Cholera: How do we stop the killing spree?

Mango season was finally here and all compounds with mango trees were littered with fruits and seeds. As usual children were always found below those trees to pick up fruits which the night wind had brought to the ground. Charles like any other child seized every opportunity at his disposal to flee to the nearest tree at dawn. It was a fresh morning like any other and Charles who had unusually overslept arrived at the neighbour’s yard after the notorious gang of mango scavengers had cleared the good fruits. Depressed by the turnout of events, he made a U-turn and suddenly paused at the sight of a partly split mango fruit. Charles picked up that fruit as fast as his hands got to it and to him it was more of a hidden treasure. A thought flashed through Charles’ mind of how much his siblings or friends could want a share from this treasured fruit that prompted him to aggressively take a big bite forgetting he hadn’t washed the mango.

Charles got home satisfied and had a wide smile when dispensing the news of his unfortunate quest. About 4 hours later Charles felt pressed and rushed to the toilet. About an hour later he was in the toilet for the 3rd time and this time he also started vomiting. He was swift to remark that his stools were not only watery but also had the appearance of rice water. He had concealed all those events but his mother could not help noticing the distinctive scary look of Charles at this point. He looked weak, had sunken eyes and right there before her eyes her son vomited and passed out stool simultaneously like a tap which had been turned on to its maximum. Astonished by the sudden onset deterioration of her son’s condition Magdalene rushed with her son to a nearby health centre.

After a precise history by Magdalene, the nurse at the emergency immediately alerted the Doctor who rallied a team of other personnel. The Doctor went further to examine Charles: he was weak but conscious in a state of dehydration. Samples of his blood and stool were sent to the laboratory. However he was temporarily sent to a solitary ward. Aggressive fluid replacement was done orally and intravenously using Oral Rehydration Solution(ORS) and lactated ringer’s solution. With a high index of suspicion of Cholera, the soiled clothes of Charles and his mother were taken off and soaked in decontaminated solution by the nurses who already had protective attires on. He was given some antibiotics and the district office was informed of this suspected case and samples were collected accordingly.

What is Cholera?

Cholera is an infectious disease caused by the bacterium Vibrio Cholerae. The toxins secreted by the Vibrio Cholerae are the cause of the profuse ‘rice water’ diarrhoea and vomiting which are the main symptoms of Cholera. Other symptoms (mostly at later stages) include

• Dry mucous membranes
• Thirst
• Low blood pressure
• Restlessness
• Rapid heart rate
• Muscle cramps

If fluids and electrolytes lost are not restored rapidly , death may occur (within 12 – 48 hours).

Is Cholera contagious?

Cholera is very contagious and is transmitted from person to person by faeco-oral route (ingesting food or water contaminated with Vibrio Cholerae). The incubation period is relatively short and ranges from 12 hours to 5 days. Cholera can be spread in many ways. Cholera bacteria can survive outside the body and contaminate water and food. Persons infected with cholera produce large numbers of Vibrio bacteria in their stools that can contaminate other people, as well as clothing, sheets, and many other items in the home.

When to seek medical care if you suspect you have cholera?

Anyone who has been in contact with an infected person and develops watery stools and/or vomiting should seek medical care immediately. The earlier fluids and electrolytes are replenished, the earlier the symptoms will resolve and risk of death is decreased greatly. A homemade Oral Rehydration Solution proposed by CDC can be taken to help restore fluids and electrolytes while waiting for medical care or on the way to a health facility;

• One litre of clean (boiled) water in a clean jar
• 6 level teaspoons of sugar
• ½ level teaspoon of salt
• Half of one lemon

For young children, little quantities can be given every hour and after every loose stool. For adults up to 3 litres can be taken in 24 hours.

How can we prevent Cholera?

1. Washing our hands with soap and water before meals and after handling faeces.

   

2. Drinking safe and clean water
3. Use latrines. Do not defecate in streams.
4. Cook food properly, wash all fruits and vegetables properly before eating and cover food properly.
5. Use protective clothing like gloves and always clean up properly when taking care of a person with cholera.
6. Taking the cholera vaccine. This is available in all regional delegations of public health.

Story by Dr. Veronica Njie and Dr. Christie Linonge

Video credit: Global Health Media Project