Causes, Symptoms, Prevention and Treatment of Cholera
By Anthony Wanjohi
Cholera is an
acute, diarrheal illness caused by infection of the intestine with
the bacterium Vibrio cholerae. The
infection is often mild or without symptoms, but sometimes can be severe. An
acute water shortage in parts of eastern and northeastern Kenya is
fuelling the spread of acute watery diarrhoea (AWD)
and cholera, with deaths from new cases being reported. People are resorting to
drinking water from anywhere because of the shortage. (IRIN,
2010). Kajiado District is such one
District that suffers from water shortage especially during prolonged droughts.
Thus, people often fall victim of this disease. No lasting measures have
yet been put in place to curb the disease. The paper examines this disease
based on the framework of it causes, signs and symptoms, diagnosis and
prevention. Further the paper gives some demonstration on the disease
to enlighten the community members more about it. Also to examine some
preventive measures that can be undertaken to safeguard world cup visitors who
may visit the place.
2.0 Causes, Symptoms,
Diagnosis, Prevention and Treatment of Cholera
Cholera is a severe
diarrhea disease that is deadly without treatment. It is caused by poor hygiene
and sanitation systems (World Health Organization, 2008). The disease is
transmitted through water borne and food borne transmission.
Waterborne transmission: one can transmit the disease once
he/ she consume water that is contaminated with feces from an infected person.
This is common in areas with poor sewage systems and unclean drinking water.
People infected with cholera suffer acute diarrhea. This liquid diarrhea,
colloquially referred to as "rice-water stool," is loaded with
bacteria that can infect water used by other people (Ryan & Ray, 2004). The
source of the contamination is typically other cholera patients when their
untreated diarrhea discharge is allowed to get into waterways or into
groundwater or drinking water supplies.
Food borne transmission: Also, consumption of cholera can be
through drinking contaminated water or eating foods that have been washed with
or made with contaminated water. Food borne transmission may also occur when an
individual eats raw or undercooked shellfish. Any infected water and any foods
washed in the water, as well as shellfish living in the affected waterway, can
cause an infection. Cholera is rarely spread directly from person to person. V.
cholera harbors naturally in the zooplankton of fresh, brackish, and salt
water, attached primarily to their chitinous exoskeleton. (Kirn 2005).
Once the bacteria exit
the stomach and reach the small intestine, they propel themselves through the
thick mucus that lines the small intestine to get to the intestinal wall where
they can thrive. V. cholerae bacteria. They
then start up production of the hollow cylindrical protein flagellin to make flagella, the curly whip-like tails
that they rotate to propel themselves through the mucus of the small
intestine. After they reach the intestinal wall, the
bacteria stops producing the protein flagellin. It
therefore starts conserving energy and nutrients by changing the mix of
proteins that they manufacture in response to the changed chemical
surroundings. The toxic protein is the one that gives the infected person a
watery diarrhea. This diarrhea carries
the multiplying new generations of V. cholerae bacteria
out into the drinking water of the next host if proper sanitation measures are
not in place (Hartwell and Veres, 2004).
The primary symptoms of
cholera:
· Profuse diarrhea sometimes called “rice
water stools”
· Abdominal pain
Others may include:
· vomiting
· leg cramps
These symptoms start
suddenly, usually one to five days after infection, and are the result of a
toxin produced by the vibrio cholera bacterium that compels profuse
amounts of fluid from the blood supply into the small and large intestines (Kindersley,
1989). An untreated cholera patient may produce several gallons
of diarrheal fluid a day (Diamond, 1999). Due to this rapid loss of
fluids, severe dehydration and shock can occur in these individuals. Shock
occurs due to collapse of the circulatory system and if the fluid is not
replaced, the patient may die within several hours.
Signs of dehydration
include:
· loss of skin plasticity
· sunken eyes
· fast heartbeat
· low blood pressure
· Rapid
weight loss
In epidemic situations,
a clinical diagnosis is made by taking a history of symptoms from the patient
and by a brief examination only. People must begin treatment even before
diagnostic work-up confirmation by laboratory analysis of specimens. Lab tests
include stool gram stain (gram negative rods) culture, dark field microscopy or
stool PCR. Stool and swab samples collected in the acute stage of the disease,
before antibiotics have been administered, are the most useful specimens for
laboratory diagnosis (Laboratory Methods for the Diagnosis of Epidemic
Dysentery and Cholera, 1999).
A new oral vaccine,
called Dukoral is available in other
countries, but prophylactic usage is not currently recommended for routine use
by the Centers for Disease Control and Prevention (CDC) because of incomplete
protective effects (WHO, 2008). The CDC therefore recommends:
Sterilization: Proper disposal and treatment of all
materials that come in contact with cholera patients should be sterilized by
washing in hot water using chlorine bleach if possible.
Sewage: anti-bacterial treatment of general sewage
by chlorine, ozone, ultra-violet light or other effective treatment before it
enters the waterways or underground water supplies helps prevent undiagnosed
patients from inadvertently spreading the disease.
Sources: Warnings about possible cholera
contamination should be posted around contaminated water sources with
directions on how to decontaminate the water (boiling, chlorination etc.) for
possible use.
Water purification: All water used for drinking, washing, or cooking should be
sterilized by boiling, chlorination, ozone water treatment, ultra-violet
light sterilization, or anti-microbal filtration
in any area where cholera may be present. Chlorination and boiling are often the least expensive and
most effective means of halting transmission.
Sensitive surveillance: Surveillance systems can provide early
alerts to outbreaks, therefore leading to coordinated response and assist in
preparation of preparedness plans. Understanding the seasonality and location
of outbreaks provide guidance for improving cholera control activities for the
most vulnerable. According to (Bertranpetit & Calafell, 1996) this will also aid in the developing
indicators for appropriate use of oral cholera vaccine.
Because death from
cholera is a consequence of dehydration, the disease is treated using oral rehydration therapy
(ORT). ORT is highly effective, safe, and simple to administer. In situations
where commercially produced ORT sachets are too expensive or difficult to
obtain, alternative homemade solutions using various formulas of water, sugar,
table salt, baking soda, and fruit offer less expensive methods of electrolyte
repletion. Severe cases of cholera require intravenous fluid replacement.
Antibiotics can shorten illness, but ORT is still necessary even when
antibiotics are used. Tetracycline is typically used as the primary antibiotic,
although some strains of V. cholerae have
shown resistance. Other antibiotics that have been proven effective against
V. cholerae include cotrimoxazole,
erythromycin, doxycycline, chloramphenicol, and furazolidone (Molson Medical Informatics, 2007).
According to Krishna & Chandrasekhar (2006), Fluoroquinolonessuch as norfloxacin also
may be used, but resistance has been reported. Use of
anti-diarrheal medicines is not recommended since they prevent flushing of
the bacteria out of the body.
3.0 Demonstration of Cholera Awareness Program
in the School Community
Sanitation and hygiene
are key to community cholera prevention
efforts. Members of community to know that they need to wash their hands each
time before handling food, before eating and after visiting the toilet. These
are the key messages (simple) which each member of the community need to know. However, a general program has various
other parts including the causes, symptoms and even treatment for those
affected.
Table 1 shows Cholera
Awareness and Prevention Program used with a school community at a school
located in Kajiado District of Kenya.
Table
1: Cholera Awareness Program for Inchorroi Primary
School in Kajiado
|
Activity |
Objective |
Methodology |
Date/
Time |
Place |
|
Explaining the causes, symptoms,
transmission, diagnosis, prevention and treatment of typhoid |
To create awareness about hygiene
among members of school community |
Materials used: Charts of the
causes and transmission process. |
14/06/10 |
InchorroiPrimary School community |
|
Discussion groups |
To discuss on the prevention and
treatment of Cholera |
Group Discussion method |
14/06/10 |
InchorroiPrimary School |
|
Reporting |
To report to the rest of group
members on the cholera prevention and treatment |
Presentation |
14/06/10 |
InchorroiPrimary School |
|
Practical Approach |
To demonstrate what is learnt |
Practical method: Washing hands
(with soup), and boiling food |
Continuous process at school and
at home |
|
4.0 Prevention/
Treatment of World Cup Visitors
For World Cup Visitors,
a number of measures should be taken to ensure that no one is infected by
Cholera virus. We understand that a person may get cholera by drinking water or
eating food contaminated with the cholera bacterium. In an epidemic, the source
of the contamination is usually the feces (stool) of an infected person. The
disease can spread rapidly in areas with inadequate treatment of sewage and
drinking water. Since Kajiado District is
one such district which is semi-arid and there is shortage of water, a number
of measures should be taken to ensure that any visitor who may visit the
district for cultural experience or even wild life tour is protected.
To prevent cholera from
infecting the visitors, personal and general preventive measures should be
taken. The following measures are essential:
When purchasing food: Do not buy food from unlicensed food premises
or illegal hawkers; Pay attention to hygienic condition of shops and the
holding temperature of food.
Food hygiene at home: Keep raw and cooked food separately.
Defrost foods only when needed; Use separate utensils and equipment to handle
raw food and cooked food to prevent cross contamination; Consume cooked food as
soon as possible; Left-over food must be stored in a refrigerator at a
temperature below 4 degrees Celsius and be reheated thoroughly before
consumption. Discard any food if spoilage is suspected; and Boil water
thoroughly before drinking.
Personal hygiene: pay attention to personal hygiene.
Wash hands thoroughly with soap, before eating, preparing food and after going
to toilet.
Environmental hygiene: Keep kitchen clean; and Store refuse in a
well-covered dustbin.
In case a visitor is
infected, the following steps should be taken.
Cholera is an easily
treatable disease. In case one is infected, there should be prompt
administration of oral rehydration salts to replace lost fluids. This
nearly always results in cure. In especially severe cases, intravenous
administration of fluids may be required to save the patient's life. Left
untreated, however, cholera can kill quickly following the onset of symptoms.
This can happen at a speed that has incited fear and paralyzed commerce
throughout history. Thus medical interventions can also be taken in the nearest
medical facility.
World Health
Organization (WHO) (2008): Cholera Retrieved May 22,
2010 from Available at: http://www.who.int/topics/cholera/en/
Ryan, K & Ray, G (2004): Sherri’s Medical
Microbiology. McGraw Hill Kirn, T
(2005): A colonization factor links Vibrio cholerae environmental survival and human infection.
Hartwell, L & Veres, R (2004): Genetics: From genes to
genomes. Boston: Mc-Graw Hill
Kindersley, D (1989): AMA Encyclopedia of Medicine. Random
House
Diamond, J (1999): Guns,
Germs, and Steel. Norton Laboratory Methods for the Diagnosis of Epidemic
Dysentery and Cholera, 1999: Atlanta
Bertranpetit J, & Calafell F (1996): Genetic and geographical
variability in cystic fibrosis. Ciba Found Molson Medical
Informatics, (2007): Cholera treatment
Retrieved from:
http://sprojects.mmi.mcgill.ca/tropmed/disease/chol/treatment.htm
Krishna, B & Chandrasekhar, MR
(2006): Fluoroquinolone-resistant, Vibrio cholerae isolated during a cholera outbreak. India
IRIN (2010). Water shortage increases cholera toll.
Retrieved May 24, 2010 from http://www.irinnews.org
Suggested Citation in APA
Wanjohi,A.M.(2011).Causes,
Symptoms, Prevention and Treatment of Cholera.KENPRO Publications. Available
online at http://www.kenpro.org/papers/causes-symptoms-prevention-and-treatment-of-cholera-at-community-level.htm
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