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Cholera

This article is about the bacterial disease. For the dish, see Cholera (food).

Cholera
Other namesAsiatic cholera, epidemic cholera[1]
A person with severe dehydration due to cholera, causing sunken eyes and wrinkled hands and skin.
SpecialtyInfectious disease
SymptomsLarge amounts of watery diarrhea, vomiting, muscle cramps[2][3]
ComplicationsDehydration, electrolyte imbalance[2]
Usual onset2 hours to 5 days after exposure[3]
DurationA few days[2]
CausesVibrio cholerae spread by fecal-oral route[2][4]
Risk factorsPoor sanitation, not enough clean drinking water, poverty[2]
Diagnostic methodStool test[2]
PreventionImproved sanitation, clean water, hand washing, cholera vaccines[2][5]
TreatmentOral rehydration therapy, zinc supplementation, intravenous fluids, antibiotics[2][6]
PrognosisLess than 1% mortality rate with proper treatment, untreated mortality rate 50–60%
Frequency3–5 million people a year[2]
Deaths28,800 (2015)[7]

Cholera (/ˈkɒlərə/) is an infection of the small intestine by some strains of the bacterium Vibrio cholerae.[4][3] Symptoms may range from none, to mild, to severe.[3] The classic symptom is large amounts of watery diarrhea lasting a few days.[2] Vomiting and muscle cramps may also occur.[3] Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance.[2] This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet.[5] Dehydration can cause the skin to turn bluish.[8] Symptoms start two hours to five days after exposure.[3]

Cholera is caused by a number of types of Vibrio cholerae, with some types producing more severe disease than others.[2] It is spread mostly by unsafe water and unsafe food that has been contaminated with human feces containing the bacteria.[2] Undercooked shellfish is a common source.[9] Humans are the only known host for the bacteria.[2] Risk factors for the disease include poor sanitation, insufficient clean drinking water, and poverty.[2] Cholera can be diagnosed by a stool test,[2] or a rapid dipstick test, although the dipstick test is less accurate.[10]

Prevention methods against cholera include improved sanitation and access to clean water.[5] Cholera vaccines that are given by mouth provide reasonable protection for about six months, and confer the added benefit of protecting against another type of diarrhea caused by E. coli.[2] In 2017 the US Food and Drug Administration (FDA) approved a single-dose, live, oral cholera vaccine called Vaxchora for adults aged 18–64 who are travelling to an area of active cholera transmission.[11] It offers limited protection to young children. People who survive an episode of cholera have long-lasting immunity for at least three years (the period tested).[12]

The primary treatment for affected individuals is oral rehydration salts (ORS), the replacement of fluids and electrolytes by using slightly sweet and salty solutions.[2] Rice-based solutions are preferred.[2] In children, zinc supplementation has also been found to improve outcomes.[6] In severe cases, intravenous fluids, such as Ringer's lactate, may be required, and antibiotics may be beneficial.[2] The choice of antibiotic is aided by antibiotic sensitivity testing.[3]

Cholera continues to affect an estimated 3–5 million people worldwide and causes 28,800–130,000 deaths a year.[2][7] To date, seven cholera pandemics have occurred in the developing world, with the most recent beginning in 1961, and continuing today.[13] The illness is rare in high-income countries, and affects children most severely.[2][14] Cholera occurs as both outbreaks and chronically in certain areas.[2] Areas with an ongoing risk of disease include Africa and Southeast Asia.[2] The risk of death among those affected is usually less than 5%, given improved treatment, but may be as high as 50% without such access to treatment.[2] Descriptions of cholera are found as early as the 5th century BC in Sanskrit.[5] In Europe, cholera was a term initially used to describe any kind of gastroenteritis, and was not used for this disease until the early 19th century.[15] The study of cholera in England by John Snow between 1849 and 1854 led to significant advances in the field of epidemiology because of his insights about transmission via contaminated water, and a map of the same was the first recorded incidence of epidemiological tracking.[5][16]

Video summary of this article with VideoWiki (script)
  1. ^ Cite error: The named reference textbook was invoked but never defined (see the help page).
  2. ^ a b c d e f g h i j k l m n o p q r s t u v w x y "Cholera vaccines: WHO position paper" (PDF). Weekly Epidemiological Record. 85 (13): 117–28. March 2010. PMID 20349546. Archived from the original (PDF) on April 13, 2015.
  3. ^ a b c d e f g "Cholera – Vibrio cholerae infection Information for Public Health & Medical Professionals". Centers for Disease Control and Prevention. January 6, 2015. Archived from the original on 20 March 2015. Retrieved 17 March 2015.
  4. ^ a b Finkelstein RA (1996). "Cholera, Vibrio cholerae O1 and O139, and Other Pathogenic Vibrios". In Baron S (ed.). Medical Microbiology (4th ed.). University of Texas Medical Branch at Galveston. ISBN 978-0-9631172-1-2. PMID 21413330. NBK8407.
  5. ^ a b c d e Harris JB, LaRocque RC, Qadri F, Ryan ET, Calderwood SB (June 2012). "Cholera". Lancet. 379 (9835): 2466–2476. doi:10.1016/s0140-6736(12)60436-x. PMC 3761070. PMID 22748592.
  6. ^ a b "Cholera – Vibrio cholerae infection Treatment". Centers for Disease Control and Prevention. November 7, 2014. Archived from the original on 11 March 2015. Retrieved 17 March 2015.
  7. ^ a b Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/s0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  8. ^ Bailey D (2011). Cholera (1st ed.). New York: Rosen Pub. p. 7. ISBN 978-1-4358-9437-2. Archived from the original on 2016-12-03.
  9. ^ "Sources of Infection & Risk Factors". Centers for Disease Control and Prevention. November 7, 2014. Archived from the original on 12 March 2015. Retrieved 17 March 2015.
  10. ^ "Diagnosis and Detection". Centers for Disease Control and Prevention. February 10, 2015. Archived from the original on 15 March 2015. Retrieved 17 March 2015.
  11. ^ "Cholera Fact Sheet". www.health.ny.gov. 2017. Retrieved 2020-05-26.
  12. ^ Harris JB (November 15, 2018). "Cholera: Immunity and Prospects in Vaccine Development". J Infect Dis. 218 (Suppl 3): S141–S146. doi:10.1093/infdis/jiy414. PMC 6188552. PMID 30184117.
  13. ^ "Cholera's seven pandemics". CBC. 9 May 2008. Retrieved 15 July 2018.
  14. ^ "Cholera – Vibrio cholerae infection". Centers for Disease Control and Prevention. October 27, 2014. Archived from the original on 17 March 2015. Retrieved 17 March 2015.
  15. ^ Cite error: The named reference rosenberg was invoked but never defined (see the help page).
  16. ^ Timmreck TC (2002). An introduction to epidemiology (3. ed.). Sudbury, MA: Jones and Bartlett Publishers. p. 77. ISBN 978-0-7637-0060-7. Archived from the original on 2016-12-03.

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