Cholera (or
Asiatic cholera or
epidemic cholera) is a severe
diarrheal disease caused by the
bacterium Vibrio cholerae.
Symptoms In general, patients must receive as much fluid as they lose, which can be up to 36 L, due to diarrhea.
Treatment typically consists of aggressive
rehydration (restoring the lost body fluids) and
replacement of electrolytes with commercial or hand-mixed sugar-salt solutions (1 tsp salt + 8 tsp sugar in 1 litre of clean/boiled water) or massive injections of liquid given intravenously via an IV in advanced cases. See:
Oral rehydration therapy for easily made rehydration solutions and
Ceralyte. Without rehydration, the death rate can be as high as (10-50%) due to the serious dehydration that cholera produces.
Tetracycline antibiotics may have a role in reducing the duration and severity of cholera, although drug-resistance is occurring.
Treatment Epidemiology Although cholera can be life-threatening, it is nearly always easily prevented, in principle, if proper sanitation practices are followed. In the United States and Western Europe, because of advanced water treatment and sanitation systems, cholera is no longer a major threat. The last major outbreak of cholera in the United States was in
1911. However, everyone, especially travelers, should be aware of how the disease is transmitted and what can be done to prevent it. Good sanitation practices, if instituted in time, is usually sufficient to stop an epidemic. There are several points along the transmission path at which the spread may be halted:
Sickbed: Proper disposal and treatment of the germ infected fecal waste (and all clothing and bedding that come in contact with it) produced by cholera victims is of primary importance.
Sewage: Treatment of general sewage before it enters the waterways or underground water supplies prevent possible undetected patients from spreading the disease.
Sources: Warnings about cholera contamination posted around contaminated water sources with directions on how to decontaminate the water.
Sterilization: Boiling, filtering, and chlorination of water kill the bacteria produced by cholera patients and prevent infections, when they do occur, from spreading. All materials (clothing, bedding, etc.) that come in contact with cholera patients should be sterilized in hot water using (if possible) chlorine bleach. Hands, etc. that touch cholera patients or their clothing etc. should be thoroughly cleaned and sterilized. All water used for drinking, washing or cooking should be sterilized by boiling or chlorination in any area where cholera may be present. Water filtration, chlorination and boiling are by far the most effective means of halting transmission.
Cloth filters, though very basic, have greatly reduced the occurrence of cholera when used in poor villages in Bangladesh that rely on untreated surface water. In general, public health education and good sanitation practices are the limiting factors in preventing transmission.
Prevention Recent
epidemiologic research suggests that an individual's susceptibility to cholera (and other
diarrheal infections) is affected by their
blood type: Those with
type O blood are the most susceptible, In this model, the genetic deficiency in the
cystic fibrosis transmembrane conductance regulator channel proteins interferes with bacteria binding to the
gastrointestinal epithelium, thus reducing the effects of an infection.
Susceptibility Persons infected with cholera have massive diarrhea. This highly liquid
diarrhea, which is often compared to "rice water," is loaded with bacteria that can spread under unsanitary conditions to infect water used by other people. Cholera is transmitted from person to person through ingestion of
feces contaminated water loaded with the cholera bacterium. The source of the contamination is typically other cholera patients when their untreated diarrhea discharge is allowed to get into waterways or into
groundwater or drinking water supply. Any infected water and any foods washed in the water, and
shellfish living in the affected
waterway can cause an infection. Cholera is rarely spread directly from person to person.
V. cholerae occurs naturally in the
plankton of
fresh,
brackish, and
salt water, attached primarily to
copepods in the
zooplankton. Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a
lysogenic bacteriophage. Coastal cholera outbreaks typically follow
zooplankton blooms. This makes cholera a
zoonosis.
Transmission Stool and Swab collected in the acute stage of the disease is useful specimen for laboratory diagnosis. A number of special media have been employed for the cultivation for cholera vibrios. They are classified as follows:
Laboratory Diagnosis Venkataraman-ramakrishnan (VR) medium Cary-Blair medium: This the most popularly carrying media. This is a buffered solution of sodium chloride, sodium thioglycollate, disodium phosphate and calcium chloride at pH 8.4.
Holding or transport media Alkaline peptone water Monsur's taurocholate tellurite peptone water Enrichment media Alkaline bile salt agar: The colonies are very similar to those on Nutrient Agar.
Monsur's gelatin Tauro cholate trypticase tellurite agar(GTTA)medium: Cholera vibrios produce small translucent colonies with a greyish black centre .
TCBS meium: This the mostly widely used medium. This medium contains Thiosulphate, citrate, bile salts and sucrose. Cholera vibrios produce Flat 2-3 mm in diameter, yellow nucleated colonies.
Plating media Most of the
V. cholerae bacteria in the contaminated water that a potential host drinks do not survive the very acidic conditions of the
human stomach Biochemistry of the V. cholerae bacterium History Cholera was originally
endemic to the Indian subcontinent, with the
Ganges River likely serving as a contamination reservoir. It spread by trade routes (land and sea) to
Russia, then to
Western Europe, and from Europe to
North America. It is now no longer considered an issue in Europe and North America, due to
filtering and
chlorination of the water supply.
1816-1826 -
First Cholera pandemic: Previously restricted, the pandemic began in
Bengal, then spread across
India by 1820. It extended as far as
China and the
Caspian Sea before receding.
1829-1851 -
Second Cholera pandemic reached Europe,
London and
Paris in 1832. In London, it claimed 6,536 victims (see:
http://www.mernick.co.uk/thhol/1832chol.html); in Paris, 20,000 succumbed (out of a population of 650,000) with about 100,000 deaths in all of France
[4]. It reached Russia (
Cholera Riots),
Quebec,
Ontario and
New York in the same year and the Pacific coast of North America by 1834.
1849 - Second major outbreak in Paris. In London, it was the worst outbreak in the city's history, claiming 14,137 lives, ten times as many as the 1832 outbreak. In 1849 cholera claimed 5,308 lives in the port city of Liverpool, England, and 1,834 in Hull, England.
1881-1896 -
Fifth Cholera pandemic ; The 1892 outbreak in
Hamburg, Germany was the only major European outbreak; about 8,600 people died in Hamburg, causing a major political upheaval in Germany, as control over the City was removed from a City Council which had not updated Hamburg's water supplies. This was the last serious European cholera outbreak.
1899-1923 -
Sixth Cholera pandemic had little effect in Europe because of advances in public health, but Russia was badly affected again.
1961-1970s -
Seventh Cholera pandemic began in
Indonesia, called
El Tor after the strain, and reached
Bangladesh in 1963, India in 1964, and the USSR in 1966. From
North Africa it spread into Italy by 1973. In the late 1970s there were small outbreaks in Japan and in the South Pacific. There were also many reports of a cholera outbreak near
Baku in 1972, but information of this was suppressed in the USSR.
January 1991 to September 1994 - Outbreak in
South America, apparently initiated by ship discharged ballast water. Beginning in
Peru there were 1.04 million identified cases and almost 10,000 deaths. The causative agent was an O1, El Tor strain, with small differences to the seventh pandemic strain. In 1992 a new strain appeared in Asia, a non-O1,
nonagglutinable vibrio (NAG) named O139 Bengal. It was first identified in
Tamil Nadu, India and for a while displaced El Tor in southern Asia before decreasing in prevalence from 1995 to around 10% of all cases. It is considered to be an intermediate between El Tor and the classic strain and occurs in a new serogroup. There is evidence as to the emergence of wide-spectrum resistance to drugs such as
trimethoprim,
sulfamethoxazole and
streptomycin.
Origin and Spread The crying and pathos in the last movement of
Tchaikovsky's (c. 1840-1893) last symphony made people think that Tchaikovsky had a premonition of death. "A week after the premiere of his
Sixth Symphony, Tchaikovsky was dead--6 Nov. 1893. The cause of this indisposition and stomach ache was suspected to be his intentionally infecting himself with cholera by drinking contaminated water. The day before while having lunch with
Modest (his brother and biographer), he is said to have poured faucet water from a pitcher into his glass and drunk a few swallows. Since the water was not boiled and cholera was once again rampaging
St. Petersburg, such a connection was quite plausible ...."
Other famous people who succumbed to the disease include:
Alexandre Dumas, père, French author of
The Three Musketeers and
The Count of Monte Cristo, also contracted cholera in the 1832 Paris epidemic and almost died, before he wrote these two novels.
James K. Polk ex-President of the United States
Mary Abigail Fillmore, daughter of U.S. president
Millard Fillmore Elliott Frost, son of American poet Robert Frost
Nicolas Léonard Sadi Carnot Georg Wilhelm Friedrich Hegel Samuel Charles Stowe, son of
Harriet Beecher Stowe Carl von Clausewitz George Bradshaw Adam Mickiewicz August von Gneisenau William Jenkins Worth John Blake Dillon Daniel Morgan Boone, founder of
Kansas City, Missouri, son of
Daniel Boone James Clarence Mangan Mohammad Ali Mirza
Dowlatshahi of
Persia Ando Hiroshige, Japanese ukiyo-e woodblock print artist.
Juan de Veramendi, Mexican Governor of Texas, father-in-law of
Jim Bowie Grand Duke Constantine Pavlovich of Russia William Shelley, son of
Mary Shelley William Godwin, father of
Mary Shelley Judge Daniel Stanton Bacon, father-in-law of
George Armstrong Custer Inessa Armand, mistress of
Lenin and the mother of Andre, his son.
Honinbo Shusaku, famous go player renowned for his play.
Henry Louis Vivian Derozio, Eurasian Portuguese Poet and Teacher. Resided in India.
Famous cholera victims The major contributions to fighting cholera were made by physician and self-trained scientist
John Snow (1813-1858), who found the link between cholera and contaminated drinking water in
1854 and Henry Whitehead, an Anglican minister, who helped John Snow track down and verify the source of the disease, an infected well in London. Their conclusions and writings were widely distributed and firmly established for the first time a definite link between germs and disease. Clean water and good sewage treatment, despite their major engineering and financial cost, slowly became a priority throughout the major developed cities in the world from this time onward.
Robert Koch, 30 years later, identified
V. cholerae with a microscope as the bacillus causing the disease in 1885. The bacterium had been originally isolated thirty years earlier (1855) by Italian anatomist
Filippo Pacini, but its exact nature and his results were not widely known around the world.
Cholera has been a laboratory for the study of evolution of virulence. The province of Bengal in
British India was partitioned into
West Bengal (a state in India) and
East Pakistan in 1947. Prior to partition, both regions had cholera pathogens with similar characteristics. After 1947, India made more progress on public health than East Pakistan (now
Bangladesh). As a consequence, the strains of the pathogen which succeeded in India had a greater incentive in the longevity of the host and are less virulent than the strains prevailing in Bangladesh, which uninhibitedly draw upon the resources of the host population, thus rapidly killing many in it.
Research In the past, people travelling in ships would hang a yellow flag if one or more of the crew members suffered from cholera. Boats with a yellow flag hung would not be allowed to disembark at any harbor for an extended period of time, typically 30 to 40 days.
Saint Adela (? - 735) and Saint Irmina (? - c. 716) were daughters of Dagobert II. Dagobert acceded to the throne of Austrasia at the age of seven, upon the death of Sigebert, but was quickly deposed. Dagobert fled to Ireland and returned to Metz in 673 and claimed the throne. During exile, he married an Anglo-Saxon princess named Matilda and had five children, with saints Adela and Irmina among them.
See also
Atrocities in Ireland
Origin and use today
Climate
Background
Births
