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" What is cholera  Cholera is an infectious disease caused by a bacterial toxin that affects the absorption of water in the small intestine.  In severe cases, it produces violent diarrhoea within only a few days. The dangerous aspect of cholera is the vast loss of fluid that can occur in a short space of time. It&amp;#039;s particularly dangerous in children in developing countries.  If untreated, the loss of fluid can be fatal within 24 hours of developing the disease. On the other hand, treatment is simple: replace the fluid with the right mix of sugar and salts \u2013 water alone is not adequately absorbed. But bad cases do require admission to hospital, where fluids can be administered straight into the bloodstream via a drip. Cholera is not really a tropical disease, but it&amp;#039;s related to standards of hygiene and the quality of drinking water. It was a single well in London in the 1850 to 1860s that was the source of several separate cholera epidemics.  John Snow is regarded as a father of public health by his simple but brilliant removal of the handle to the Broadwick Street water pump! Improved sanitation and hygiene are still the basic foundation of the fight against cholera in those countries where it occurs. What causes cholera? Cholera is caused by a specific bacterium, Vibrio cholerae.  When an adequate quantity of the bacteria has passed into the stomach in food, they accumulate and begin to produce poisonous substances (toxins). It&amp;#039;s the toxin that causes the symptoms of the disease. The cholera toxin has the unpleasant ability to affect the cells of the gastrointestinal tract, so that the affected person doesn&amp;#039;t just get ordinary diarrhoea but also starts to lose large quantities of fluid. It&amp;#039;s this fluid loss that can be serious. How is cholera transmitted? Bacteria are excreted in faeces and if this comes into contact with drinking water, the bacteria can infect people.  Bacteria can also spread to food, if people don&amp;#039;t wash their hands thoroughly after using the toilet. The food prepared at the funeral of a cholera victim is a common source of secondary spread in Africa! The disease can be spread through fish and shellfish from contaminated water. Shellfish filter large quantities of water and concentrate the bacteria. The cholera outbreak in Peru in 1998 was thought to be related to contaminated algae, and it appears that this is an effective way for cholera to spread to coastlines.\u00A0Ghana in West Africa has suffered in recent years. Direct infection by contact with another person via their faeces or vomit may occur, but it&amp;#039;s unusual. A certain amount of bacteria is needed before people with normal quantities of stomach acid become ill (stomach acid is able to kill small quantities of bacteria). So, the bacteria need an opportunity to multiply in water or food before it actually constitutes a risk. Haiti had an outbreak caused by infected toilet water contaminating water sources used by the locals. Where does cholera occur? Cholera is very common in parts of Asia and Africa, where epidemics occur at regular intervals.  Unfortunately, the &amp;#039;El Tor&amp;#039; cholera bacterium found its way to parts of Peru in the 1990s, and from there, spread rapidly throughout the remainder of the South America. Densely populated, poor areas with little sanitation and unsatisfactory food hygiene are particularly affected by epidemics. What are the symptoms of the disease? The incubation period, from infection until the disease breaks out, is generally less than two days, although it can be as long as five days.  The infection is often a mild illness with ordinary diarrhoea, and it can even evolve without any symptoms at all. But the individual is still able to pass on the disease. Typically, cholera begins over quite a short period of time with stomach pains without feeling sick. There may also be a mild fever. Then vomiting and diarrhoea begins and may continue for several hours. This is followed by copious, watery diarrhoea that&amp;#039;s pale and flaky and looks like rice water. The fluid loss may be as high as 1 litre every hour.  Danger signals If the fluid loss is not replaced and exceeds 5 to 10 litres, it can be fatal. Extensive dehydration can produce floppy skin, muscle cramps and a hoarse voice. There&amp;#039;s also an effect on the level of consciousness, and this may manifest itself as lethargy and confusion.  The electrolyte (salt) balance may also be disturbed. In children particularly, this can cause convulsions or cardiac arrest. Prospects Mild cases of cholera usually recover on their own. Classic cholera has a high mortality rate if it&amp;#039;s not treated. In developing countries, mortality among those admitted to hospital without treatment is 60 per cent. If the illness is treated quickly and properly, the mortality rate is below 1 per cent and the patient recovers completely.  How can you avoid infection?  Only drink boiled water or water that has been sterilised or treated in another way. Hot coffee and tea, fizzy water and other uncontaminated bottled drinks are usually safe enough to drink. Boil unpasteurised milk before you drink it. Avoid ice cubes in drinks, unless you can be sure they were made from &amp;#039;safe water&amp;#039;! Ice cream from doubtful sources may also be contaminated.  Use high-quality filtration systems such as Life Saver Systems. Food must be properly prepared and still hot when it&amp;#039;s served. If it&amp;#039;s allowed to stand at room temperature for several hours other bacteria, such as Escherichia coli, may develop.  Avoid raw fish and shellfish.  Avoid raw fruit and vegetables, unless you peel it yourself.  Be careful eating food from street stalls. If you have to eat this type of food, think carefully about its preparation. Make sure it doesn&amp;#039;t contain anything that hasn&amp;#039;t been properly prepared.   This advice will protect you, not just against cholera, but also against a whole range of bacteria that can cause unpleasant diarrhoea. Some bacteria, however, produce toxins that are not destroyed by boiling. This is why correct food storage is also important. Vaccination against cholera is now possible with two doses (one week apart) of the oral vaccine Dukoral. But this vaccine does not provide 100 per cent protection against the disease, and people who have had the vaccine will still need to follow the measures outlined above to avoid illness. This vaccine is most likely to be suitable for backpackers and those travelling to situations where the risk of cholera is greatest (eg refugee camps).  If you think you have caught cholera on a trip If you think you have caught cholera, you should see a doctor immediately. But do not despair if you are miles away from a hospital or doctor. The most important thing you can do yourself, in any case of violent diarrhoea, is to consume large quantities of fluid with salt and sugar (alternatives include flat cola drinks), even if you&amp;#039;re vomiting in between. There are powders with salt, bicarbonate and sugar in the correct ratio mixture that can be dissolved in water and taken, such as Dioralyte and Electrolade.  You can also produce this fluid yourself from the following ingredients. The liquid should be about as salty as tears.  1 litre of boiled water.  8 level or 4 heaped teaspoons of sugar (white, brown or honey).  1/2 teaspoon of salt. The juice of a lemon or orange (to add taste only).   How is the disease diagnosed? Many diseases cause diarrhoea. But if it&amp;#039;s violent with watery stools, the doctor will treat you immediately. To make a definite diagnosis, the stools have to be examined to detect the cholera bacteria. How is cholera treated? Severe cases of the disease must be treated in hospital.  The first and most vital measure is to replace the fluid lost. If speed is important, fluid may be administered directly into the bloodstream by a drip. During epidemics, 90 per cent of those who get ill would be okay if they drank large amounts of rehydration solutions. The course of the disease can be shortened and the excretion of bacteria stopped quicker by giving antibiotics, such as doxycycline (eg Vibramycin). Last updated 10.07.2015 "^^<http://www.w3.org/2001/XMLSchema#string>
<http://www.netdoctor.co.uk/conditions/infections/a5683/cholera/>