Cholera

Definition | Aetiology | Pathophysiology | Risk Factors | Signs and Symptoms | Investigations | Management | References

Definition

Cholera is an acute diarrhoeal illness caused by infection with the bacterium Vibrio cholerae. It is characterised by severe watery diarrhoea, which can lead to dehydration and, if untreated, death.

Aetiology

Cholera is caused by ingestion of food or water contaminated with Vibrio cholerae, typically in areas with poor sanitation and inadequate water treatment.

Pathophysiology

The pathophysiology of cholera involves:

• Ingestion of Vibrio cholerae bacteria.
• The bacteria produce cholera toxin in the small intestine.
• The toxin stimulates the secretion of water and electrolytes into the intestinal lumen.
• This leads to severe watery diarrhoea, causing rapid loss of fluids and electrolytes.
• If untreated, this can result in dehydration, metabolic acidosis, and hypovolaemic shock.

Risk Factors

• Living in or travelling to areas with poor sanitation and inadequate water treatment.
• Consumption of contaminated food or water.
• Low socioeconomic status.
• Lack of access to clean water and proper sanitation facilities.
• Immune suppression.

Signs and Symptoms

The signs and symptoms of cholera include:

• Severe, watery diarrhoea, often described as "rice water" stools.
• Vomiting.
• Rapid heart rate.
• Loss of skin elasticity.
• Dry mucous membranes.
• Low blood pressure.
• Thirst.
• Muscle cramps.
• In severe cases, hypovolaemic shock and death.

Investigations

Specific investigations to diagnose cholera include:

• Stool culture: To isolate Vibrio cholerae from the patient's stool.
• Rapid diagnostic tests: To detect cholera antigens in stool samples.
• Polymerase Chain Reaction (PCR): To detect cholera DNA in stool samples.
• Serology: To detect antibodies against Vibrio cholerae (not typically used for acute diagnosis).

Management

Primary Care Management

• Rehydration therapy: Oral rehydration salts (ORS) solution for mild to moderate dehydration.
• Antibiotics: Doxycycline, azithromycin, or ciprofloxacin to reduce the duration of diarrhoea and bacterial shedding.
• Hydration: Ensuring adequate fluid intake and monitoring for signs of dehydration.
• Education: Providing advice on hygiene and safe drinking water practices to prevent further infection.

Specialist Management

• Intravenous (IV) fluids: For severe dehydration or patients unable to take oral fluids.
• Monitoring: Close monitoring of fluid and electrolyte balance, vital signs, and urine output.
• Advanced care: In severe cases, admission to an intensive care unit (ICU) may be necessary.
• Public health measures: Reporting cases to public health authorities and implementing measures to prevent outbreaks, such as improving sanitation and access to clean water.

References

1. NHS (2024) Cholera. Available at: https://www.nhs.uk/conditions/cholera/ (Accessed: 24 June 2024).
2. Centers for Disease Control and Prevention (2024) Cholera. Available at: https://www.cdc.gov/cholera/index.html (Accessed: 24 June 2024).
3. World Health Organization (2024) Cholera. Available at: https://www.who.int/news-room/fact-sheets/detail/cholera (Accessed: 24 June 2024).
4. British Medical Journal (2024) Cholera: clinical features, diagnosis, and management. Available at: https://www.bmj.com/content/368/bmj.m1280 (Accessed: 24 June 2024).

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