Cholera is a disease caused by drinking water and eating food that is contaminated with a bacterium known as Vibrio cholerae. It is characterized by vomiting, severe diarrhea and loose skin among other symptoms. Severe diarrhea usually leads to dehydration because of extreme loss of electrolytes and fluid which might lead to death if not treated. Even though cholera is easy to manage, people are getting infected and die from it. For example, since January 2019 at least 890 cases of cholera have been reported in Kenya including 4 deaths. These cases have been reported in the counties of Kajiado, Narok, Nairobi, and Garissa. For this reason, it is important to understand cholera in detail to know the causes, symptoms, treatment, and measures to take when there is an outbreak.
As mentioned, cholera is caused by ingesting food and/or water contaminated with Vibrio cholerae. This bacterium thrives in dirty, damp, and moist environments as well as in the stools of patients diagnosed with cholera. Although V. cholera bacteria live in shallow and salty water on tiny crustaceans, they also dwell in colonies of biofilms that often coat the surface of plants, water, shells, stones, and similar items. The strains of this bacterium are toxic as they produce a poison that prompts severe diarrhea in human beings. When the V. cholera bacteria find their way to where humans live, they quickly cause extreme epidemics. That is the reason cholera is among the few diseases whose outbreak is declared in an area immediately one person is diagnosed. Overall, the V. cholera bacteria are often present in water or food contaminated by feces from an individual with the infection. Therefore, people should be careful with the following sources;
- Water supplies from a single source such as municipal or city council water supply
- Drinks and foods sold by street vendors
- Ice made from municipal/city/county water
- Raw or undercooked seafood and fish caught in waters contaminated with sewage
- Vegetables grown close to contaminated water or irrigated using water that contains human wastes
- Swimming pool contaminated with sewage water or feces of cholera patients
Cholera symptoms may show up a few hours after infection or may take up to five days to be evident. In most cases, symptoms are minor, but sometimes they may be severe. Approximately 1 in 20 infected people shows severe symptoms that are characterized by watery diarrhea alongside vomiting. Essentially, the main symptoms of cholera are explosive diarrhea (rice water stools), leg cramps, and vomiting that cause dehydration. Signs of dehydration include:
- Loss of skin elasticity or simply loose skin (If pinched, it takes longer to return to original position)
- Rapid heart rate
- Dry mucous membranes in the nose, throat, mouth, and eyelids
- Rapid weight loss
- Dry mouth
- Muscle cramps
- Low blood pressure
A doctor will suspect cholera if the patient shows the above-mentioned symptoms especially if they have traveled to a place with poor sanitation, history of cholera, or recently consumed shellfish as well as undercooked fish/seafood. The doctor will order a laboratory test for the patient’s stool sample, but even before the results are out, the patient will be put on treatment.
Since dehydration is the leading cause of death from cholera, the doctor issues oral rehydration solution (ORS) mostly called oral rehydration therapy (ORT). ORS is simply a mixture of salt and sugar blended with large volumes of water. Due to the limited distribution of the ORS solution in developing countries due to cost, most people use homemade ORS recipes made from common ingredients in the house. For example, as of April 2019, the ORS EFF tablets 12’S full dose retails for KSH.895.00. This is quite expensive given that a homemade remedy can be made for ingredients valued at KSH.100 or less.
However, extreme cholera cases call for intravenous fluid replacement issued depending on a person’s body weight. For example, a mature person with 70 Kgs or more would require 7 liters of intravenous fluids.
Antibiotics may also be used because they help to minimize the duration of the illness but their use is discouraged because they might lead to bacterial resistance.
Lastly, three cholera vaccines can be used namely Shanchol, Dukoral, and Euvichol. It is recommended to take two doses for full protection.
As mentioned, many infected individuals show mild symptoms, but they can still contribute to the spread of the infection. For this reason, once one case of cholera is reported in an area, the residents should be cautious by taking the necessary measures explained below.
Important measures to take when traveling to areas with a history of or where there is an outbreak of cholera include:
- Consume thoroughly cooked food
- Avoid raw fish, salads, and uncooked vegetables
- Use boiled or bottled and treated water
- Take fruits you have peeled yourself (Wash it thoroughly with clean water before peeling)
- Avoid street food as much as possible as they can carry the bacteria and other diseases
If you experience the symptoms mentioned above, seek medical attention immediately. The easiest way to go about it is by using the Uzima Health App which will help you find the nearest hospital and/or doctor for quick assistance.