Cholera is a serious infectious disease caused by a bacterial infection that usually lies in contaminated water. In fatal cases, it causes a severe level of diarrhea and dehydration that can lead to death within hours if immediate treatment care is not provided on time. The cholera disease can be caught even to a person who was quite healthy before the occurrence of this contaminated water-induced infection.

Cholera emerged as an outbreak quite earlier time when there was a scarcity of good and well-managed water and sewage systems. It was prevalent in the U.S. during the 1800s however now with the emergence of much advanced, modernized water treatment and sewage system cholera is almost eliminated in many countries along with such a well-managed system.

Now only about ten cases of cholera disease reported in the U.S. in a year and half of these cases belong to contamination acquired from abroad mostly from underdeveloped or developing countries travel. The disease is still problematic in Asia, Africa, Latin America, and Middle East countries. Areas that are affected with natural or human-made disasters such as wars, natural calamities, and more than the average population below the poverty line, have a greater risk of developing this infectious disease.

This particularly happens because people over there are forced by circumstances to live in crowded areas where there is an immense lack of sanitation that gives a natural boost to the growth of cholera causing bacteria and infection thereon in the mass population. Cholera is a treatable condition even in its serious cases with simple and less expensive rehydration solution. People who are about to travel in areas which are known for active cholera threat such as highly crowded places, poor sanitation, war, and famine should take care of their foods and drinks in order to prevent their risk of contracting this bacterium infectious disease.

Causes

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Cholera is an infectious disease caused by a bacteria known as Vibrio cholera. The severe symptoms of this disease occur as a result of a hard toxin called CTX that is released by these bacteria in the affected person’s small intestine. This particular harmful toxin interferes with the normal flow of sodium and chloride in your body when it attaches itself to the intestinal walls.

After the attachment of these bacteria in the small intestine’s wall, your body starts releasing an excessive amount of fluid that leads to diarrhea, the rapid loss of fluids, and electrolytes.

Contaminated water supplies are the primary source of these cholera causing bacteria that makes a person infected when they drink this impure water. Apart from this, raw and improperly cooked foods like fruits, vegetables, and seafood are other sources of this bacteria that can make a person infected with this infectious disease after its intake.

Some common contaminated water supplies that are the primary source of the bacteria responsible for the cholera infection include contaminated public wells, ponds, highly crowded places with inadequate sanitization, etc.

Areas where cholera is widespread the grains like rice and millet usually contaminates after cooking if kept at room temperature for many hours as the cholera bacteria grows in it and makes people infected when they eat these foods. Cholera disease usually does not spread from one person to another through a casual contact however an infected person’s stool can contaminate the food and water supplies as these bacteria usually pass through the stool.

Symptoms

In the majority of cases, people who develop cholera infection do not develop any symptoms of illness. In many cases, people even remain unaware that they have been exposed to cholera infection. Once a person contracts this infection he or she will continue shedding the cholera bacteria in their stool for at least 7 to 14 days.

It usually causes mild to moderate level diarrhea as it happens in many other illnesses. One out of ten people who contract cholera infection starts developing its typical symptoms within 2 to 3 days of this infection. The common symptoms of cholera disease include-

Diarrhea
Nausea
Vomiting
Mild to severe dehydration

The rapid loss of excess fluids and salts from the body leads to many associated health issues including weakness, tiredness, dry mouth, excessive thirst, sunken eyes, reduced urine quantity, shriveled skin, low blood pressure, and irregular heartbeat. Extreme dehydration causes loss of minerals in the blood leading to electrolyte imbalance. This causes a severe level of muscles-cramp. If electrolyte imbalance does not control on time it can lead to shock.

Children infected with cholera disease usually develop the same symptoms as the adults, however, they may also develop some additional symptoms including fever, severe drowsiness, coma, and convulsions.

Risk Factors

Every individual has the risk to develop cholera disease if they come in contact with contaminated water excepting infants who get immunity from their nursing mothers who have past history of cholera disease. However certain factors make you more susceptible to develop this infectious disease with its severe symptoms. The risk factors for cholera disease include-

Poor Sanitary Environment

Contaminated water or non-sanitized environment is more likely to increase the risk of developing cholera disease of a person who lives in such poor sanitary place. Places where there is a scarcity of safe water supply, or it is difficult to maintain the same, have a high risk of cholera infection. The sanitization related problems are very common in refugee camps, areas affected by war, natural disasters, famine, and impoverished countries.

Insufficient Stomach Acid

The bacterium that causes Cholera disease cannot survive in an acidic environment. In general, the human stomach acidic content works as a defense mechanism against cholera bacteria. However, it gets problematic for those who have an insufficient level of stomach acids such as older adults, children, and those who are taking H-2 blockers or proton pump inhibitors and antacids. Their body lacks this natural defense mechanism increasing their risk of cholera disease growth.

People Living with Infected Partner or Family Member

People living with a partner or a family member who has diagnosed with cholera disease have greater exposure to this infectious disease.

Type O Blood Group People

With unclear reasons, people with type O blood groups are highly susceptible to develop cholera disease with a comparison to other blood group people.

Raw or Half-Cooked Shellfish Intake

Usually, sea fishes do not contain the risk of causing Cholera disease, especially in industrialized nations. However, if someone eats raw or undercooked shellfish derived from the water bodies known for harboring the bacteria then their risk of developing cholera increases.

Complications

In severe cases or symptoms of cholera disease, it can be fatal containing the risk of death and major organs failure in the affected person. The complications associated with severe cases of cholera include rapid fluids and electrolytes loss that leads to death as faster as within two to three hours.

Also in general cases, if the patient is not provided with appropriate treatment on time then the affected patient can die due to excessive dehydration in body and shock as faster as within 18 hours of the onset of the symptoms.

Apart from shock and serious diarrhea which are the two most common complications of cholera disease, some other health complications may also occur including-

Kidney Failure- The kidney loses its filtering ability which is its primary and important function needed for the overall health of the body. As a result of these high amounts of fluids and waste products, a build-up occurs internally which is a life-threatening condition. The kidney failure health condition in cholera patients remains accompanied by shock.

Low Blood Sugar Level- The rapid loss of fluids from the body leads to low blood sugar or glucose level which is the primary source of energy for the human body. This condition also occurs under the condition where the patient is extremely ill to eat something that can fulfill his or her necessity of glucose level in the body. Children are more susceptible to develop this complication that can lead to unconsciousness, seizures, and even death risk.
Low Potassium Level- As a result of rapid fluids and electrolytes loss from body people with cholera health condition lose enough amounts of healthy minerals including potassium through their stools. The very low potassium level in the body interferes with heart and nerve function that increases the death risk in the affected person.

Diagnosing and Treatment

If you are noticing the symptoms of cholera as discussed above you should immediately contact your doctor for avoiding the risk of the complication. The doctor will ask you for the stool sample test as its testing will help in identifying the bacteria responsible for cholera symptoms growth and its associated health impacts.

Once the doctor gets confirmed about cholera disease they will start their treatment procedure accordingly to control and relieve your symptoms. The main aim of treatment remains to add the loss fluid and electrolyte level in the body to balance it at a normal level for stabilizing your health status. The patient’s body is rehydrated with oral salts and intravenous fluid supply. These rehydration methods help in shorting the length of diarrhea which otherwise can last for a very long duration causing serious health impacts.

It is the major dehydration that causes death among cholera patients. This is the reason why once a patient started developing the signs of cholera disease they should immediately be provided with Oral Hydration Solution (ORS) also known as Oral Rehydration Therapy (ORT). This liquid solution will remain consists of a large amount of water mixed with sugar and salt blend.

The ORS packets you can easily avail over-the-counter at any drug store without showing any prescription. However if it is not available which may be possible in the cases of developing countries where the widespread distribution of these prepackaged mixtures is limited, in that case, it can even be prepared at home without any difficulty.

Simple household ingredients like purified water, salt, and sugar are enough to prepare your own ORS recipe which will not only be a cost-effective but handy solution where commercial prepackaged mixtures are not available.

In the fatal cases of cholera with severe symptoms, intravenous fluid replacement is required to stabilize the patient’s health. An adult person with 70 kg weight, needs a minimum of 7 liters of intravenous fluids to replenish the fluid loss.

The application of antibiotics can reduce the illness duration and intensity but the WHO prohibits the mass usage of antibiotics for the cholera patient as it increases the risk of bacterial resistance in the patient which is harmful to future health.

The reason why patients are not given anti-diarrheal medicines is that it prevents cholera causing bacteria from flushing out of the body through the stool. However, the good news about the cholera disease is that with proper care and treatment the fatality rate associated with this disease is only 1 percent.

Prevention

The cholera infection rate is not very high as with comparison to other infectious diseases worldwide. In the United States, Cholera is a rare disease and the cases which are prevalent are related to travelers returning to the U.S. from outside countries. Some cases are related to the consumption of contaminated and inappropriately cooked seafood derived from Gulf coast waters.

You risk of contracting cholera increases if you are planning to travel in an area where there is a lack of proper sewage system leading to contaminated water presence and cholera outbreak. However, with some active precaution measures you can reduce this risk to a very great extent, mentioned below:

Drink Only Purified Water- Contaminated water is the primary source of cholera causing bacteria. So to avoid your risk of developing cholera you must drink only safe purified sealed water or drink only self disinfected or boiled water during your stay in places known for the cholera outbreak. Also even for brushing or mouth rinsing purposes use only bottled water. Hot beverages such as canned or bottled drinks are safe however before gulping them wipe the outside of the bottle and then drink it. Do not use ice in it if it is not prepared by you with safe or purified water.
Wash Your Hands Very Frequently- While on your travel to active cholera areas you should wash your hands more frequently than you do in your regular place. Wash your hands every time with soap or hand wash and water at least for 15 seconds before rinsing it. In case you do not have soap or water then sanitize your hands with an alcohol-based sanitizer.
Consume More Fruits and Vegetables that you can Peel Yourself- Avoid consuming already cut fruits and vegetables in the form of salad or fruits that can’t be peeled such as berries, grapes, etc. Instead of that, you should stick to fruits and vegetables that can be peeled by yourself such as oranges, avocados, bananas, etc.
Avoid Half or Improperly Cooked Fishes- Avoid consuming half or improperly cooked fishes including foods that use raw fishes for dressing purposes such as sushi etc. Similarly, improperly cooked fishes and seafood of all types are hazardous so its intake must be avoided.
Eat Only Fully Cooked and Hot Foods- Eat only foods that are properly cooked and hot. Self-prepared foods are the best solution to prevent your risk of contracting cholera disease while on your stay to cholera active areas. Avoid eating street foods as much as it is possible. However, if you have to buy food from a street vendor make sure the food is prepared in your presence properly.

Cholera vaccine

A vaccine known as Vaxchora is available in the US for adult people traveling to certain cholera affected areas from the United States. This is a kind of liquid dose that needs to be taken by mouth, a minimum of 10 days before your travel to outside of the United States. Apart from the United States some other countries also provide oral vaccines for cholera prevention.

People who are planning to travel in cholera active areas should consult with their doctor or local healthcare bodies regarding the availability of these vaccines in order to prevent their risk of contracting this infection. However, even if someone is taking this vaccine dose then also it is essential to follow the above-mentioned precautions measures in order to ensure a hundred percent safety of their health.

The cholera vaccine does not work as effectively as it should so even with vaccine people have little chances of contracting cholera. For this reason, awareness is the key to minimize a person’s risk of developing cholera disease if they are going to a country where there is an active cholera threat.

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Cholera: Causes, Symptoms, Diagnosis And Treatment