thus, increasing the risk of a Cholera epidemic. 

It is an easily treatable disease. Also, death from severe dehydration is stoppable with an easy and pocket-friendly rehydration solution.

What is Cholera? 

As mentioned earlier, cholera is a bacterial infection that spreads mainly through contaminated water. V. cholera bacteria is responsible for the disease and was discovered in 1883 by the German bacteriologist Robert Koch. 

During the epidemic in Egypt, Robert Koch studied the disease and found these bacteria in the intestines of deceased patients of cholera but failed to isolate the organism nor identify infected animals with it. However, later that year, it was in India that he successfully isolated the bacteria. His research discovered that these bacteria thrive in damp, dirty linens, moist earth, and Cholera patients’ stools. The bacteria also live in various other places, such as on the surface of water, plants, shells, and eggs of midges. 

When these bacteria enter poor and unsanitary habitation, the toxic strains generate a poison that causes violent diarrhea, causing a severe epidemic. The epidemic can be controlled with weather changes, reduced population, and improved sanitation. 

Cholera is Caused By

The leading cause of cholera is the presence of a bacterium known as Vibrio Cholerae. The toxins from the bacteria cause the body to eliminate a large amount of water from the body. Thus, causing diarrhoea and quick loss of fluids and electrolytes. It is present in the small intestine of cholera patients. 

People exposed to the disease may not notice any signs of illness. However, they are responsible for passing the bacteria from their stool, contaminating food and water supplies. The bacteria is present in:

  • Surface or well water: Contaminated public wells are the regular source of cholera outbreaks. Crowded areas with inadequate sanitation pose a higher risk of contamination. 
  • Raw or uncooked seafood: Eating raw or uncooked seafood, particularly shellfish, from a contaminated source can expose people to cholera. However, the most recent cases in the USA traces back to seafood from the Gulf of Mexico. 
  • Fruits and vegetables: Eating raw, unpeeled fruits and vegetables grown from contaminated areas is an infection source. Sometimes in developing countries, uncomposted manure fertiliser or unfiltered raw sewage mixed with irrigation water may contaminate the produce. 
  • Grains: In countries where cholera is prevalent, grains, including rice and millet, get contaminated after cooking. The bacteria grow in cooked grains and millet several hours after keeping it at room temperature. 

Cholera Symptoms 

Most infected people do not fall ill or are unaware that they are infected. However, they continue to spread the bacteria causing cholera through their stool for 7 to 14 days, contaminating the water and, thus, infecting others.

For some cholera-infected patients, symptoms of mild or moderate diarrhea appear. It becomes challenging to differentiate between cholera and other health problems that can cause similar symptoms. In non-severe cases, the patients notice signs of cholera within a few days of getting infected. The following are the symptoms of cholera:

  • Diarrhea: Diarrhea due to cholera appears suddenly and rapidly causes fluid loss, approximately 1 liter per hour – that could be dangerous. One of the ways to distinguish cholera-based diarrhea is that it often has a pale, milky appearance similar to rice-rinsed water. 
  • Vomiting and Nausea: In the early stages of cholera, a patient may experience vomiting that can last for hours.
  • Dehydration: It can quickly develop within hours of cholera symptoms and may be mild to severe. Fluid loss of 10% or more of the body indicates that the patient is severely dehydrated. Irritability, fatigue, sunken eyes, dry mouth, extreme thirst, dry and shrivels skin that bounces back slowly when pinched into a fold, little to no urination, low blood pressure, and an irregular heartbeat are all signs of dehydration. Also, dehydration leads to the loss of minerals responsible for maintaining a balance in the body’s fluid levels. The imbalance is called electrolyte imbalance.

Cholera Symptoms In Children

Children infected with cholera exhibit similar symptoms as adults. But may also experience other symptoms, such as:

  • Fever
  • Convulsions
  • Severe drowsiness
  • Coma 

When to See a Doctor

Industrialized nations are at significant risk of cholera. If you stay in an infected area, you are less likely to get infected when you strictly follow food safety recommendations. However, if you experience severe diarrhoea after visiting a cholera-infected site, immediately seek medical help and treatment. Note that severe dehydration needs immediate medical care.

Danger Signs 

In extreme cases, people with cholera can die of dehydration or shock. Apart from dehydration and shock, some other complications of cholera are:

Low blood sugar (hypoglycemia) – cholera can lead to excessive low blood sugar levels, which are caused when people are too ill to eat or drink. Hypoglycemia can lead to seizures, unconsciousness or even death, especially in children.

Low potassium levels – People suffering from cholera lose essential minerals like potassium through their stool—low levels of potassium damage the heart and nerve functioning, which can be fatal.

Kidney failure – During cholera, the kidneys lose their ability to filter, leading to a build-up of excess fluids, electrolytes and waste in the body.

Typical Signs of Dehydration 

Classical signs in a dehydrated person can be:

  • Dry mouth and skin
  • “Glassy” eyes with no tears
  • State of confusion, lethargy and sleepiness
  • Rapid pulse
  • Reduced or no urine
  • Thirst

Diagnosing Cholera 

The cholera bacteria can be detected through a stool test. Doctors use rapid cholera dipstick tests in remote areas to diagnose cholera. Quick confirmation will allow the government to take steps to control an outbreak of cholera.

Treatment of Cholera 

Cholera disease is caused by the cholera bacteria which requires immediate treatment to avoid complication.

  • Your doctor will prescribe Oral Rehydration Salts (ORS) for replacing lost electrolytes and fluids.
  • Intravenous fluids to control fluid loss.
  • Antibiotics like Doxycycline to control the cholera symptoms.

Prevention and Control 

Prevention

  • Drink sterilized or boiled water.
  • Avoid the use of ice cubes in drinks.
  • Boil milk before consumption.
  • Eat well cooked and hot food.
  • Avoid consuming raw fruits, vegetables, fish or meat.

Control

Cholera can be controlled by following certain measures:

  • Provision of clean drinking water.
  • Good sanitation and hygiene at home.
  • Avoiding contaminated food.
  • Vaccination
  • Restricting the movement of people.
  • Giving antibiotics to a large number of people who are not sick or showing symptoms of cholera.
  • Restricting the import of food from affected areas.

Cholera Vaccine

If you are an adult travelling from the USA to cholera-affected regions, you will be given a liquid dose of vaccination named Vaxchora by mouth. You must take this vaccination at least ten days before travelling. However, it is crucial to take the necessary precautions to prevent contracting cholera after the vaccination. 

Several other countries also offer oral vaccinations. You have to contact your nearest doctor or a local medical officer of the public for more information.

What Are The Risk Factors of Cholera? 

Everyone is at a higher of contracting cholera. However, breastfeeding infants nursing from a previously infected mother is an exception. Certain factors make you likely to develop severe signs and symptoms of cholera. The following are the risk factors, such as:

  • Poor sanitary conditions: Cholera bacteria are known to thrive in unsanitary environments such as refugee camps, impoverished countries, and regions affected by natural disasters and calamities. 
  • Decreased or nonexistent stomach acid: The bacteria fails to survive in an acidic environment, such as stomach acid, as it is a barrier from infections. However, children, older adults, and people taking medications such as antacids, H2 blockers or proton pump inhibitors have decreased levels of stomach acids, leading to lowered protection and an increased risk of developing cholera.
  • Household exposure: Your risk of cholera increases if you live with a cholera patient.
  • Type O blood group: individuals with type o blood are two times more prone to develop cholera than any other blood type for unknown reasons.
  • Raw and undercooked shellfish: eating raw and undercooked seafood, particularly shellfish from cholera-contaminated water, is at risk of developing cholera. 

What are the Complications of Cholera?

In severe cases of cholera, it can rapidly become fatal. The rapid loss of fluids and electrolytes may lead to death within hours. However, not severe cases, people failing to receive treatment die due to dehydration and shock either hours or days after the symptoms start to appear. Shock and death are major complications of cholera, other complications include:

  • Decreased blood sugar level: Also known as hypoglycemia, the blood sugar levels fall dangerously low when patients are too sick to eat. Sugar or glucose provides the primary energy source to the body. Children are at an increased risk of developing this complication that may cause seizures, unconsciousness, and sometimes death.
  • Low potassium levels: Cholera patients often rapidly lose fluids and minerals, including potassium, through their stools. Therefore, low potassium levels cause heart and nerve functioning issues and are more likely to become life-threatening. 
  • Kidney failure: When kidneys fail to perform the filtering process, excess fluids and electrolytes build up, causing a possible life-threatening condition. Cholera patients with kidney failure often experience shock.

Conclusion

Although you can get infected by cholera from unsanitary environments and contaminated water, it is crucial to maintain necessary precautions. However, you are a cholera patient, and immediate medical attention is vital to get quickly treated and prevent cholera from becoming life-threatening. 

FAQs

How can I protect myself if I plan to be in an area with cholera?

If you plan to visit a cholera-affected area, you must maintain preventive measures, such as 

  • Use safe drinking water to brush, cook food, or make ice
  • Often wash your hands with clean water and soap
  • Use toilets or bury your stool. However, avoid using water bodies when you pass motion. 
  • Eat well-cooked hot food and peel fruits and vegetables 
  • Regularly clean kitchen counter and floor and bathroom areas as well.

Does cholera still exist?

Cholera still exists in countries such as Africa, Haiti, and Southeast Asia.

Why is cholera The Blue death?

Yes, cholera is the blue death. It is another name for cholera as the patients of cholera turn blue from severe fluid loss.

Which country is most affected by cholera?

The major cholera outbreak is reported in Afghanistan, Bangladesh, the Democratic Republic of Congo, Ethiopia, and Nigeria. 

Which bacteria are responsible for cholera?

The vibrio cholerae bacteria is responsible for cholera.

Which food is good for cholera?

As cholera causes dehydration, liquids that replace the electrolytes and salts can be consumed. A patient should be given lots of water, soda and coconut water throughout the day.

How is cholera transmitted?

Cholera is transmitted from human to human through faeces and contaminated water.

References:

https://www.askapollo.com/symptom/cholera/delhi

https://www.apollohospitals.com/patient-care/health-and-lifestyle/our-doctors-talk/infections-after-rains/

https://www.apollohospitals.com/patient-care/health-and-lifestyle/understanding-investigations/stool-culture-test

https://www.apollohospitals.com/patient-care/health-and-lifestyle/diseases-and-conditions/cholera/

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Verified By Dr Amitav Mohanty
MBBS, MD -Medicine, Senior Consultant - General Medicine, Apollo Hospitals Bhubanswar
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