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$Unique_ID{BRK03595}
$Pretitle{}
$Title{Cholera}
$Subject{Cholera Asiatic Cholera Epidemic Cholera}
$Volume{}
$Log{}
Copyright (C) 1986 National Organization for Rare Disorders, Inc.
144:
Cholera
** IMPORTANT **
It is possible that the main title of the article (Cholera) is not the
name you expected. Please check the SYNONYM listing to find the alternate
names and disorder subdivisions covered by this article.
Synonyms
Asiatic Cholera
Epidemic Cholera
General Discussion
** REMINDER **
The information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section.
Cholera is a bacterial infection involving the entire small intestine and
marked by severe diarrhea and vomiting. Symptoms are caused by a toxin
released by the Cholera bacteria. There are several varieties of these
bacteria, which differ somewhat in the severity of illness they cause.
Cholera is rare in the United States, but is endemic in India, the tropical
parts of Asia, Korea, as well as in the Middle East and parts of Africa.
With appropriate treatment, or in mild cases, the prognosis is good, with
recovery within about a week; without treatment, mortality can be as high as
fifty percent.
Symptoms
Symptoms of Cholera vary in severity. The mildest infections can be
asymptomatic or mild, uncomplicated diarrhea for a few days. Severe Cholera
can be life threatening.
The first symptoms usually consist of painless diarrhea appearing very
suddenly and associated with vomiting. Serious changes in water and salt
balance occur when large amounts of fluid, sodium, chloride, potassium, and
bicarbonate are lost in this way. Intense thirst, decreased urination,
muscle cramps, and weakness can develop. The tissues may become soft and
dehydrated so that the eyes look sunken and the skin wrinkled. The blood
volume may decrease, with resulting low blood pressure and changes in pulse
rate. Metabolic derangements such as acidosis and electrolyte abnormalities
may develop. Circulatory collapse, cyanosis (bluish discoloration due to
failure of the blood to carry sufficient amounts of oxygen to the tissues),
and stupor can result if the illness is not treated. If blood volume remains
low for extended periods of time, kidney damage with renal failure can also
result.
Causes
The bacterium that causes Cholera is known as Vibrio cholerae, serogroup 01,
and occurs as several, variably virulent, biotypes. The bacteria produce a
protein that causes the wall of the small intestine to secrete large amounts
of the fluid.
Ingestion of water, seafood, vegetables, and other foods contaminated
with the excrement of symptomatic or asymptomatic Cholera victims spreads the
disease.
Affected Population
Cholera is endemic in India and parts of the Middle East, Asia, and Africa.
In these areas, children are affected most often, with outbreaks occurring
during the warmest part of the year.
Cholera occasionally spreads to Europe, Japan, Australia, etc., where
epidemics can occur at any time of the year and affect persons of all ages
equally.
Related Disorders
Cholera resembles the illness caused by enterotoxin producing strains of
Escherichia coli. (E. coli normally inhabits the intestine without causing
any symptoms or abnormalities whatsoever, but occasionally virulent strains
appear). Some salmonella or shigella infections also produce similar
clinical features.
Related bacteria of the Vibrio genus that do not produce toxins can cause
stomach and intestinal inflammation (gastroenteritis). Pancreatic Cholera is
not a bacterial disease at all. Clinical symptoms and complications similar
to those of true Cholera result from dysfunction of the pancreas, usually due
to a tumor in that organ.
Therapies: Standard
The symptoms of mild or uncomplicated cases of Cholera resolve spontaneously
within 3 to 6 days of onset, and the bacteria disappear with two weeks.
Treatment of patients in shock or circulatory collapse aims to restore
blood pressure and electrolyte balance to normal levels quickly. Various
solutions containing salts and glucose or lactate, administered
intravenously, will accomplish this. The patient should also be given as
large amounts of fluids by mouth as tolerated. Plasma and related products,
and drugs raising blood pressure are useless in Cholera, and should not be
administered. After the initial crisis is over, patients may continue on
intravenous fluid and salt replacement, or these substances may be given
orally to replace stool losses.
The pathogenic bacteria can be eliminated with antibiotics, and this will
usually prevent severe illness if administered early. Tetracycline is the
preferred antibiotic. Furazolidone is effective against resistant strains of
the bacteria.
To prevent Cholera outbreaks, water supplies must be purified and human
excrement disposed of properly. Individuals in areas where Cholera poses a
threat should boil water and avoid eating uncooked vegetables. Cholera
vaccines exist, but they offer only partial protection, and require booster
injections every 6 months. Tetracycline may be used prophylactically to
protect against cholera if exposed to contaminated food or water.
Persons living in endemic areas usually develop immunity to the Cholera
bacterium. Americans travelling to susceptible areas of the world should be
vaccinated against this disorder.
Therapies: Investigational
This disease entry is based upon medical information available through
September 1989. Since NORD's resources are limited, it is not possible to
keep every entry in the Rare Disease Database completely current and
accurate. Please check with the agencies listed in the Resources section for
the most current information about this disorder.
Resources
For more information on Cholera, please contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
Centers for Disease Control (CDC)
1600 Clifton Road
Atlanta, GA 30333
(404) 639-3311
National Institute of Allergy and Infectious Diseases (NIAID)
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-5717
References
THE MERCK MANUAL 15th ed: R. Berkow, et al: eds; Merck, Sharp & Dohme
Research Laboratories, 1987. Pp. 91, 773, 1064.
CECIL TEXTBOOK OF MEDICINE, 18th ed.: James B. Wyngaarden, and Lloyd H.
Smith, Jr., Eds.: W. B. Saunders Co., 1988. Pp. 1651-3, 1388-9.