Cholera

1. During the 19th century, cholera spread across the world from its original reservoir
in the Ganges delta in India.
2. Six subsequent pandemics killed millions of people across all continents.
3. The current (seventh) pandemic started in South Asia in 1961, and reached Africa in
1971 and the Americas in 1991.
4. Cholera is now endemic in many countries

A. Causes
1. Caused by a small, comma-shaped, motile bacterium called ___________.
2. It enters the body through ingestion of contaminated food or water.
3. The bacteria multiply rapidly in small intestine and release enzyme
neuraminidase and enterotoxin (a toxin produced in or affecting the intestines,
such as those causing food poisoning or cholera) called _______________.
4. Neuraminidase changes the surface protein of ______________ to become the
receptor for choleragen and choleragen acts on the mucosal epithelium lining of
small intestine.
5. Choleragen disrupts the in channels in the epithelium, allowing chloride ions to
move out of the cells into lumen. The ______________________ from cells
__________ the water potential and form a water gradient which causing the
water move from cells to lumen.

B. Symptoms
1. Watery diarrhoea (loss of much water)
2. Severe dehydration
3. Vomiting
4. Nausea
5. Dry mucus membrane or mouth
6. Dry skin
7. Excessive thirst
8. Glassy or sunken eyes
9. Lack of tears
10. Lethargy (fatigued)
11. Low urine output
12. Unusual sleepiness/tiredness
13. Leg cramps
C. Transmission
1. In many developing countries in Africa and Asia, ________________, overcrowding and
lack of clean water encourage the spread of this disease.
2. _________________________ with faeces of person infected with cholera is one of the
ways of transmission.
3. _________________________ with faeces of a person infected with cholera as a result
of poor hygiene is also possible means of transmission.
4. The bacteria are also found in _______________, especially with a lot of backwater and
coastal water.
5. Raw shellfish, especially raw oysters can also be a source of cholera.

D. Treatment
1. For patients who are able to drink, most effective treatment is _________________
______________________ that is oral intake of packs of water containing balanced
mineral salts and glucose. WHO has developed an oral rehydration solution that is
cheaper and easier to use than the typical intravenous fluid. This solution of sugar and
electrolytes is now being used internationally.
2. For patients who are unable to drink, they require administration of _____________
fluids (by a drip feed into a vein).
3. In cases that are severe, antibiotics such as ___________and ____________are often
effective at destroying the vibrios and decreasing the diarrhoea. Mass administration of
antibiotics is not recommended, as it has no effect on the spread of cholera and
contributes to increasing antimicrobial resistance.

E. Prevention
1. The supply of clean and safe drinking water such as mineral water and boiled water.
2. Hygienic disposal of faeces which includes proper sewage treatment and sanitation.
3. Health education for improved hygiene and safe food handling practices by the community.
4. Control of flies which act as vectors in transferring faecal materials to food.
5. Isolation of patients and hygienic disposal of faeces and vomit in patients.
6. Carriers should be identified and prevented from working in the food industry.
7. Immediate examination of diarrhoeal diseases for bacterial content and treatment
supplied immediately.
8. Close contacts should be treated with drugs to kill any possible cholera bacteria, and the
people in the area should be vaccinated.
9. Oral cholera vaccines to provide protection in infants and children less than 5 years of age.
10. Further, information should be provided to travellers and the community on the potential
risks and symptoms of cholera, together with precautions to avoid cholera, and when and
where to report cases