Causes and risk factors
Cholera is caused by infection with a bacterium, Vibrio cholera.
Cholera is spread by intake of contaminated water (in most cases) and intake of contaminated food (in few cases).
The risk factors for development of cholera include:
- Chronic gastritis caused by infection with Helicobacter pylori
- Living in a poorly sanitized area
Clinical presentation
Cholera can present as a mild or severe illness.
In its mild form, it resembles diarrhea caused due to several other bacteria. The patient will pass several liquid stools each day. However the quantity is not sufficient enough to cause dehydration.
In its severe form, cholera is characterized by copious amounts of diarrhea and vomiting. The stool is mostly composed of fluid with specks of mucus giving it a characteristic rice-water appearance. The cholera stool typically has a sweetish or fishy odor.
Signs of dehydration may develop which include diminished elasticity of skin, tachycardia, low blood pressure, thread pulse, severe thirst and coldness of extremities. The abdomen sinks in assuming a scaphoid shape. The patient may develop tachypnoea and Kussmaul respiration.
Severe dehydration can give rise to complications like hypovolaemic shock, metabolic acidosis, renal failure, coma and even death.
Some patients may present with ‘cholera sicca’ a severe form of the disease which is extremely fatal.
Diagnosis & Investigations
Treatment for suspected cases of cholera is begun immediately even before the results of investigations are out. Any delay in treatment can be fatal.
The tests to confirm cholera include stool examination and culture.
Treatment
The most important treatment modality in cases of cholera is to prevent dehydration.
Oral rehydration solutions should be given to the patient to replace the water loss and prevent dehydration. Intravenous fluid is given to severely dehydrated patients.
Oral antibiotics are prescribed in severe cases.
Cholera can be prevented by improving environmental sanitation and getting vaccinated against cholera.
Recent updates
Certain indigenous groups were found to use the sap of the Croton lechleri tree to treat diarrhea. A new drug Crofelemer derived from this sap is being studied to determine its efficacy in cases of cholera.
