ASIAN Cholera

 Cholera is a disease caused by bacteria that produce a watery diarrhea that can rapidly
lead to dehydration.
 Cholera symptoms and signs include a rapid onset of copious, smelly diarrhea that
resembles rice water and may lead to signs of dehydration (for example, vomiting,
wrinkled skin, low blood pressure, dry mouth, rapid heart rate).
 Cholera is most frequently transmitted by water sources contaminated with the
causative bacterium Vibrio cholerae, although contaminated foods, especially raw
shellfish, may also transmit the cholera-causing bacteria.
 Cholera is presumptively diagnosed by patient history and examination of stool for rice-
water appearance and presence of V. cholerae-like organisms microscopically; definitive
diagnosis is done by isolation and identification of V. cholerae from stool samples.
 The main treatment for cholera is fluid and electrolyte replacement, both oral and IV.
Antibiotics usually are used in severe infections in which dehydration has occurred.
 The prognosis of cholera ranges from excellent to poor. Rapid treatment with fluid and
electrolytes result in better outcomes while people with other health problems beside
cholera or those who are not rapidly replenished with fluid treatments tend to have a
poorer prognosis.
  It's possible to prevent cholera with appropriate measures such as safe drinking water
and non-contaminated foods; some protection can be obtained from oral vaccines while
avoiding areas where cholera commonly occurs or has had a recent outbreak.

In June 2016, the FDA approved an oral vaccine for use in the U.S. for
travelers to cholera-endemic areas to protect them from getting cholera;
this oral vaccine is about 80% effective three months after a single oral
dose in adults 18-64 years old.

How Long Is Cholera Contagious?

A person is no longer contagious for cholera when they have no cholera symptoms and no
detectable Vibrio bacteria in their stools. Cholera, in general, usually lasts about one week,
unless severe symptoms develop. Although a person may be no longer contagious for cholera,
the infection does not provide enough immunity to prevent the person from coming down with
cholera again if reexposed to the bacteria.

What is cholera?
 Cholera is an acute infectious disease caused by a bacterium, Vibrio cholerae (V.
cholerae), which usually results in a painless, watery diarrhea in humans.
 Some affected individuals have copious amounts of diarrhea and develop dehydration
so severe it can lead to death.
 Most people who get the disease ingest the organisms through food or water sources
contaminated with V. cholerae. Although symptoms may be mild, some previously
healthy people will develop a copious diarrhea within about one to five days after
ingesting the bacteria. Severe disease requires prompt medical care.
 Hydration (usually by IV with a rehydration solution for the very ill) of the patient, and
antibiotics in some individuals, is the key to surviving the severe life-threatening form of
the disease.

The World Health Organization (WHO) has maps of current and past
areas with cholera outbreaks (see WHO reference). It is estimated that
about 1.4 million to 4.3 million people are infected worldwide each year,
with approximately 28,000-142,000 deaths per year. Only about one in 10
people infected with cholera develop the typical signs and symptoms.
Outbreaks of cholera in 2015-2016 include South Sudan, United Republic
of Tanzania, and Kenya, with over 216 deaths and most recently, 121
people diagnosed with cholera in Iraq, their first outbreak since 2012 and
in Cuba, the first outbreak in over 130 years.

What are cholera symptoms and signs?

The symptoms and signs of cholera-related disease are a watery diarrhea that often contains
flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are
about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and
smells "fishy." Although many bacterial infections may cause diarrhea, the volume of diarrhea
with cholera can be enormous; high levels of diarrheal fluid, such as 250 cc per kg or about 10 to
18 liters over 24 hours for a 154-pound adult, can occur. People may go on to develop one or
more of the following symptoms and signs:

 Watery diarrhea (sometimes in large volumes)

 Rice-water stools (see figure 1)
 Fishy odor to stools
 Vomiting
 Rapid heart rate
 Loss of skin elasticity (washer woman hands sign; see figure 2)
 Dry mucous membranes (dry mouth)
 Low blood pressure
 Thirst
 Muscle cramps (leg cramps, for example)
 Restlessness or irritability (especially in children)
 Unusual sleepiness or tiredness

Other symptoms that may occur, especially with more severe disease, include the following:

 Abdominal pain (cramps)

 Rectal pain
 Fever
 Severe vomiting
 Dehydration
 Low or no urine output
 Weight loss
 Seizures
 Shock
 Death
What causes cholera, and how does cholera spread?
 Cholera is caused by the bacterium Vibrio cholerae. This bacterium is Gram stain-
negative, comma-shaped, and has a flagellum (a long, tapering, projecting part) for
motility and pili (hairlike structures) used to attach to tissue.
 Although there are many V. cholerae serotypes that can produce cholera symptoms, the
O groups O1 and O139, which also produce a toxin, cause the most severe symptoms of
cholera.
 O groups consist of different lipopolysaccharides-protein structures on the surface of
bacteria that are distinguished by immunological techniques.

What is the incubation period for cholera?

The incubation period (time period from exposure to the bacteria to the development of
symptoms) may vary from a few hours (about six to 12 hours) to five days, with the average
incubation period being about two to three days. About six to 12 hours is considered a very
rapid incubation period and may suggest that rapid/immediate intervention is required for
recovery.

What is the contagious period for cholera?

The contagious period for cholera begins as soon as organisms are excreted in the feces. This
can occur as early as about six to 12 hours after exposure to the bacteria and can last for about
seven to 14 days. Some individuals who are asymptomatic (infected but not having symptoms)
will also excrete contagious organisms for about seven to 14 days.

What physicians usually treat cholera?

Because most individuals have either mild or no symptoms, these people are either not treated
or treated by their primary care physician. However, in some children and in individuals who
have more severe disease, besides the primary care physician or pediatrician, an infectious-
disease specialist, a critical care specialist, a gastroenterologist, and/or an internist may be
needed to help the team manage and treat the patient.

What is the treatment for cholera?

The CDC (and almost every medical agency) recommends rehydration with ORS (oral
rehydration salts) fluids as the primary treatment for cholera. ORS fluids are available in
prepackaged containers, commercially available worldwide, and contain glucose and
electrolytes. The CDC follows the guidelines developed by the WHO (World Health
Organization) as follows:

 Tetracycline (Sumycin)
 Doxycycline (Vibramycin, Oracea, Adoxa, Atridox, and others)
 Furazolidone (Furoxone)
 Erythromycin (E-Mycin, Eryc, Ery-Tab, PCE, Pediazole, Ilosone)
 Azithromycin (Zithromax)
 Sulfamethoxazole/trimethoprim (Bactrim, Septra)
 Ampicillin
 Ciprofloxacin (Cipro, Cipro XR, ProQuin XR)
 Norfloxacin (Noroxin)

What is the prognosis of cholera?

The prognosis (outcome) of cholera can range from excellent to poor, depending on the severity
of the dehydration and how quickly the patient is given and responds to treatments. Death
(mortality) rates in untreated cholera can be as high as 50%-60% during large outbreaks but can
be reduced to about 1% if treatment protocols (see above treatment section) are rapidly put into
action. In general, the less severe the symptoms and the less time people have dehydration
symptoms, the better the prognosis; in many people, if dehydration is quickly reversed, the
prognosis is often excellent.

Adverse Effects
Dehydration

Diarrhea

Food Poisoning

Low Back Pain

Low Blood Pressure

Muscle Cramps

Nausea and Vomiting