A Family Doctor's Tale - CHOLERA

DOC I HAVE CHOLERA

At one stage it was thought that cholera can be eliminated by the development of a vaccine against cholera.

However the success rate of immunization against Cholera is only 20-30%  so most doctors now do  not recommended it.

Cholera is always present in water borne disasters such as floods as evidenced recently in the Haiti earthquake and unsanitary conditions.


Cholera is an acute infectious illness caused by the Vibrio cholorae bacteria.



The bacteria which causes Cholera is the Vibrio cholorae which is an extremely hardy bacteria able to live in  polluted water, contaminated food and soiled clothes.


There are 2 main types of cholera bacteria:
1.the classic short slihtly curved Gram negative aerobic rods


2.The El Tor strain which is hardier,persists longer in nature and is more likely to cause carrier states in humans.


Incubation period is 12 hours to 6 days.

The main symptoms of Cholera are
1. Vomiting after 12 hours of ingestion of bacteria


2. abrupt painless rice water diarrhoea


3. abdominal pain


4. prostration and muscle cramps


Severe cases may have dehydration leading to:
1.hypotension


2.cardiovascular collapse


3.tachycardia


4.difficulty in breathing and cyanosis


5.weak peripheral pulses


6. delirium and disorientation


7. lassitude and tiredness


8. convulsions in small children


Symptoms usually appear within 12 hourss after exposure to the germ and last up to 1 week.



Cholera epidemics are water borne especially after severe flooding.
The germs can also be transmitted by food handlers.

Diagnosis of cholera:


Doctors generally diagnose Cholera based on the symptoms and a physical examination.

Confirmation is by blood tests and stool cultures.

Complications of Cholera are:


Cholera is a disease which can kill especially through its complications:
1.Severe dehydration especially in young children and the very old patients

2.Hypovolemic shock


3.uncompensated metabolic acidosis


4.renal failure

Treatment of cholera is by:

Cholera is an infectious disease which can spread to other people through contaminated food and water. It is therefore advisable to quarantine the patient in hospitals.

1.The most important complication in Cholera is dehydration so prompt replacement of fluids and electrolytes intravenously is necessary.

WHO diarrhea treatment solution consists of
a.4gms of sodium chloride
b.6.5gms of sodium acetate
c.1 gm of potassium chloride
d.10gms of glucose
in 1 liter of sterile distilled water.

Where intravenous administration of diarrhea solution is not available, isotonic drinks and coconut water may act as replacements.

2. Careful monitoring of the patient as 1 liter of fluid may be lost in the stools in one hour.

3.Antibiotics is the main treatment against typhoid.
The best antibiotic is tetracycline or deoxycyline.

Symptomatic treatment includes:
1.Paracetamol for relief of fever and headache


2.antispasmodic drug to stop abdominal cramps


3.medicine to harden the stools such as kaolin


4.slow down the intestinal movement (lomotil or loperamide).

Gradually reintroduce food, starting with bland, easy-to-digest food, like porridge or soups.


Get plenty of rest.



Prevention of Cholera can be by vaccination with the cholera vaccine.

However the success rate of immunization against Cholera is only 20-30%  so most doctors have not recommended it.

You can avoid infection by:
1.Avoid eating or drinking foods or liquids that might be contaminated


2.Good food hygiene



Prognosis of cholera is excellent with prompt treatment of rehydration therapy.

After replacement of salts and water symptoms usually clear within 48 hours with tetracycline treatment.