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One of the earliest known infections

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Bernice Clark |
Vibrio cholerae bacteria Cholera is a disease caused by the bacteria Vibrio cholerae that infects the intestine. It is one of the most feared diseases on Earth that killed hundreds of thousands of people through history.

The bacteria Vibrio cholerae is excreted by an infected person in the stools and vomit. The germ can also contaminate food or water supplies. When that happens, that causes an explosive outbreak because many people will ingest the germ in a short period of time.

When they enter the intestine germs multiplies and produces a toxin that causes the cells in the intestine to secrete volumes of fluid and leads to diarrhea and vomiting. A patient under treatment can lose more than 50 litres of fluid during a bout of cholera. A patient who is not treated will die of dehydration very fast. In fact, death usually occurs when 10 to 15 percent of the total body weight is lost: in severe cases this may take only a couple of hours. If untreated, the disease can result in death in more than 50 percent of patients, and the mortality rate is increased in pregnant women and children.

Who can get cholera? Anyone can get cholera if they drink water or eat food contaminated with the cholera bacterium. In an outbreak situation the source of contamination is usually the stool of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water.

Symptoms can occur within hours up to five days after consumption of contaminated food or water, usually in two or three days. The disease is diagnosed by isolating the cholera bacterium from stool or vomit, or by finding evidence in the blood of the recent production of antibodies against cholera.

Cholera can be treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can often be treated with oral rehydration solution, but severe cases also require intravenous fluid replacement. With prompt rehydration, less than one percent of cholera patients will die. Antibiotics shorten the duration of the disease, but they are not as important as entering fluid.

The good news is that cholera has been very rare in developed nations for the last 100 years. The bad news is that the disease is still common in other parts of the world, including the Indian subcontinent and sub-Saharan Africa. Since 1991, epidemic cholera has been a problem in South America. A few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another unless they touch each other.

If travelling to an area where cholera has occurred buy bottled water or bring it to a boil for one minute before you drink it. Bottled carbonated water is safer than uncarbonated water. Other safe beverages include tea and coffee made with boiled water and carbonated bottled beverages with no ice.

Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself. Avoid undercooked or raw fish or shellfish, make sure all vegetables are cooked, avoid salads, foods and beverages from street shops. A simple rule of thumb is: "Boil it, cook it, peel it, or forget it!" Note that vaccine is available but it offers only an incomplete immunity and is not recommended for travellers.

Abraham Eisenstein, M.D.

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