What is Cholera? Symptoms, Transmission Routes, and Treatment

Cholera

Cholera is a serious intestinal infection that can spread rapidly, especially in regions with inadequate hygiene and clean water, and can be fatal if left untreated. Caused by the bacterium Vibrio cholerae, this disease is typically transmitted through the consumption of contaminated water and food. Symptoms include sudden onset of profuse, watery diarrhea and vomiting. Early diagnosis and treatment significantly reduce the risk of death. Raising awareness about cholera, learning methods of protection, and taking hygiene measures are of vital importance.

What is Cholera?

Cholera is an acute infectious disease of the small intestine caused by the bacterium Vibrio cholerae, resulting from the consumption of contaminated water and food, and characterized by severe diarrhea and vomiting. Diagnosing the disease as soon as possible minimizes the risk of life-threatening complications.

Cholera is more common in places where water and personal hygiene are inadequate. It can easily spread in crowded environments, natural disasters, poverty, or war, leading to fatalities. Additionally, sewage waste mixing into drinking water can cause cholera to spread rapidly. The risk of occurrence is high following natural disasters such as heavy rainfall, floods, and earthquakes. Improving living conditions and raising public awareness are essential for preventing the disease.

What Are the Symptoms of Cholera?

Cholera symptoms begin in two ways. The first is cholera with a slow onset. Diarrhea, vomiting, and mild pain are observed. There is no abdominal pain or straining during defecation. Defecation begins suddenly and noisily, appearing like rice water. The person may vomit without nausea or a gag reflex.

Another type of cholera symptom is sudden-onset cholera. Sudden diarrhea and vomiting occur. This classic form of cholera is called cholera gravis. The person experiences fatigue and loss of appetite. There is no abdominal pain during diarrhea, and the stool is passed suddenly and in large quantities. Enterotoxins of the cholera bacteria that settle in the intestinal mucosa cause this diarrhea.

Symptoms of cholera do not include blood or mucus in the stool; it is odorless, resembles rice water, and contains white particles that look like cooked rice grains. Vomiting is also usually projectile in nature.

In severe cases, defecation can occur 15-30 times a day. The amount of fluid lost along with cramps can range from 3 to 20 liters per day. A condition called dehydration occurs due to fluid loss. Dehydration is a state of rapid loss of fluids and minerals from the body. Other symptoms can be listed as follows:

The tongue is dry, lips are purple, eyes are sunken, and the face appears anxious.

The skin is cold and the hands are wrinkled.

In some cases, high fever may be observed.

The pulse is between 90-120 beats per minute.

Patients may experience tinnitus and decreased reflexes.

Pupils dilate and eyelids do not close completely.

In patients with increased severity of dehydration, cramps may occur in the arms, legs, and abdominal region.

Diphtheria-like inflammation may occur in the oral mucosa.

The patient's general body resistance decreases. During the acute phase, symptoms such as frequent urination or inability to urinate at all may be seen. Cholera contracted during pregnancy can cause muscle cramps and poses a risk of miscarriage. A healthcare facility should be consulted from the first moment symptoms appear.

What Causes Cholera?

The causative agent of cholera is comma-shaped (vibrio) bacteria. The enterotoxin produced by the bacteria adheres to the inner wall of the intestine and disrupts the body's fluid balance. The cholera bacterium can remain alive on vegetables and fruits for 5-7 days and in water for 15-20 days. Boiling is one of the methods that ensures the bacteria die in 1-2 seconds. It is quite sensitive to acid. It can remain alive on paper money for 2-3 days.

Cholera may not be seen in individuals with good stomach and intestinal health because stomach acid and pancreatic secretions kill the bacteria. Individuals with stomach ailments, low pancreatic secretion, frequent alcohol consumption, or various intestinal diseases have a higher risk of contracting cholera.

Incubation period: Varies from a few hours to a week. It is generally accepted as five hours to three days.

Transmission Routes: Cholera is a disease that requires international notification. When the infection is transmitted through water, it can appear as epidemics, and when transmitted by carriers, it can appear as chain cases.

The only source for the cholera bacterium is humans. There is no intermediate host. The transmission routes of cholera are directly from human to human. The mixing of sewage waste into drinking water plays a major role in the spread of the disease. Washing vegetables and fruits with this water causes many people to become ill and leads to widespread outbreaks. Outbreaks increase especially in the summer months.

Cholera transmission routes usually occur as a result of direct contact (fecal-oral) with vomit and stool excreted by infected persons. Touching contaminated items can also increase infectivity. Houseflies are also largely instrumental in the spread of cholera. Food and beverages should be stored in covered containers in places where flies cannot enter.

Measures for Public Health: Not only individual practices but also health measures taken at the community level play a major role in preventing the disease. It is very important for municipalities to regularly check water infrastructure, improve sewage systems, conduct food inspections, and raise public awareness.

How is Cholera Diagnosed?

Cholera can be confused with other gastrointestinal infections due to symptoms of vomiting and diarrhea. For example, straining during defecation and the presence of blood and mucus in the stool in dysentery are symptoms that distinguish it from cholera. Therefore, accurate diagnosis of the disease and early intervention are critical for a positive response to treatment.

The examination begins with a detailed preliminary assessment by the physician. This step is important for determining the transmission route of cholera. In cases of severe diarrhea and vomiting, microbiological examination of the stool is performed. A sample taken via stool or rectal swab is examined under a microscope. Visualization of the Vibrio cholerae bacterium can confirm the diagnosis. Some cholera cases may recur shortly after the patient recovers.

The absence of blood and leukocytes in the stool examination helps distinguish cholera from other diarrhea-causing bacterial infections. In other infections such as amoebic dysentery, blood and mucus may be found in the stool. Once diagnosed, the disease must be reported and treatment started immediately.

How is Cholera Treated?

Cholera treatment must be carried out in a clinical setting. Treating the patient in accordance with isolation conditions is a very important step to prevent contagion. Patient relatives should pay attention to hand washing and disinfection steps.

The main goal of cholera treatment is to restore the fluid and electrolytes lost by the patient. For this, the amount of fluid the patient takes in and excretes is measured. In mild cases, sufficient fluid is provided orally. In patients who cannot be fed normally, fluid replacement is performed intravenously. In patients with severe conditions, antibiotic treatment may be applied in addition to supplying fluid loss.

It is recommended that patients who can be fed orally be given soft foods that are high in nutritional value, rich in vitamins, and do not cause gas. The patient's general condition and vital functions are monitored frequently.

There is a cholera vaccine against the disease. The vaccine provides protection for about 4-6 months. On average, it can only provide about 50% immunity. Therefore, it does not have widespread use like other vaccines.

Frequently Asked Questions

Cholera is a disease caused by the bacterium Vibrio cholerae, usually transmitted as a result of consuming water and food contaminated with feces. Non-hygienic food and lack of attention to hand disinfection are among the primary transmission routes. Cholera outbreaks can spread rapidly in regions where clean water and sanitation conditions are inadequate. Water sources contaminated by the feces of infected persons and food that comes into contact with this water cause the outbreak to spread. The risk of outbreaks increases in crowded living spaces and camps after natural disasters. The most important issue in the course of the disease is the early recognition and replacement of the rapidly developing fluid and electrolyte loss in the body. When symptoms of diarrhea and vomiting begin, a healthcare facility should be consulted without delay. Cholera is characterized by sudden onset, profuse, watery, and odorless diarrhea. Diarrhea usually has the appearance of rice water, and defecation occurs as if emptying without straining. If left untreated, cholera can pose a life-threatening danger. Severe fluid and electrolyte loss can lead to hypovolemic shock and death in a short time, but the mortality rate is very low with early diagnosis and intervention. There are various vaccines developed for cholera. Although vaccines do not provide full and long-term protection, they can be applied as a protective measure, especially for people traveling to epidemic regions and populations at risk. Cholera can be largely prevented by following hygiene rules. The spread of the infection can be prevented by measures such as ensuring drinking water is clean, sewage systems working properly, and food being well-cooked and stored appropriately. The basic approach in cholera treatment is to ensure fluid and electrolyte balance orally or intravenously. In moderate and severe cases, antibiotic treatment targeting the bacteria can be applied. People who have had cholera may develop immunity against the bacteria that cause the disease for a while. This immunity may decrease over time, and the person may become vulnerable to the risk of re-infection. Therefore, having had the disease does not mean that one is completely protected and that it is not recurrent. The specialty department to consult when cholera symptoms are seen is the Department of Infectious Diseases and Clinical Microbiology. If symptoms have started suddenly, the emergency department should be consulted within a short time.

Take Cholera Symptoms Seriously

Sudden onset of severe diarrhea and vomiting can lead to serious fluid loss that can create a life-threatening risk in a short time. Hisar Hospital provides services in the diagnosis and treatment of cholera and other infectious diseases with its expert staff of Infectious Diseases physicians and advanced laboratory infrastructure.

If you suspect you have cholera, it is of vital importance that you consult a healthcare facility without delay.

You can contact us to get detailed information and make an appointment.