Cholera is a word that most Americans have never heard, or perhaps only in antiquated stories of our forefathers. For most people in industrialized nations, clean water is something taken for granted. Because water comprises such a large part of our bodies, we constantly need to replenish ourselves through constant water drinking. No one expects that water will make them sick, in fact they assume the opposite. However, for those who are denied basic human rights, water can be lethal.
Pathology: Cholera is acquired through the contraction of the bacteria Vibrio cholerae. This bacteria lives in feces, so one can contract this through direct fecal contact or through eating contaminated food or drinking contaminated water. Thus, in areas where there is a lack of proper sanitation or a clean water source, it is very easy to spread the bacteria.
The bacteria has an incredibly short incubation period- anywhere from a couple of hours to five days. For someone who is already immuno-compromised (such as with an HIV infection), the bacteria can kill a person within hours of contact. In fact, it is considered the most rapidly fatal illnesses. This short incubation period also contributes to its catastrophic nature- many people can develop and spread this quickly, leading to a cholera outbreak.
The usual progression for those who die from the infection is as follows: Symptoms begin within an hour or so of contamination, a liquid stool follows in the next hour, and then the person continues to have liquid stools continuously until they end up in shock (approximately 4-12 hours after contamination). From that point, it takes no longer than a few days for the person to die from severe dehydration if no therapy is offered.
Symptoms: Cholera is a severe form of diarrhea. Like tuberculosis, many people can become infected and never show symptoms (up to 75%). Some develop mild symptoms that is virtually indistinguishable from a regular version of diarrhea. The remaining 20% will develop diarrhea so severe that they will become incredibly dehydrated.
Treatment: Cholera treatment is simple and inexpensive: oral rehydration therapy. When people die from cholera, they die from being too dehydrated. Oral rehydration therapy gives infected patients a drink similar to Gatorade which replenishes fluid and sodium. This nearly always completely cures cholera.
Sadly, those infected with cholera are not getting this easily accessible treatment. The WHO estimates that under 1% of cholera infections could lead to death with adequate treatment. Currently, up to 50% of those with severe cholera end in a painful death.
Prevention: The best prevention is through clean water and sterilization. For countries with proper sewage and access to clean water, cholera has been completely eradicated. If you are going to visit a foreign country, make sure to research whether that area has cholera and ask your physician for the proper way to prevent infection.
Mortality (# of deaths): This is hard to measure, but anywhere from 5-50% of those infected with cholera in a location will die from it.
Morbidity (incidence of disease): The WHO believes this is impossible to measure, as many countries do not report cholera cases. In 2006, there were approximately 200,000 cases reported around the world, but the WHO believes this represents no more than 5-10% of the true cases (which would put cholera incidence around 2,000,000 to 4,000,000)
Epidemiology (where the disease is prevalent): In underdeveloped nations, most notably in Africa
- It is estimated that in a 6 day course of cholera, an adult may release up to 36 Liters of diahreal stool.
- Cholera was the leading killer on the Oregon Trail
- President James Polk, author Alexander Dumas, and composer Tchaikovsky all suffered from cholera
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