Cholera

Characteristics A bacterium that is a corkscrewed shaped gram negative bacillus that shows up as smooth convex colonies on MacConkey agar.

Etiology Cholera can be an endemic, epidemic, or a pandemic disease. Owing to the relatively large infectious dose, transmission occurs almost exclusively via contaminated water or food. Transmission via direct person-to-person contact is rare.

Symptoms Once infected, it takes a couple of hours to five days for symptoms.  The majority of people infected with Cholera experience no symptoms.  “One in 20 cases develops mild or severe symptoms.  Symptoms include watery diarrhea, vomiting, loss of skin elasticity, low blood pressure, rapid heart rate, and leg cramps. Secondary complications include dehydration and shock, due to the severe and rapid loss of fluids.  If Infection is not treated, death can result within hours of symptoms.

Treatment Hydration is the mainstay treatment for Cholera. Treatment will consist of oral or intravenous solutions to replace lost fluids. Antibiotics, which kill the bacteria, are not part of the treatment for emergency cases but they can reduce the duration of diarrhea by half and also reduce the excretion of the bacteria, thus helping to prevent spread.

Epidemiology History Cholera was first described in India 1563 by Garcia del Huerto, a Portuguese physician.  John Snow was able to determine the mode of transmission in 1849.  In 1883, Robert Koche was able to isolate the Vibrio Cholerae organism from the intestinal discharges of Cholera patients and as a result able to prove that it was the pathogenic agent for Cholera In the United States, cholera has virtually been eliminated because of improved hygiene and sanitation systems

Epidemics In the past 200 years, seven Cholera pandemics have killed millions of individuals worldwide.  We experienced our seventh pandemic with an excess of over a 1000 deaths in Haiti after an earthquake attack in October of 2010.   An estimated 3-5 million cases and over a 100,000 deaths occur each year around the world.

The spread of Cholera Following host ingestion of contaminated food or water, V. cholerae colonizes the small intestine for 12 to 72 hours before symptoms appear. Symptomatic patients may shed bacteria before the onset of illness and will continue to shed organisms for 1 to 2 weeks. Asymptomatic patients typically shed bacteria in their stool for only 1 day. Cholera is spread due to a lack of sanitation, thus causing contaminated water or food.

Cholera in 1832 Cholera possibly came to Philadelphia through Canada. Cholera spread to the railroad workers; most likely from men fleeing other infected camps. As Irish were poor immigrants, looked down upon because of their Catholic faith, they were ‘expendable’ and received little medical help. Death rate was 50%

Duffy’s Cut Cholera came to this camp in August 1832. 57 people died at the camp. Seven are believed to have been murdered. 50 were buried in a mass grave; the other seven were buried in nailed coffins. The seven were believed to be murdered because of the fear of Cholera spread.