ABOUT Cholera

Cholera is a widespread acute condition in poverty areas, and most strikingly in disaster situations like the Haiti and Nepal earthquakes, and in war zones. It occurs because of poor sanitation. Stool bacteria get into water used for drinking and for fruits and vegetables.

The cause of cholera is a bacterium Vibrio cholera, of which there are at least 6 genetic types. Some cause mild illness, and some severe illness.

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Clinical Progression

Illness begins 2 to 7 days after exposure to contaminated water or polluted fruits or vegetables. A small exposure is not enough to produce a disease, but a full glass of water or a complete meal can get things started.

The illness begins with sudden copious diarrhea, classically described as “rice water diarrhea.”

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As much as 10 to 20 liters per day can be lost through this diarrhea. So dehydration is an immediate threat, particularly in children. There may also be intense projectile vomiting. Usually the diarrhea is painless at first, but as electrolytes (sodium, potassium, magnesium) become depleted, there may be abdominal pain and cramping. There usually is tremendous thirst, so oral rehydration fluids are consumed liberally.

Typically there is no fever with cholera. This differentiates it from typhoid, malaria, Lassa, and even Ebola.

The typical course lasts just a few days if treatment is instituted and hydration is adequate. With treatment, only 1% or so die from cholera. By contrast, though, in regions with inadequate medical support such as in disaster or war zones, mortality rates can be 50-60%!

Complications

The major threat from cholera is dehydration, especially in children. Dehydration leads to sunken eyes, cold skin, wrinkling of skin with poor elasticity, and bluish coloration.

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Lack of electrolytes lead to abdominal and generalized muscle cramping. If dehydration and electrolyte loss become severe enough, there can be kidney failure, deep and labored breathing from metabolic acidosis, mental confusion, seizures, coma, and finally death.

Diagnosis

There is a dipstick screening test which can eliminate cholera as a diagnosis when it reads negative. However, it is not specific enough to confirm a diagnosis of cholera. So if the stools are dipstick positive – especially in the midst of classic clinical history – a stool culture and sensitivity should be done. This does take time, so doctors typically institute antibiotic treatment right away according to local experience in the specific epidemic – along with intravenous and oral rehydration.

Treatment

The first goal in treatment is certainly to institute proper hydration, with electrolytes as are found in common oral rehydration fluids. Clinical experience seems to validate rice-based rather than sugar-based rehydration. Intravenous treatment when possible is ideal. In children, zinc supplementation seems to be helpful.

eRemedies from eremedyonline.com/module/13/cholera/ has a very high chance of producing rapid relief of symptoms and should certainly be tried if you have a cellphone or computer from which to answer questions for the expert system and then to play the chosen healing signal directly.

Antibiotics are also known to be very effective, if available. Antibiotic resistance is very common in this situation, so it is important to identify the best antibiotics via cultures and sensitivity early in the epidemic. Doxycycline and Cipro have been effective but are waning in value. Erythromycin, tetracycline, Septra, and azithromycin tend to be good antibiotics in cholera epidemics.

Prevention

Of course, attention to sanitation is crucial. This does tend to be problematic in war zones and disaster zones, so world-level institutions need to bring effective assistance.

For travelers coming to cholera-prone regions, there is a vaccine that needs to be administered 6 days before entry. This vaccine is about 50% effective for 6 months, so attention to limiting yourself to bottled water and avoiding raw fruits and vegetables, and even inadequately cooked seafood are all important precautions.