Cholera : Causes, Symptoms, Diagnosis and Treatment

Cholera refers to the bacterial disease that spreads due to the use of contaminated water. The condition can trigger severe diarrhea and subsequent dehydration. So, the disease can cause severe complications. Without proper treatment, the disease can prove fatal within a few hours. A previously healthy person can see the deterioration of their health within a few hours. While modern sewage systems and water treatment have eliminated the disease in several industrialized countries, the condition is still prevalent in several developing countries. Therefore, the disease also known as blue death exists in several parts of Africa, Haiti, and Southeast Asia.

The risk of the blue death epidemic is high when a natural disaster, war or poverty strikes. It is because during such conditions people live in a crowded condition with poor hygiene and without adequate sanitation. It is easy to treat the bacterial infection. But, timely intervention is necessary to prevent severe dehydration. Even simple and inexpensive rehydration solution at home can reduce the severity of the disease. Want to know more about the disease? Then, read ahead.

History Of Cholera

choleraCholera is one of the oldest diseases affecting humans for many centuries. Reports indicate the presence of the disease in India in 1000 AD. The term is derived from the word Khole, which means illness and bile. Later in the 14th century, French termed it as colere and English referred to the illness as choler. The term cholera came into existence in the 17th century to describe the severe gastrointestinal disorder. The disease, causing severe diarrhea and vomiting plagued people for several centuries. Historical writings indicate the presence of the illness. Several documents suggest multiple blue death outbreak in different parts of the world, resulting in the deaths of a large number of people. It is one of the deadliest diseases affecting people on the planet and still exists in different parts of the world.

About Cholera

Dr. John Snow performed a study to learn more about the disease. He studied one of the major water sources known as Broad Street Pump to know the exact cause of pandemic that caused 500 deaths in ten days. While Dr. Snow never discovered the cause of the disease, he became successful in uncovering the mode of transmission of disease and the methods to stop a local outbreak. The disease is caused by a bacteria known as Vibrio Cholerae. Filippo Pacini became successful in isolating the bacteria causing the disease in 1854. But, his discovery remained uncovered, until Robert Koch brought it to light. Robert Koch discovered the actual cause of tuberculosis in people. He also offered guidelines to fight the disease. But, the recent breakout of the disease in Yemen during 2017, resulting in five lakh people becoming affected reveals the presence of the disease in recent times.

Why Cholera Has The Name Blue Death?

Cholera is referred to as blue death. Do you know why? It is because people who suffer from the disease show a blue tint on their skin due to the bacterial infection. While the disease has different names, it is usually known as blue death among people. People in France used to refer to the disease as Dog death. The other names include blue terror and black cholera. But, while the name invokes fear in your minds, it pales in comparison to the actual effects the disease has on your body. A normal adult body holds forty-four liters of water. The water content is distributed in your different parts of the body among the organs and cells. Due to the bacterial infection, the rate of acceleration of water discharge increases. So, from day one the affected person feels worse.

Why Cholera Has The Name Blue Death

Blue death can cause loss of up to twenty liters of water within a day. So, a person who feels healthy in the morning can feel disastrous side effects after the onset of the disease. You may not receive any prior indication of the disease. As soon as the bacteria activates, you can see the deadly effect. Within a few hours, you can go into shock and suffer from severe complications. Without proper medical treatment, an infected person can succumb to death within twelve hours. With severe loss of water, your body can see changes. Your skin starts to lose its elasticity, eyes sink, and the teeth protrude. Since the blood becomes thick, your skin turns blue. So, the blue appearance of your skin due to dehydration makes people refer to the disease as Blue Death.

Symptoms Of Cholera

Symptoms Of Cholera

The bacterium V. cholerae causes the disease. So, when people become exposed to the bacteria without realizing their exposure or infection. Since the infected person can shed the bacteria in their stools for seven to fourteen days, the chances of infecting others through contaminated water increases. The person suffering from blue death suffers from mild to moderate diarrhea. Since it is difficult to differentiate diarrhea caused by a bacterial infection and loose stools caused by other problems, you need to consult a doctor for proper evaluation. Others develop serious signs and symptoms within a few days of the infection. The symptoms associated with cholera include:

Diarrhea

Diarrhea caused due to bacterial infection comes on suddenly as a result of dangerous fluid loss. So, people suffering from the infection can see the loss of about one liter (a quart) in an hour. Loose stools have a pale milky appearance that resembles the water you see after rinsing rice.

Nausea/Vomiting

Loss of fluid from your body can also occur when you vomit. Nauseous feelings or vomiting can occur during the early stages of the infection. The condition lasts for several hours.

Dehydration

Within hours of contracting the infection, you see the symptoms. The mild to severe symptoms include loss of fluids from your body. When your body loses around 10% of the fluid or more, then you can suffer from severe dehydration.

Electrolyte Imbalance

Severe dehydration can result in the rapid loss of minerals from your bloodstream. Since minerals are necessary to maintain the fluid balance in your body, the loss can result in electrolyte imbalance.

Muscle Cramps

The rapid loss of salts from your body can cause aches and pain in the muscle. So, you can suffer from pain and discomfort due to loss of sodium, potassium, and chloride.

Shock

It is one of the most serious complications of dehydration. Shock occurs when the low blood volume results in a drastic drop in blood pressure. So, it also results in the drop of oxygen amount in your body. Without treatment, the condition can result in severe hypovolemic shock, which results in death within minutes.

Other Signs

The other signs of the disease include the following:

See A Doctor For Cholera

The risk of cholera in countries with better sewage systems and water treatment facilities is less. Even in an area with the outbreak, you may not suffer from the problem when you follow food safety recommendations. But, if you develop diarrhea after visiting any of the regions known for active blue death infection, then see a doctor immediately. Severe diarrhea needs immediate medical attention as it can cause dehydration and put your life at risk. Severe dehydration is a medical emergency requiring immediate medical attention.

Causes Of Cholera

A bacterium called Vibrio cholerae causes cholera infection. The deadly effects of the disease are the result of a toxin the bacteria produces in the small intestine. The toxin causes the body to secrete enormous amounts of water, leading to diarrhea and a rapid loss of fluids and salts (electrolytes). While all people who are exposed to the bacteria may not suffer from the disease. But, they still can pass the bacteria and contaminate water supplies as well as food. So, the main sources of infection in people can occur in the following ways:

Surface/Well Water

When you drink water from contaminated public wells it increases your disease. The contaminated well can cause large-scale outbreaks of blue deaths. People living in large crowded areas with adequate sanitation are at risk of the disease.

Eating Seafood

Eating raw or undercooked seafood can increase your risk of the disease. It is especially high in people who eat shellfish that come from areas contaminated with the bacteria causing blue death. In countries like the USA, the outbreak of blue death occurred due to consuming seafood obtained from the Gulf of Mexico.

Raw Fruits And Vegetables

Raw and unpeeled fruits, as well as a vegetable, are the frequent source of blue death in the areas with frequent outbreaks. Along with that, developing countries with irrigation water consisting of raw sewage or un-composted manure fertilizers trigger contamination of the vegetable/fruit produce in the field.

Grains

In places suffering from the outbreak of cholera, food grains like millet and rice can become contaminated after cooking it. By keeping the cooked food grains at room temperature for a long time can offer a favorable environment for the bacteria causing the disease to grow.

 Risk Factors Linked To Cholera

While every person is susceptible to blue death, some people are more susceptible to the disease. Infants with mothers who previously suffered from cholera have immunity to the disease. They receive immunity through breast milk. The factors that make you more vulnerable to the disease or suffer from severe signs, as well as symptoms, are:

Poor Sanitary Conditions

The bacterial disease can affect people who live in poor hygienic conditions with bad sanitary conditions. It is because the bacteria causing the disease can flourish in areas with difficulty to maintain the safe water supply. The condition is common in improvised countries, refugee camps, and areas of the world affected by natural disasters or famine.

Nonexistent/Reduced Stomach Acid

The bacteria causing the disease cannot survive in an acidic environment. In normal cases, ordinary stomach acids offer people defense against infection. But, people having low stomach acid can suffer from bacterial infection due to the lack of protection. So, the following people are more at risk of the problem:

  • Small children
  • People with advanced age
  • Individuals taking proton pump inhibitors or H-2 blockers

Household Exposure

If someone from your household develops the disease, then you are more at risk of getting it. So, when someone you live with has the disease, then you face enhanced risk.

 Type O blood

While reasons are not clear, people with type O blood have a greater risk of developing bacterial disease twice as likely compared to people with other blood types.

Eating Raw/Undercooked Shellfish

Several industrialized nations have eradicated blue death outbreaks from their country. But, the possibility of developing the disease by eating raw or undercooked shellfish from waters known to harbor the disease-causing bacteria. Consuming such raw seafood can increase your risk greatly.

Complications Due To Cholera

Since blue death can quickly become a fatal condition, you need to maintain caution. People who suffer from severe cases of the disease can experience a rapid loss of fluids from their bodies. It can result in electrolyte imbalance and death within hours. In less severe cases, people who fail to get proper treatment can die from a complication of dehydration. They can suffer from shock within hours or days after the first symptoms of the disease appear. While shock and severe dehydration as the worst complications of the disease, people can also suffer from other complications like:

Hypoglycemia

It is the medical term for low sugar. Like high sugar can cause severe health complications, dangerously low sugar levels of glucose (blood sugar) can cause great risk. Since glucose is the main source of energy in people, low sugar levels can cause illness. You find it difficult to eat or perform any task. The condition causes great complication in children as they can experience the following:

  • Unconsciousness
  • Seizures
  • Death
  • Low Potassium Levels

When people suffer from blue death, they lose a large number of minerals like potassium from their bodies through their stools. The low levels of potassium can interfere with several body functions like nerve a heart function. So, it results in life-threatening complications.

Kidney Failure

Due to losing excess body fluids, the kidneys lose their filtering ability. As the kidneys fail to filter the waste, electrolytes, and fluids, it accumulated in your body. So, you can suffer from severe complications like shock and kidney failure. It is a deadly side effect associated with the disease.

Diagnosis Of Cholera

While the signs and symptoms associated with the condition alone can point towards the disease. Especially, if it affects people in the areas with the unmistakable presence of blue death. But, a confirmed diagnosis is possible only by identifying the bacteria in the sample of stool provided by the affected person. Other tests like Rapid cholera dipstick allows doctors in remote areas to quickly confirm the diagnosis. With quick confirmation, it is possible to decrease the death rates due to the outbreak of the disease. Early diagnosis can aide in swift public health intervention for better outbreak control.

Treatment For Cholera

When you suffer from blue death, it requires immediate treatment. It is because the condition can cause death within hours. It is a treatable disease, but escalates quickly due to dehydration. So, getting treatment immediately can offer relief. Hydration is the mainstay treatment option available for the condition. Depending on the severity of diarrhea suffered by the affected person, your doctor decides a treatment. It consists of an oral or intravenous solution to replace lost fluids from your body.

Ensure Rehydration

Ensure Rehydration

For replacing the severely lost fluids as well as electrolytes from your body, your doctor suggests a simple rehydration solution. Also known as ORS (oral rehydration solution), it can maintain the electrolyte balance in the body. The ORS solution is available in a powder that you can make it easily with boiled or bottled water. Since dehydration is the main cause of death in people suffering from blue death, rehydration is an effective treatment option. Rehydration alone can drop the fatalities rates to less than 1%.

Give Intravenous Fluids

Most people suffering from blue death can get well with rehydration alone. But, in the case of severely dehydrated people, they need intravenous fluids to avoid any severe complications.

Prescribe Antibiotics

While it is not the standard part of the treatment, your doctor can prescribe antibiotics to reduce its severity. Taking antibiotics reduces the duration and severity of diarrhea in severely ill people.

Take Zinc Supplements

Several studies have suggested the positive effect of zinc supplements on diarrhea. So, taking zinc supplements as suggested by the doctor can reduce the fluid loss due to loose stools and shorten its duration, especially in children.

Preventing Cholera

Cholera is not prevalent in all parts of the world. So, people get affected by the disease when they visit or reside in such areas. When you are in areas known for blue death cases, you need to become aware of the basic facts to prevent the disease. It will protect you and your family from the disease. While the risk of getting the disease is low for people who visit such an affected area for a short time, you need to take precautions. With ample caution, you can prevent any chance of contracting the disease. Most people suffer from the problem when they drink contaminated water or consume improperly cooked seafood. Therefore, such people need to follow the steps to avoid the risk of contracting the disease:

Wash Your Hands

hand sanitizer
Source: Amazon.com

You need to wash your hands properly and frequently with soap and water. It is necessary, especially after you use the toilet and before you start handling food. Follow the proper washing routine. You need to wet your hands with water and use soap. Rub the hands together for at least fifteen seconds before rinsing it well with water. In the areas where you have no access to soap and water, use a hand sanitizer with 60% alcohol.

Drink Safe Water

When you drink water, make sure it is safe. So, either use only bottled water when you travel out or use water you have boiled/disinfected yourself. Use only safe water for brushing, making ice, or cooking. You can get bottled water with a broken seal, which is unsafe. So, only opt for bottled water without a broken seal or bottled/canned carbonated drinks. Use only clean and safe water to clean the utensils in the kitchen as well as the preparation area to avoid contamination. You have to use soap and safe water to clean and allow it to dry completely before reuse.

Use Hot/Boiled Water

Generally, hot beverages are safe to drink. So, apart from canned or bottled drinks, you can use hot beverages. When you use canned or bottled drinks, try to wipe the outside before opening it. Try to use water boiled for one minute or higher when you are at a higher elevation and filter it. Use a commercial chemical disinfectant to make it safe. Use ice that you make using the safe water with your drinks.

Avoid Raw Food

You need to eat food that is completely cooked and hot.  Here are some of the pointers you need to follow to avoid any chances of complications:

  • Eating street food can increase the chances of blue death due to contamination. If you opt to buy a meal from the street vendor, then only eat food cooked in your presence and served piping hot.
  • Avoid raw meat or seafood of any kind. So, try not to eat sushi, improperly cooked food, and undercooked meat/shellfish. Since fish caught in tropical reefs have high levels of contamination, avoid them.
  • Stick to vegetables and fruits, which you can peel yourself. So, include orange, bananas, etc. Stay away from unpeeled fruits and vegetables.
  • Using unpasteurized milk and milk products increases your chances of getting cholera.

Cholera Vaccine

Cholera Vaccine

Several countries in the world like the United States of American make it necessary for its citizens who are traveling to areas affected by cholera to get the vaccine. The FDA approved the oral vaccine, Vaxchora can prevent bacterial disease if taken ten days before they travel. The vaccination offers 85% protection for the first six months after taking the vaccination. While the percentage of protection offered decreases as time passes, the vaccine can protect people for at least two years. In some countries injectable vaccine for the disease is available. The vaccine is available in the attenuated and inactivated form. So, talk to your doctor or public health department to know more about the vaccine.

Conclusion

You can several instances of cholera around the world from time to time. So, why is history repeating? The disease occurs when you eat or drink contaminated food and water. Food and water containing V. cholera can easily and rapidly transmit to different people. Until every person on the planet has access to safe and clean drinking water as well as food, the outbreaks of the disease will continue to happen. People, local authorities, and government need to work together to make the basic needs like clean water and food easier to access.

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