Description
Cholera is an infectious disease caused by the bacterium Vibrio cholerae and is accompanied by severe diarrhea. It happens that patients additionally vomit bile. This is how the disease got its name: “cholera” means “flow of yellow bile” in German.
There are two so-called serogroups of cholera bacteria that can cause epidemics in humans: O1 and O139. They are further subdivided into subforms.
Cholera bacteria live worldwide in coastal waters and brackish water at temperatures above ten degrees Celsius. However, the disease they cause is only widespread in Asia, Africa and South America – especially in regions with poor drinking water supplies and inadequate hygienic conditions, such as refugee areas. In industrialized countries, cholera occurs only sporadically, with those affected usually having contracted the disease while traveling abroad.
Mandatory reporting and quarantine
In Germany and Austria, the suspicion of cholera is already subject to mandatory reporting. Doctors must also report illnesses and deaths from cholera to the authorities by name. In Switzerland, there is also a reporting obligation in this regard: physicians must notify the health authorities of the clinical findings of a cholera illness by name.
According to the World Health Organization (WHO), cholera is one of the diseases that must be quarantined, along with yellow fever, plague and smallpox. Patients are quarantined until there is no longer any risk of them infecting other people.
Cholera: Symptoms
Cholera symptoms usually begin suddenly. They are very similar to other diarrheal diseases, especially at first. Cholera starts with:
- watery diarrhea
- Abdominal Pain
Diarrhea is typically cloudy, becomes increasingly watery, and contains milky white mucus flakes. Therefore, it is referred to as rice water stool. The massive diarrhea-induced loss of fluids – up to 20 liters per day – can cause life-threatening dehydration of the body. The loss of water and salt also causes the following cholera symptoms:
- high, hoarse voice ( called “vox cholerica”)
- Muscle cramps
- weak pulse at the extremities
- low blood pressure
- palpitations (tachycardia)
- cold arms and legs without fluid intake
As the disease progresses, urinary retention (inability to urinate) may develop initially. Subsequently, kidney failure, impaired consciousness, and circulatory failure may occur, which can be fatal.
Cholera: Causes and risk factors
They continue into the small intestine, where they multiply and attach to the mucosa of the small intestine. They then produce a toxin called cholera toxin. It penetrates the mucosa and causes enormous amounts of water and salts (electrolytes) to be released into the bowel and then excreted as diarrhea.
Risk factors
There are also people who become infected with cholera bacteria and excrete them, but do not fall ill themselves.
Cholera: examinations and diagnosis
If cholera is suspected, your doctor will first ask you in detail about your medical history (anamnesis). He will ask you the following questions, for example:
- Have you been abroad recently?
- Did you drink tap water or eat raw foods such as lettuce while you were there?
- When did the symptoms first appear?
- How many times a day do you have diarrhea?
- Can you describe the diarrhea?
- Do you experience vomiting or abdominal pain?
The diagnosis of cholera is confirmed 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. Vomit and small intestine secretion (duodenal juice) are also suitable as sample material.
Differentiation from other diseases
The full-blown cholera must also be distinguished from an infection with the bacterium Clostridium difficile, other food poisoning, and a tumor of the pancreas (VIPoma).
Cholera: Treatment
If cholera is suspected, treatment must be started immediately in a hospital! In this way, the course and outcome of the disease can be positively influenced.
Only in second place in cholera treatment is the administration of antibiotics. These are active ingredients that kill bacteria or inhibit them from multiplying. In the case of cholera, antibiotic classes such as quinolones or macrolides are used.
Cholera: course of the disease and prognosis
In severe cases, violent watery diarrhea occurs, sometimes with vomiting. Patients lose a lot of fluids and salts, which without treatment can lead to muscle cramps, circulatory collapse, shock and death. However, if the loss of water and salts is compensated for early on, the mortality rate from cholera can be reduced to less than one percent.
Rapid treatment is very important, especially for children and the elderly!
Cholera: Prevention
The best way to prevent cholera is through good food and drinking water hygiene. However, this is often not guaranteed, especially in very poor countries, crisis areas and refugee camps. As a traveler to cholera areas, you should:
- drink only boiled water or mineral water from sealed bottles,
- do not use tap water for brushing teeth or washing dishes,
- refrain from adding ice cubes to your drink,
- do not eat raw foods such as salads, and
The normal tourist has only a small risk of contracting cholera. The hygienic conditions in hotels are often sufficient.
Cholera vaccination
There is the possibility of a vaccination against cholera. It includes two vaccination doses and is applied orally, i.e. ingested.
