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Cholera is an acute diarrheal infection
that affects the intestinal tract. It is caused by a potent
enterotoxin that is often associated with epidemic
outbreaks, or found in pandemic, warm
regions.
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- Bacterium Vibrio cholera. Vibrio cholerae is often found
in aquatic environs, such as brackish water marshes, and is
often associated with algal blooms (plankton).
- Cholera is spread by contaminated water and food.
Rarely, it is transmitted by direct person-to-person
contact.
- It has a short incubation period, from less than one day
to five days, and produces an enterotoxin that is
responsible for the
symptoms.
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- The majority of individuals infected with V. cholerae do not develop major symptoms, even though the bacterium is present in their stool for 7-14 days.
- Less than 10% of those infected with cholera develop typical cholera, characterized by copious, painless, watery diarrhea, and nausea and vomiting that can lead to moderate to severe Dehydration, and even death if treatment is delayed.
- Peculiar, characteristic, thin, high-pitched voice is often present.
- The excessive diarrhea and vomiting may lead to loss of fluids and important Electrolytes (e.g., Potassium), Dehydration, kidney problems, and acidosis (acidification of the blood).
- Eventually, the Low Blood Pressure and loss of Potassium and other Electrolytes may result in heart problems and overall circulatory failure.
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- The diagnosis is made clinically. The watery diarrhea is speckled with flakes of mucus and surface cells of the intestine (epithelial cells), thus the appellation of "rice-water stool," containing enormous numbers of vibriones.
- Cholera can be confirmed only by the isolation of the V. cholerae from the diarrheal stool of infected individuals.
- Blood tests may be done to evaluate electrolyte imbalance and kidney function.
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- Most cases of diarrhea caused by V. cholerae can be adequately treated with a solution of oral rehydration salts, glucose, and electrolyte replacement, but patients who become severely dehydrated must be given intravenous fluids, Sodium chloride, Sodium bicarbonate, Potassium chloride, etc.
- In severe cases, antibiotics can reduce the volume and duration of diarrhea, and the period of Vibrio excretion. Tetracycline is the antibiotic of choice, but resistance to it is increasing. Other antibiotics include furazolidone, chloramphenicol, cotrimoxazole, and erythromycin.
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Physician evaluation is prudent, especially in young children and infants. Infants are especially prone to Dehydration and
electrolyte imbalance. If severe cases go untreated, adults and children alike may be at risk for life-threatening complications. Do not hesitate to seek emergency medical treatment, if you suspect the more virulent forms of this infection.
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- When traveling, it is essential to ensure an adequate supply of safe drinking water and food. Practice good food hygiene by assuring that cooked foods are not contaminated via contact with raw foods, including water (and ice); by cooking food thoroughly and eating it while still hot; by controlling insects such as flies and roaches that may come into contact with food; and by avoiding raw fruits or vegetables unless properly washed and prepared.
- Washing your hands often and routinely after using the toilet is highly recommended.
- Those eating in private homes are less likely to develop symptoms than those eating meals in restaurants or from street vendors, the most common and most dangerous source of contamination.
- The safest drinks are bottled carbonated water, beer, wine, and hot coffee and tea. When brand name bottled beverages are unavailable, water should be boiled or chemically treated with iodine or chlorine tablets, which can be purchased in specialized stores, like camping or travel retail outlets. Boiling water for five minutes (longer at high altitudes) will make it safe to drink. However, portable water filters are not a proven method of purification in affected areas, and are not currently recommended.
- Oral cholera vaccines that provide
high-level protection for several months against cholera
caused by V. cholerae O1 have recently become available in a
few countries but their use does not mean that above
precautions should be ignored.
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- Additional information on cholera, as well as other
travel-related health concerns, can be obtained from the CDC
by automated hotline (404) 332-4559 (note: the CDC is a
catch-all for health warnings).
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