Cholera

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Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours, even in previously healthy people.

Signs and symptoms of cholera in children

In general, children with cholera have the same signs and symptoms adults do, but they are particularly susceptible to low blood sugar (hypoglycemia) due to fluid loss, which may cause:

  • An altered state of consciousness
  • Seizures
  • Coma

When to see a doctor

If you have diarrhea, especially severe diarrhea, and think you may have been exposed to cholera, seek treatment right away. Severe dehydration is a medical emergency that requires immediate care regardless of the cause.

Causes

A bacterium called Vibrio cholerae causes cholera infection.

Contaminated water supplies are the main source of cholera infection.

The most common sources of cholera infection are standing water and certain types of food, including seafood, raw fruits and vegetables, and grains.

  • Surface or well water.
  • Seafood.
  • Raw fruits and vegetables.
  • Grains.

Risk factors

Risk factors for cholera include:

  • Poor sanitary conditions.
  • Reduced or nonexistent stomach acid (hypochlorhydria or achlorhydria).
  • Household exposure.
  • Raw or undercooked shellfish.

Complications

Although shock and severe dehydration are the most devastating complications of cholera, other problems can occur, such as:

  • Low blood sugar (hypoglycemia).
  • Low potassium levels (hypokalemia).
  • Kidney (renal) failure.

Investigations

  • Stool specimen to identify the organism.
  • U&E, as the patient is likely to be significantly dehydrated, and to monitor IV fluid replacement. Creatinine may rise if the kidneys fail with circulatory collapse.
  • FBC will often show a high Hb with haemoconcentration.
  • WCC is likely to be raised but will not aid diagnosis or management.

A good way of estimating net fluid loss or gain if changes are large is to weigh the patient daily. 1 kg of weight represents 1 litre of fluid.

Treatments and drugs

Cholera requires immediate treatment because the disease can cause death within hours.

  • The goal is to replace lost fluids and electrolytes using a simple rehydration solution, oral rehydration salts (ORS).
  • Intravenous fluids.
  • While antibiotics are not a necessary part of cholera treatment, some of these drugs may reduce both the amount and duration of cholera-related diarrhea. A single dose of doxycycline or azithromycin may be effective.
  • Zinc supplements.

Prevention

If you’re traveling to cholera-endemic areas, your risk of contracting the disease is extremely low if you follow these precautions:

  • Wash hands with soap and water frequently, especially after using the toilet and before handling food. Rub soapy, wet hands together for at least 15 seconds before rinsing. If soap and water aren’t available, use an alcohol-based hand sanitizer.
  • Drink only safe water.
  • Eat food that’s completely cooked and hot and avoid street vendor food.
  • Avoid raw or improperly cooked fish and seafood of any kind.
  • Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados.
  • Be wary of dairy foods, including ice cream, which is often contaminated, and unpasteurized milk.

 

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