Basic Information On Cholera

Dr Ajughoro Oghenetegha

 

What is Cholera?

Cholera is an Acute diarrheal infection that occurs after eating food or drinking water contaminated with
Vibrio Cholerae bacteria.

The main presentation of this infection is profuse secretory diarrhea which can lead to severe
dehydration and sometimes death.

Countries affected by war, poverty and natural disasters have the greatest risk for cholera outbreak.

Epidemiology

According to the WHO, it’s estimated each year 1.3 to 4 million cases of cholera and 21,000 to 143,000 deaths worldwide due to cholera.

In Nigeria Cholera is endemic and seasonal, occurring annually mostly during the rainy season with the first reports of outbreak between 1970-1990.

Huge outbreaks have been recorded in Nigeria in 1991, 2010, 2014 and 2018.

In 2018 there were 43,990
cholera cases and 836 deaths.

As at September 5, 2021, a total of 69,925 suspected cases, including 2,323 deaths, have been reported by the Nigeria Centre for Disease Control (NCDC). About 98% of these cases are mainly accounted for the 19 Northern States.

Mostly affecting Bauchi, Zamfara, Gombe and Kano.

Risk Factors

-Areas with poor access to good water supply
-People living where there’s poor sewage disposal
-Poor food and hand hygiene
-Healthcare workers, relief workers who respond to outbreaks
-Low levels of stomach acid (achlorhydria, use of antacids)
-People with type O blood
-Eating raw shellfish, poorly cooked meals.

Pathophysiology

There are many serogroups of V. Cholerae but only two cause outbreaks:
– V. Cholerae 01 (responsible for recent outbreaks)
– V. Cholerae 0139 (sporadic cases)
Vibrio Cholerae is a comma-snapped gram negative aerobic or facultatively anaerobic bacillus with an antigenic structure consisting of a flagellar H antigen and a somatic O antigen.
The El Tor bio type of V.Cholerae 01 is the predominant Cholera pathogen.

Cholera

When food that is contaminated with V.cholera is ingested and gets to the small intestine, the bacteria
binds to the intestinal walls and releases an enterotoxin (CTX) which interferes with the normal flow of Sodium and Chloride causing the intestine to secrete large amounts of water into the lumen causing diarrhea and rapid loss of fluids and electrolytes.

There is usually no difference in the illness caused by the two serogroups

Clinical Presentation

Once infected symptoms usually appear within 2 to 3 days, and while infected the bacteria is present in the feces for 7-14 days.

Symptoms include:

-Voluminous watery diarrhea (rice water stool)
-Nausea and Vomiting
-Cramps
-Generalized weakness
-Severe dehydration

Diagnosis

A provisional diagnosis is usually made on account of the clinical presentation (rice water stool) in an endemic region.
-Thorough History taking
-Clinical presentation (rice water stool)
-Physical examination

-Stool microscopy, culture and sensitivity

-Serology and bio typing

Management

-Assess for the level of dehydration
-Oral Rehydration Salt / Intravenous fluid for rehydration and maintenance
-Monitor stool volume (using bedside diarrhea cots)
-Antibiotics (doxycycline, tetracycline, ciprofloxacin)
-Zinc supplements
-Diet

Key Facts On Cholera

Prevention

Regular and Proper hand washing
Try to eat only fruits you peeled personally.
Drink only water from safe sources
Avoid eating from places with poor food and personal hygiene
Cook your food properly.

VACCINATION Dukoral vaccine, Shanchol, Euvichol vaccine.

Complication
The main complication from Cholera infection is Severe dehydration and hypovolemic shock.
There are few other complications which includes:
Hypoglycemia
Hypokalaemia (can cause cardiac arrhythmias)
Kidney failure

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