Tue. Sep 17th, 2019

Cholera Infection Sheet

3 min read
Globally, cholera cases have increased steadily since 2005 and the disease occurs predominantly in Asia and Africa, with periodic large outbreaks, most recently in Haiti and other parts of the Caribbean (Filion K et al. 2015). The higher incidence can be attributed to poor sanitation and remote access to clean and safe drinking water.

 

Name of diseaseCholera
Name of causative agentVibrio cholera O1 or O139 (WHO facts on Cholera).
  Gram reactionGram Negative
  MorphologyCurved rods
Epidemiology
  Geographic prevalenceGlobally, cholera cases have increased steadily since 2005 and the disease occurs predominantly in Asia and Africa, with periodic large outbreaks, most recently in Haiti and other parts of the Caribbean (Filion K et al. 2015). The higher incidence can be attributed to poor sanitation and remote access to clean and safe drinking water.
Average rates of                             infectionAn estimated 2.86 million cholera cases (uncertainty range: 1.3m-4.0m) occur annually in endemic countries (Alim M et al, 2015).
  ReservoirReservoirs consist of contaminated water, intestinal tracts of animals and humans, soil, plants, and prepared foods (Bauman, 2015, p.723).
  Transmission modeFoodborne: Spread through ingestion of contaminated food or water (WHO cholera factsheet).
Pathology
  Major tissues/organsCholera is found along the Gastrointestinal tract. Bacteria binds to the intestinal lining of small intestine and humans to release a toxin.
  Major signs/symptomsSymptoms of cholera are   severe acute watery diarrhoea, profuse diarrhea (Looseness of bowl movement) and vomiting of clear fluid (Zafar M et al.2016). Dehydration, Nausea are common in cholera.

Additionally muscle cramps, Dry mucous rate, increased heart rate can be seen.

  Complications?Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as: Low blood sugar (hypoglycemia). Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death.
Latency?It takes between 12 hours and 5 days for a person to show symptoms after ingesting contaminated food or water. Median incubation period of toxigenic cholera is 1.4 days. Five percent of cholera cases will develop symptoms by 0.5 days and 95% by 4.4 days after infection (Azman AS et al 2013).
Treatment
  Main treatment methodsRehydration is  major treatment process. The majority of people can be treated successfully through prompt administration of oral rehydration solution (WHO factsheet). Rehydration is accomplished in 2 phases: rehydration and maintenance. Zinc supplements are also given for treatment.

In conjunction with hydration, treatment with antibiotics is recommended for severely ill patients as well as  those who are hospitalized. Doxycycline is recommended as first-line treatment for adults, while azithromycin is recommended as first-line treatment for childre,  pregnant women (CDC, 2015)

Typical length of treatmentAntimicrobial agents typically are administered for 3-5 days. Patient recovers in 6-8 days but weakness may remain for few more days.
  Prophylaxis?Currently there are three WHO pre-qualified oral cholera vaccines (OCV): Dukoral®, Shanchol™, and Euvichol®. All three vaccines require two doses for full protection (WHO cholera factsheet).
Interesting fact?Cholera was originally found in  Ganges delta in India during the 19th century. There have been six pandemics in which cholera spread to each continent. (Facts about cholera, Helen Barker blog).

 

References

  1. Ali, M., Nelson, A. R., Lopez, A. L., & Sack, D. A. (2015). Updated Global Burden of Cholera in Endemic Countries. PLoS Neglected Tropical Diseases, 9(6), e0003832. http://doi.org/10.1371/journal.pntd.0003832.
  2. Azman AS, Rudolph KE, Cummings DA, Lessler J (2013), The incubation period of cholera: a systematic review, The journal of Infection, 66(5):432-8
    Centers for Disease Control and Prevention. (2018). General information about cholera. Retrieved June 10, 2018 from this website: https://www.cdc.gov/cholera/general/index.html
  3. Fillion K, Mileno MD (2015), Cholera in travelers: shifting tides in epidemiology, management, and prevention. Current  Infectious Disease Report 17(1): 455
  4. Helen Barker blog, The Borgen project, Facts about Cholera, Retrieved June 10, 2018 from this website: https://borgenproject.org/10-facts-cholera
  5. World Health Organization (2018) Facts sheet about cholera, Retrieved June 10, 2018 from this website: http://www.who.int/news-room/fact-sheets/detail/cholera
  6. Zafar MZ, Gulzar H (2016) A Case Study: Cholera. Occup Med Health Aff 4:252. doi:10.4172/2329-6879.1000252
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