cholera

description

Cholera is an infectious disease caused by the bacterium Vibrio cholerae and associated with severe diarrhea. It happens that patients additionally vomit bile. So the disease came to her name: “Cholera” in English means “river of yellow bile”.

The pathogens live worldwide in coastal waters and brackish water at a temperature of over ten degrees Celsius. The disease itself is only common in Asia, Africa and South America. It mainly affects regions with poor drinking water supplies and poor hygiene conditions, for example refugee areas. In total, around six million cholera diseases occur worldwide every year. In Germany, the disease does not normally appear. It is very rare for travelers to lure the disease from, for example, Southeast Asia.

Cholera has been known since the beginning of history records. First, she appeared exclusively endemic in the Ganges Delta. An endemic area is a region where a pathogen is permanent and can not be removed. From the 19th century, cholera spread worldwide in several pandemics. A pandemic refers to the increased occurrence of a disease in the same period, but in different places.

There are different types of cholera bacteria. The most important are the classic Vibrio cholerae and the Vibrio cholerae of the El Tor type. The El Tor is responsible for the last pandemic since 1960. He is considered more environmentally friendly, but less dangerous than the classic guy.

According to the World Health Organization (WHO), cholera is one of the quarantine diseases in addition to plague, smallpox and yellow fever. Therefore, a medical officer may quarantine patients until there is no risk of infecting other people. Not only the disease itself, even the suspected cholera is notifiable.

Cholera: symptoms

The cholera symptoms usually start suddenly. At first they are very similar to other diarrheal diseases. Cholera starts with:

• watery diarrhea
• Vomiting of watery stomach contents, blood and bile
• stomach pain

The diarrhea is typically cloudy, becomes increasingly watery, and contains milky white mucus. Therefore, he is referred to as a rice water chair. Due to the massive diarrheal fluid loss – up to 20 liters per day – the body can dry out life-threatening. Water and salt loss also causes the following cholera symptoms:

• “Vox cholerica” ​​(high, hoarse voice)
• muscle cramps
• sunken face, sunken eyes, sunken stomach
• weak pulse on the extremities
• low blood pressure
• fast beating heart (tachycardia)
• without hydration cold arms and legs

In the course of the disease it may initially lead to a urinary retention. Subsequently, it can lead to kidney failure, impaired consciousness and circulatory failure, which can be fatal.

Cholera: causes and risk factors

The cause of cholera is the bacterium Vibrio cholerae. It passes through the mouth into the gastrointestinal tract of humans. There it must first pass the stomach. Since it is acid-sensitive, large amounts of bacteria are killed by stomach acid. For a disease outbreak so it needs a lot of pathogens. Only then is there a chance that some of them will survive the passage of the stomach and then multiply in the small intestine and attach to the mucous membrane. In people who produce less stomach acid, even a smaller amount of bacteria can lead to disease outbreak, as less pathogens are killed in the stomach.

If the bacteria are on the small intestinal mucosa, they produce a poison called cholera toxin. It penetrates into the mucous membrane and causes an enormous amount of water and salts (electrolytes) to be released into the intestine and then excreted as diarrhea.

risk factors

The cholera pathogen is one of the water germs and is accordingly transmitted to humans via contaminated drinking water or contaminated seafood. A fecal-oral infection from human to human is also possible. This happens especially with poor hand hygiene. The bacteria can be transmitted by cholera patients. There are also people who excrete the pathogen without even getting sick.

Especially in areas with high population density and poor hygienic conditions such as in refugee areas, the disease occurs frequently. It is considered a “disease of the poor” because people who are undernourished, weakened and suffering from another underlying disease get cholera. In addition, especially small children and old people get sick.

Cholera: examinations and diagnosis

If cholera is suspected, your doctor will first ask you in detail about the medical history (anamnesis). He asks you for example the following questions:

• Have you been abroad recently?
• Did you drink tap water there or eat raw food such as salad?
• When did the symptoms first appear?
• How many times a day do you have diarrhea?
• Can you describe the diarrhea?
• Do you suffer from vomiting or abdominal pain?

Then follows the physical examination. At the same time the doctor feels your pulse and hears and feels your belly.

The diagnosis of cholera is backed up with a stool sample. This is examined in the laboratory for the pathogens, either under the microscope or after culturing the bacteria in a culture. In addition, vomit and small intestine secretions (duodenal juice) are suitable as sample material.

Cholera has to be differentiated from other diarrheal diseases such as Salmonella or Shigella. This is not always possible, especially for mild cases, because of similar symptoms. In addition, the full picture of cholera must be differentiated against infection with the bacterium Clostridium difficile, other food poisoning or a pancreatic tumor (VIPoma).

Cholera: treatment

Already in case of suspected cholera, the therapy must be started immediately in a hospital! This helps to positively influence the course and outcome of the disease. Most important is the symptomatic treatment of cholera. This means that the heavy liquid and salt losses must be replaced. This works best with glucose-containing fluids that are given to the patient to drink. It is also possible to give the patient liquid and salts (electrolytes) as an infusion into the vein.

Only second in cholera treatment are the antibiotics. These are agents that kill bacteria or inhibit their reproduction. In the case of cholera, antibiotic classes such as quinolones or macrolides are used.

You can already do something about the massive fluid and salt losses at home: give the patient plenty of cola and sweet tea to drink and offer him salt sticks. Nevertheless, treatment in the hospital must be done as quickly as possible!

Cholera: prevention

Diarrheal disease is best prevented by good food and drinking water hygiene. But especially in very poor countries, crisis areas and refugee camps, this is often not guaranteed. As a traveler in cholera areas you should:

• only drink boiled water or bottled water from sealed bottles.
• Do not use tap water for brushing or dishwashing.
• to give up ice cubes in your drink.
• do not eat raw foods like salads.
• Disinfect your hands regularly, especially before eating.

The average tourist has a low risk of contracting cholera. The hygienic conditions in hotels are often sufficient.

Cholera vaccination

There is the possibility of vaccination against cholera. This is not generally recommended because it protects against disease only in 60 percent of cases and is effective only for up to half a year. There are two different vaccines available: one oral vaccine and one dead vaccine. The cholera oral vaccine contains attenuated pathogens, the dead vaccine dead pathogens. Both vaccines can not trigger the full picture of cholera disease. Nevertheless, they stimulate the human immune system to produce specific antibodies. A vaccination should only take place if a travel destination requires it or if people work as disaster relief workers in a cholera area.

Quarantine and registration

If cholera occurs, immediate therapy is required. To avoid further contagion (epidemic), it is important to follow strict hygiene. Sufferers are therefore quarantined. In addition, the suspicion of cholera is already notifiable, so that disease control measures can be initiated.

Cholera: disease course and prognosis

Cholera begins after an incubation period of several hours to five days. This is the time between the infection with the pathogens and the onset of symptoms. One differentiates mild and heavy courses. A mild form of the disease usually ends after five days. After only two days, the symptoms usually do not get worse. In the full picture of cholera, the disease usually ends after six days. The hardest part of the first 24 hours is the excretion of up to one liter of watery stool per hour. Cases are also reported in which patients succumb to cholera within a few hours.

With timely treatment both mild and severe courses are often treatable. Despite treatment, about two percent of patients die from severe cholera. If left untreated, cholera will be fatal in up to 60 percent of cases. Especially children’s lives are at risk from cholera, as they can dry out more quickly and make up for salt loss less well than adults.

After surviving disease only a limited immunity to the pathogen remains. This means that those affected again with cholera can be infected.