20/07/2024
Understanding cholera: Diagnosis, Treatment and Prevention
Cholera, an acute bacterial infection caused by vibrio cholerae (serotype 01 or 0139) remains a significant public health threat in Nigeria and a key indicator of poor social development. Cholera outbreak shows a seasonal variation mostly reaching it peak during raining season.
For a cholera outbreak to occur, two conditions have to be met:
• There must be significant breach in sanitation, and hygiene infrastructure, permitting large-scale exposure to food or water contaminated with Vibrio cholerea.
• Cholera case must be present in the population.
Transmission of Cholera
Cholera usually occurs in the lowest socio-economic group living under unsanitary conditions due to overcrowding, low standard of living, inadequate supply of safe water, and absent or poor sewage disposal as often seen in developing countries.
Cholera has been proven to be transmitted by faecal-oral route via food and water contaminated by carriers of the infection and inadequate sanitary conditions of the environment, where individuals come in contact with vomitus, excreta and contaminated food and water brought about by overcrowding. Movement of people from one place to another can also contribute to transmission of cholera.
Clinical Features of Cholera
Cholera present with sudden onset of effortless profuse watery diarrhoea characterised to have the Rice water appearance and Vomiting, which will eventually lead to dehydration which is characterised by sunken eyes, hollow cheeks, sub normal temperature, scaphoid abdomen, absent of pulse etc. Decrease in urine output, intense thirst, restlessness and cramps. The severity depends of rapidity and duration of fluid loss which ranges from mild to severe.
Diagnosis
The diagnosis of cholera is frequently based on clinical signs and symptoms in resource-limited areas of endemicity where laboratory facilities are not available. In the developed laboratory setting, for the diagnosis of cholera, stool or re**al swab culture is the gold-standard reference method.
Management
Disease can be successfully managed through;
• Rehydration Therapy is the cornerstone of cholera care, since dehydration is the major cause of death. Treatment with Oral dehydration salt (ORS) or intravenous fluids (Ringer’s lactate) restores electrolyte balance and maintains blood pressure.
• Zinc supplementation is also important, especially in children, as it reduces the duration and severity of diarrhea.
• Antibiotics can also be use for severe cases, irrespective of the age of the patient. Antibiotics were found to shorten the length of diarrhoea, and decrease the volume of stool. Tetracycline, azithromycin, quinolones are commonly used.
• Supportive care for cases that developed complications e.g electrolyte Imbalance, and shock.
Prevention
• Health Education; Raising awareness on campaigns on cholera, risk factors, transmission, signs and symptoms, management and how to prevent occurrence.
• Sanitation and Hygiene: Provision of safe water, disinfection, proper excreta disposal, food sanitation are approaches that can help prevent spread of infectious diseases.
• Vaccination can be administered to at-risk populations in endemic areas to provide protection. There are three types of cholera vaccine available. Dukoral, Sanchol and Euvichol.
