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Join date : 2009-04-10
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PostSubject: CHOLERA INFORMATION   Mon Oct 25, 2010 5:25 pm


What is cholera and what causes it ?
It is a highly infectious and potentially serious diarrheic disease, caused by a comma-shaped microscopic bacterium called Vibrio cholera.

Where does it occur ?
Anywhere in the world, particularly in places with poor sanitation and/or sewage handling practices. In fact, it is endemic in many areas of the world.

How is it transmitted ?
By the so-called “fecal-oral route”, which basically means the fecal contamination of consumable (edible or drinkable) items.

How long between infection and the appearance of symptoms ?
As little as 24-48 hours.

Which are the symptoms ?
The sudden onset of watery diarrhea and vomiting. The diarrhea in particular, can be quite voluminous and has a “rice water” appearance and fishy odor. Abdominal cramps are common, but fever is rare in adults, occurring mainly in children. The fluids and electrolytes (potassium, sodium, chlorides, magnesium, etc.) loss caused by the diarrhea can be quite serious, leading to thirst, dry mouth, weakness, dehydration, shock and death, if untreated.

Who is at risk ?
Everybody, particularly those taking medications which lower the stomach’s acid production, as the offending organism is very susceptible to and unable to survive in an acidic environment. Pregnant women and children have a higher mortality (see ahead).

Is this condition serious ?
It certainly can be !! As already stated, severe dehydration can lead to shock and death in over 50% of untreated cases.

What is one to do?
See under “Precautions” below. Seek immediate medical attention for such diarrheic condition. DO NOT PROCRASTINATE OR DELAY IN DOING SO, as severe dehydration, shock and death can ensue within a couple of days (while you are debating whether to seek medical attention).

How is cholera treated ?
The mainstay of therapy centers on fluids and electrolytes replacement. If this is done promptly, the reduction in mortality is dramatic and most gratifying, as it drops from over 50% to under 5%, if treated on time. Initially, fluids and electrolytes replacement must be done intravenously until the diarrhea improves substantially, at which time it is possible to switch to the oral route. Antibiotics can be used and do help some, but fluids and electrolytes replacement is and remains the most important measure.

What can one do to prevent this ?
1- Do not consume food or drink sold on the street.
2- Avoid eating any uncooked food (salads, shellfish, ceviche and so on).
3- Do not drink any water or use ice of uncertain origin or unsure about the water source for its manufacture. Drink only bottled water or carbonated drinks. If unsure about water, proceed to boil it for a minimum of 10 minutes before using it. If you cannot boil it, put 2 drops of household bleach (chlorine) or ½ tablet of iodine in every liter of water before drinking it.
4- Eat only fully cooked meals while still hot.
5- Wash hands thoroughly prior to eating and/or insist your house’s help does likewise as well. Use hand sanitizer often.
6- Only eat fruits after they have been immersed in chlorine water for disinfection and if you can peel them yourself. An useful rule of thumb is: “boil it, cook it, peel it, or forget it” !!

Is there a vaccine against cholera ?
The existing vaccines are of limited usefulness and do not prevent the transmission of this disease.

I hope this helps.

Rafael G. Belliard, MD.

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