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Cholera

Dr. Rajendra Kumar

The common occurrence of cholera in our country is attributed to a lack of proper hygiene that leads to the growth of the cholera causing bacteria, i.e. Vibrio cholerae. So many epidemics have already taken place in our country. Our aim should be to avoid further outbreaks of this disease by maintaining personal and public hygiene. The term frequently used now is gastroentritis.


Cholera is a severe infection caused by Vibrio cholerae. Its common occurrence in our country can be attributed to the poor hygiene. The maximum occurrence of this disease is in the valleys of Ganga, where a large number of cholera epidemics have occurred. These epidemics break out often following the large religious festivals in this region. The bacterium, Vibrio cholerae is transmitted by contaminated drinks or food. It is passed in the stools or vomit of the patients with cholera.

Transmission
A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. Sudden large outbreaks are usually caused by contaminated water supply and the source of contamination is the faeces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The disease is unlikely to be transmitted by direct contact.
Vibrio cholerae is often found in the aquatic environment and is a part of the normal flora of brackish waters and estuaries. It is often associated with algal blooms (plankton), which are influenced by the temperature of the water. Human organisms are also one of the reservoirs of pathogenic form of Vibrio cholera.

Symptoms

  • Diarrhoea
  • Vomiting
  • Increased thirst
  • Reduced urine production
  • Muscular cramps
  • Weakness
  • Sunken eyes
  • Cold sweat
Symptoms
The incubation period is one to three days. The symptoms start with diarrhoea without pain followed by vomiting. The stools take the form of the typical rice water material, which consists of clear fluid with flecks of mucus. The resultant severe loss of fluid and salt leads to intense thirst, reduced urine production, muscular cramps, weakness and signs of dehydration. The skin becomes cold, clammy and wrinkled and the eyes sunken. Blood pressure falls and the pulse becomes imperceptible. The urine output also decreases. In severe cases death from acute circulatory failure may occur within a few hours unless fluids and electrolytes are replaced with proper treatment, the patient improves with a rapid pace.

Precautions
All travelers to areas which are infected with cholera should observe the following recommendations:
  • Drink only boiled or chlorinated water. Other safe beverages include tea and coffee made with boiled water and bottled beverages with no ice.
  • Eat food that is cooked properly and is hot.
  • Eat fruits that you have peeled yourself.
  • Avoid undercooked or raw seafood.
  • Avoid food from street vendors.
Trade in Food Products Coming from Cholera-Infected Regions
The publication “Guidelines for Cholera Control”, available through WHO’s Distribution and Sales Unit, states the following: “Vibrio cholerae 01 can survive on a variety of foodstuffs for up to five days at ambient temperature and up to 10 days at 5-10 degrees Celsius. The organism can also survive freezing, low temperatures, however, limit proliferation of the organism and thus may prevent the level of contamination from reaching an infective dose.

“The cholera vibrio is sensitive to acidity and drying, and commercially prepared acidic (ph 4.5 or less ) or dried foods are therefore without risk. Gamma irradiation and temperatures above 70 degrees Celsius also destroy the vibrio and foods processed by these methods, according to the standards of the Codex Alimentarius, “The foods that cause greatest concern to importing countries are seafood and vegetables that may be consumed raw. However, only rare cases of cholera have occurred as a result of eating food, usually seafood, transported across international borders by individuals.

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