Cholera is a massive diarrheal disease that can cause severe fluid loss. Cholera is caused by the bacterium Vibrio cholerae. Without treatment, cholera is mostly fatal.
What is cholera?
The infectious disease cholera is a massive diarrheal disease. It is caused by the Vibrio cholerae bacterium and is fatal in 2/3 of all untreated cases. Cholera infection mostly occurs through contaminated drinking water. A person suffering from cholera suffers from this bacterial infection mainly due to enormous fluid losses caused by a constant diarrhea. It is not uncommon for cholera to be accompanied by nausea and vomiting, which can lead to additional fluid and mineral (electrolyte) loss. Mortality from cholera is therefore mostly due to kidney failure or circulatory collapse. Today, cholera occurs mainly in Southeast Asia, Africa and South America. Only rarely are cases of cholera reported in Germany, since the hygienic conditions in western industrialized countries are usually better developed. Nevertheless, it can happen that individual vacationers are infected with cholera and can bring this disease to Germany and infect other people. Even the suspicion of cholera is notifiable in Germany. If a cholera case occurs, it is immediately put into quarantine treatment.
Causes
As mentioned above, the main cause of infection of cholera is the bacterium Vibrio cholerae. The risk of infection is mainly in southern countries, tropical or third world countries, because here the hygienic conditions are sometimes poor. The cholera bacterium can spread easily, especially through animal carcasses and human corpses in rivers and lakes. Since these places are mostly used by the population for water supply, infection with cholera is quickly possible. Holidaymakers from Europe can thus also become infected in these countries. Direct contact transmission of the pathogen from person to person is also possible. The incubation period, i.e. the time from infection to the outbreak of the disease, is usually a few hours, sometimes up to five days.
Symptoms, complaints, and signs
Cholera infection often goes unnoticed because no symptoms are noticeable. About 80 to 90 percent of infections result in no symptoms. If cholera makes itself felt, diarrhea occurs first and foremost. This can be quite harmless, but in severe cases it can also be life-threatening. The incubation period is two to three days. In a mild course of the disease, the bacteria cause mild diarrhea and abdominal cramps. In a severe course of the disease, severe diarrhea and vomiting set in. The stool is then very watery and is described as resembling rice water. This leads to a considerable loss of fluid. Thus, patients can lose one liter of fluid per hour. The body becomes dehydrated, i.e., dehydrated. The mucous membranes become dry, and body temperature and blood pressure drop. Often the face of the affected person appears sunken. With the water, the body also excretes vital salts (electrolytes) such as sodium and potassium. The result is hyperacidity of the body, which in turn can lead to muscle cramps. In the absence of treatment with fluid and electrolyte administration, the kidneys fail. In severe cholera infections that are not treated, the mortality rate is about 50 percent. However, with appropriate therapy, mortality drops to less than two percent.
Course
Cholera, when it has a mild course, can easily be mistaken for diarrheal disease or diarrhea. Nevertheless, the risk of infection to other people is considerably high. Cholera must be treated by a doctor, as the mortality rate is extremely high even in cases of initially mild disease. Even with timely treatment, about one percent of those affected still die.
Complications
Cholera is a very serious disease that is treated by a physician in any case. If the treatment is carried out too late or not at all, the disease usually leads to death. The outbreak of the disease itself occurs only in about 15 percent of cases of infection. The incubation period is between two and three days, so that the affected person usually does not notice at first that he or she has contracted the disease.In most cases, the symptom of cholera is vomiting diarrhea, which is very often interspersed with mucus flakes. Abdominal pain rarely occurs. Since relatively much fluid is withdrawn from the body during diarrhea, the patient also suffers from dehydration, which can be seen mainly by wrinkles and sunken cheeks on the face. The body reacts to the disease by symptoms such as drowsiness, coma, versation or skin rash. In most cases, treatment leads to success if the disease is detected and treated in time. The body can defend itself against the infection, but it needs many nutrients due to fluid loss. If the disease is not treated, it usually leads to death, as has happened in many epidemics throughout history.
When should you go to the doctor?
Before going abroad to a country with poor drinking water and sanitation, preventive cholera vaccination is indicated. If infection is suspected, a doctor must be consulted immediately. Typical warning signs include severe nausea and diarrhea as well as hoarseness, cramps and abdominal pain. The symptoms usually increase rapidly in intensity and eventually cause circulatory shock and death of the infected person. Therefore, the following applies: already at the first signs of an illness, the affected person should go to the doctor. In particular, people who suffer from said symptoms after a trip to the tropics or third world countries should consult a doctor. The same applies if the symptoms are due to contact with a person who may be ill. In any case, the symptoms must be clarified if they have not subsided after three days at the latest or if they rapidly increase in intensity. Due to the high mortality rate and risk of infection, cholera must be clarified immediately and treated in hospital. In case of impaired consciousness or circulatory collapse, the emergency physician must be alerted immediately.
Treatment and therapy
Cholera must be treated urgently by a physician to minimize mortality. In addition, cholera is reportable, so failure to treat can result in legal action. The doctor can determine the cholera pathogen in the stool or vomit of the affected person by laboratory tests. After that, cholera therapy involves the rapid administration of fluids with electrolytes or sugar. This is usually done as an inpatient and under quarantine in a hospital. The fluid lost through diarrhea and vomiting is replaced with the help of infusions. Up to 7 to 10 liters per day of body fluid can be lost in cholera, so this amount must be re-administered. In addition to infusions, antiobiotics is incorporated into the treatment for cholera. It is mainly used to kill bacteria in the gastrointestinal region.
Outlook and prognosis
The prognosis is very good for cholera that is well treated. If the patient receives adequate fluids and nutrients, he can be expected to survive the most severe part of the infection well within a few days and eventually be considered healthy. However, his stool may still contain the pathogens weeks later, so caution is advised here. It is crucial for the success of treatment that it is started as early as possible – i.e. before the affected person suffers life-threatening dehydration. If left untreated, however, up to 70 percent of sufferers die from cholera. It mainly affects malnourished and immunocompromised people and those who can no longer care for themselves because of the disease. Death usually occurs due to an undersupply of the brain or organ failure. Notwithstanding that there is an oral vaccine for cholera, for the most part it is hardly available in cholera-affected areas. Moreover, once cholera has been survived, it does not protect against further cholera infections. Despite the practical eradication of cholera in many parts of the world, pockets of infection flare up from time to time, leading to epidemics. Because cholera is highly contagious and benefits primarily from poor sanitation, it will continue to persist in structurally weak areas.
Follow-up
After initial cholera therapy is completed, comprehensive follow-up care is needed. Administration of fluid and electrolyte replacement must continue. The patient must consult the primary care physician at regular intervals for this purpose. In severe cases, prolonged hospitalization is necessary.Afterwards, rest and sparing are advisable, as the disease can place an enormous strain on the body. Further medical examinations are part of the aftercare to rule out complications. It must also be ensured that the cholera pathogen has been completely flushed out of the body. Affected children must take zinc supplements and also take it easy in the weeks and months following treatment. Although cholera can be treated in many cases, the long-term effects on physical health are manifold. This makes comprehensive follow-up care all the more important. Patients in hygienically underserved areas should leave the region if possible. Vacationers who have contracted cholera after returning from a high-risk country must follow the doctor’s instructions regarding the use of medications and nutritional supplements as part of their follow-up care. If no further complications or symptoms occur, treatment for cholera can be completed. No further follow-up measures are necessary after recovery.
Here’s what you can do yourself
Because cholera is a potentially life-threatening disease, no action should be taken on your own under any circumstances. Instead, the patient must seek medical treatment during the illness, usually requiring a stay in the hospital. The patient must follow all the instructions of the medical staff, otherwise his or her life will be in danger. In order to promote the healing process, all medical preparations must be taken as prescribed. In the treatment of cholera, regular intake of fluid replacement plays the most important role in preventing further dehydration. The doctor decides at what intervals and in what form these are to be taken. Infusions as well as drinking solutions are available, whereby the patient must comply with the respective instructions. In addition to fluid intake, physical rest plays an important role in recovery. Patients therefore limit physical activities to a minimum. With regard to food, particular attention must be paid to hygiene, and usually only meals adapted to the impaired digestive activity are considered. In order to rapidly regenerate the gastrointestinal tract after the illness, patients adhere to medical advice and rebuild the intestinal flora by means of suitable preparations.