More on cholera

Cholera, as you would know by now, is an infectious disease that causes severe watery diarrhoea, which can lead to dehydration and death if untreated. Without treatment, over half the people who contract cholera will die. It is caused by eating food or drinking water contaminated by a bacterium calledVibrio cholerae. This disease is most common in places where poor sanitary conditions prevail.

The bacteria that causes cholera is usually found in food or water contaminated by faeces from a person with the infection. Common sources include:

◆ Some municipal water supplies

◆ Ice made from contaminated water

◆ Foods and drinks sold by street vendors

◆ Vegetables grown with water containing human wastes

◆ Raw or undercooked fish and seafood caught in waters polluted with sewage

◆ Unsafe water sources including rivers, wells and some boreholes.

◆ Unwashed hands of infected persons

When a person consumes the contaminated food or water, the bacteria release a toxin in the intestines that produces severe diarrhoea. It is not likely you will catch cholera just from casual contact with an infected person and not everyone who ingests the cholera bacteria will get diarrhoea.

Symptoms of cholera can begin as soon as two hours or as long as five days after infection. Often symptoms are mild. But sometimes they are very serious. About one in 20 people infected have severe painless, profuse watery diarrhoea accompanied by vomiting, which can quickly lead to dehydration. Although many infected people may have minimal or no symptoms, they can still contribute to spread of the infection. Cholera will kill you via dehydration. Signs and symptoms of dehydration include: a rapid heart rate, loss of skin elasticity, low blood pressure, excessive thirst, muscle cramps and dry mucous membranes; including the inside of the mouth, throat, nose and eyelids.

If not treated, dehydration can lead to shock and death in a matter of hours, especially in cholera.

Suitable fluids to drink when you have diarrhoea from cholera, or any cause for that matter, include oral rehydration solutions, water, clear soups and broths and diluted juices. If you have nausea, try taking small sips of the fluid often. Intravenous fluids (via a drip), are needed in crisis situations. Oral rehydration is the first line therapy for diarrhoea. Rehydration fluids contain not only the water replacement that is required in diarrhoea or vomiting-induced dehydration, but also important electrolytes that must be replaced. If dehydration is sufficiently severe, water alone is inadequate.

Oral rehydration solutions replace fluids lost, but do not treat the cause or stop the diarrhoea. Commercial preparations should be mixed exactly to the manufacturer’s directions. It is very important to comply with the expiry dates of the rehydration solutions once they have been opened or made up. The standard formula for homemade rehydration solution is a six teaspoons sugar and half a teaspoon of salt to a litre of clean water.

While you have diarrhoea, avoid caffeine (tea, coffee, cola drinks), alcohol and foods that are fatty, very sweet or high in fibre. Dairy products may aggravate symptoms, but yoghurt (which contains less lactose than milk) may be tolerated. Resume eating solid food slowly and choose foods that are bland, low in fat and low in fibre. This includes crackers, boiled potatoes, plain rice, or toast.

Diarrhoea can affect the way that some medicines (such as the contraceptive pill) are absorbed. If you take the contraceptive pill and develop diarrhoea, you should use a back-up method of contraception, such as condoms, until your next menstrual period because the diarrhoea may make the pill less effective.If you are taking any other regular medicine, talk to your doctor about the effects that diarrhoea may have had on its effectiveness.

If your diarrhoea and other symptoms are suspected to be from cholera, you need to be prepared to be sent to an infectious diseases unit for investigations and treatment.