Cholera

From: https://en.wikipedia.org/wiki/Cholera

Cholera is an infection of the small intestine by some strains of the bacterium Vibrio cholerae.[1] Symptoms may range from none, to mild, to severe.[2] The classic symptom is large amounts of watery diarrhea that lasts a few days.[3] Vomiting and muscle cramps may also occur.[2] Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance.[3] This may result in sunken eyes, cold skin, decreased skin elasticity, and wrinkling of the hands and feet.[4] The dehydration may result in the skin turning bluish.[5] Symptoms start two hours to five days after exposure.[2]

Cholera is caused by a number of types of Vibrio cholerae, with some types producing more severe disease than others. It is spread mostly by water and food that has been contaminated with human feces containing the bacteria.[3] Insufficiently cooked seafood is a common source.[6] Humans are the only animal affected. Risk factors for the disease include poor sanitation, not enough clean drinking water, and poverty. There are concerns that rising sea levels will increase rates of disease. Cholera can be diagnosed by a stool test.[3] A rapid dipstick test is available but is not as accurate.[7]

Prevention involves improved sanitation and access to clean water.[4] Cholera vaccines that are given by mouth provide reasonable protection for about six months. They have the added benefit of protecting against another type of diarrhea caused by E. coli. The primary treatment is oral rehydration therapy—the replacement of fluids with slightly sweet and salty solutions.[3] Rice-based solutions are preferred.[3] Zinc supplementation is useful in children.[8] In severe cases, intravenous fluids, such as Ringer's lactate, may be required, and antibiotics may be beneficial. Testing to see what antibiotic the cholera is susceptible to can help guide the choice.[2]

Cholera affects an estimated 3–5 million people worldwide and causes 58,000–130,000 deaths a year as of 2010.[3][9] While it is currently classified as a pandemic, it is rare in the developed world. Children are mostly affected.[3][10] Cholera occurs as both outbreaks and chronically in certain areas. Areas with an ongoing risk of disease include Africa and south-east Asia. While the risk of death among those affected is usually less than 5%, it may be as high as 50% among some groups who don't have access to treatment.[3] Historical descriptions of cholera are found as early as the 5th century BC in Sanskrit.[4] The study of cholera by John Snow between 1849 and 1854 led to significant advances in the field of epidemiology.[4][11]

Cholera has been found in two animal populations: shellfish and plankton.[12]
Cholera is typically transmitted to humans by either contaminated food or water. Most cholera cases in developed countries are a result of transmission by food, while in the developing world it is more often water.[12] Food transmission occurs when people harvest seafood such as oysters in waters infected with sewage, as Vibrio cholerae accumulates in zooplankton and the oysters eat the zooplankton.[18]

People infected with cholera often have diarrhea, and disease transmission may occur if this highly liquid stool, colloquially referred to as "rice-water", contaminates water used by others.[19] The source of the contamination is typically other cholera sufferers when their untreated diarrheal discharge is allowed to get into waterways, groundwater or drinking water supplies. Drinking any infected water and eating any foods washed in the water, as well as shellfish living in the affected waterway, can cause a person to contract an infection. Cholera is rarely spread directly from person to person.

Both toxic and nontoxic strains exist. Nontoxic strains can acquire toxicity through a temperate bacteriophage.[20] Coastal cholera outbreaks typically follow zooplankton blooms, thus making cholera a zoonotic disease.

History

The word cholera is from Greek: χολέρα kholera from χολή kholē "bile". Cholera likely has its origins in the Indian subcontinent; it has been prevalent in the Ganges delta since ancient times.[12] Early outbreaks in the Indian subcontinent are believed to have been the result of poor living conditions as well as the presence of pools of still water; both of which are ideal living conditions for cholera to thrive.[56] The disease first spread by trade routes (land and sea) to Russia in 1817, later to the rest of Europe, and from Europe to North America and the rest of the world.[12] Seven cholera pandemics have occurred in the past 200 years, with the seventh pandemic originating in Indonesia in 1961.[57]

The first cholera pandemic occurred in the Bengal region of India starting in 1817 through 1824. The disease dispersed from India to Southeast Asia, China, Japan, the Middle East, and southern Russia.

The second pandemic lasted from 1827 to 1835 and affected the United States and Europe particularly due to the result of advancements in transportation and global trade, and increased human migration, including soldiers.[58]

The third pandemic erupted in 1839, persisted until 1856, extended to North Africa, and reached South America, for the first time specifically infringing upon Brazil.
Cholera hit the sub-Saharan African region during the fourth pandemic from 1863 to 1875.

The fifth and sixth pandemics raged from 1881–1896 and 1899–1923. These epidemics were less fatal due to a greater understanding of the cholera bacteria. Egypt, the Arabian peninsula, Persia, India, and the Philippines were hit hardest during these epidemics, while other areas, like Germany in 1892 and Naples from 1910–1911, experienced severe outbreaks.

The final pandemic originated in 1961 in Indonesia and is marked by the emergence of a new strain, nicknamed El Tor, which still persists today in developing countries.[59]

In 19th century American medical records,  it is common to see three types of cholera reported: cholera morbus, cholera infantum, and Asiatic cholera. Cholera morbus and cholera infantum were both terms for non-specific diarrhea and/or dysentery in adults and children under age five respectively.  Cholera morbus was sometimes called the summer complaint and was usually found in older children and adults from July to September

Since it became widespread in the 19th century, cholera has killed tens of millions of people.[60] In Russia alone, between 1847 and 1851, more than one million people perished of the disease.[61] It killed 150,000 Americans during the second pandemic.[62] Between 1900 and 1920, perhaps eight million people died of cholera in India.[63] Cholera became the first reportable disease in the United States due to the significant effects it had on health.[12] John Snow, in England, was the first to identify the importance of contaminated water as its cause in 1854.[12] Cholera is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies, but still heavily affects populations in developing countries.

In the past, vessels flew a yellow quarantine flag if any crew members or passengers were suffering from cholera. No one aboard a vessel flying a yellow flag would be allowed ashore for an extended period, typically 30 to 40 days.[64] In modern sets of international maritime signal flags, the quarantine flag is yellow and black.

Historically many different claimed remedies have existed in folklore. In the 1854–1855 outbreak in Naples homeopathic Camphor was used according to Hahnemann.[65] While T. J. Ritter's "Mother's Remedies" book lists tomato syrup as a home remedy from northern America. While elecampagne was recommended in the United Kingdom according to William Thomas Fernie[66]

Cholera cases are much less frequent in developed countries where governments have helped to establish water sanitation practices and effective medical treatments.[67] The United States, for example, used to have a severe cholera problem similar to those in some developing countries. There were three large cholera outbreaks in the 1800s, which can be attributed to Vibrio cholerae's spread through interior waterways like the Erie Canal and routes along the Eastern Seaboard.[68] The island of Manhattan in New York City touched the Atlantic Ocean, where cholera collected just off the coast. At this time, New York City did not have as effective a sanitation system as it does today, so cholera was able to spread.

Cholera morbus is a historical term that was used to refer to gastroenteritis rather than specifically cholera.

Mary Seacole dealt with Cholera in several countries.

Notable cases

• Tchaikovsky's death has traditionally been attributed to cholera, most probably contracted through drinking contaminated water several days earlier.[86] "Since the water was not boiled and cholera was affecting Saint Petersburg, such a connection is quite plausible .... "Tchaikovsky's mother died of cholera, and his father became sick with cholera at this time but made a full recovery. Some scholars, however, including English musicologist and Tchaikovsky authority David Brown and biographer Anthony Holden, have theorized that his death was a suicide.
• After the 2010 earthquake, an outbreak swept over Haiti, traced to a United Nations base. This marks the worst cholera outbreak in recent history, as well as the best documented cholera outbreak in modern public health.
• Other famous people believed to have died of cholera include:
  • Sadi Carnot, Physicist, a founder of thermodynamics (d. 1832)
  • Charles X, King of France (d. 1836)
  • James K. Polk, eleventh president of the United States (d. 1849)
  • Carl von Clausewitz, Prussian soldier and German military theorist (d. 1831)
  • Elliot Bovill, Chief Justice of the Straits Settlements (1893)
  • Famous People Who Died of Cholera (114 people listed)

For Additional Reading:

• World Health Organization – Cholera
• CDC – Cholera
• WebMD - Cholera
• MedicineNet.com – Cholera
• Medscape - Cholera
• MNT - What is Cholera: What Causes Cholera?
• Encyclopeaedia Britannica - Cholera
• Contagions - Historic Meanings of Cholera

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