Cholera

Cholera is an acute infection caused by consuming water or food contaminated with the Vibrio cholerae bacillus. It primarily affects the digestive system, and while most cases present mild symptoms, severe cases can lead to death in a short time if untreated. It is estimated that between 21,000 and 143,000 people die each year due to cholera infection. Currently, this disease is prevalent in impoverished areas where access to adequate sanitation and clean drinking water is unavailable.

Preventing cholera is complex, as it requires providing access to clean water and basic sanitation in numerous geographic areas suffering from extreme poverty. To address this, the Global Task Force on Cholera Control (GTFCC) of the World Health Organization (WHO) launched the strategy Ending Cholera: A Global Roadmap to 2030 in 2017. This plan aims to reduce cholera-related deaths by 90%.

Symptoms

Many people infected with cholera remain asymptomatic, which can contribute to the spread of the disease since the bacteria persist in feces for up to ten days.

When symptoms do appear, the most common ones include:

• Mild diarrhea, often referred to as "rice water" due to its clear color.
• Nausea.
• Vomiting.

In cases of severe diarrhea, rapid dehydration can occur within hours. Symptoms of dehydration include:

• Extreme thirst.
• Dry skin.
• Sunken eyes.
• Fatigue.
• Irritability.

Causes

Cholera is caused by an infection with the Vibrio cholerae bacteria found in feces, which, upon contact with the intestine, triggers excessive water production. Fecal-oral transmission occurs in the following situations:

• Stagnant water.
• Irrigation with wastewater.
• Fertilization with uncomposted manure.
• Fishing in contaminated waters.

Risk Factors

Extreme poverty significantly increases the risk of contracting cholera. Other factors that exacerbate the risk include:

• Living in overcrowded conditions.
• Lack of basic hygiene systems.
• No access to clean drinking water.
• Low gastric acid levels, which protect against infections. This is more common in children, the elderly, and people taking certain medications.

Complications

Severe cholera can lead to death due to:

• Extreme dehydration: Rapid loss of fluids and electrolytes.
• Hypoglycemia: Low blood sugar levels due to insufficient food intake.
• Electrolyte imbalance: Loss of minerals like potassium, which are essential for proper heart and nerve function.
• Acute kidney failure: Often leading to hypovolemic shock, resulting in an excessive accumulation of fluids and electrolytes.

Prevention

The best way to prevent cholera is to provide at-risk areas with resources to:

• Access clean drinking water.
• Properly treat fecal waste.
• Detect and monitor Vibrio cholerae infections to implement measures preventing outbreaks and epidemics.

Since cholera is rare in developed countries, prevention recommendations mainly apply to travelers visiting high-risk areas:

• Wash hands frequently.
• Drink and brush teeth with bottled water.
• Avoid raw or undercooked foods.
• Peel fruits and vegetables before eating.
• Avoid consuming raw vegetables that cannot be peeled.

Vaccination is recommended only for high-risk individuals or healthcare personnel working in endemic areas, as its effectiveness is limited. The vaccine consists of two oral doses taken at least one week apart. The second dose must be administered at least three weeks before travel.

Which Doctor Treats Cholera?

Cholera prevention and research efforts are conducted by specialists in infectious diseases. Treatment, especially in impoverished areas, is typically handled by general practitioners or humanitarian aid doctors attending to the affected population.