Cholera, an acute bacterial disease that affects the intestinal tract, is caused by Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.
Symptoms
The symptoms may appear from six hours to five days after exposure. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In thee persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.
Complications: Most people who get campylobacteriosis recover completely within 2 to 5 days, although sometimes recovery can take up to 10 days. Rarely, some long-term consequences can result from a Campylobacter infection. Some people may have arthritis following campylobacteriosis; others may develop a rare disease that affects the nerves of the body beginning several weeks after the diarrheal illness. This disease, called Guillain-Barré syndrome, occurs when a person's immune system is "triggered" to attack the body's own nerves, and can lead to paralysis that lasts several weeks and usually requires intensive care. It is estimated that approximately one in every 1000 reported campylobacteriosis cases leads to Guillain-Barré syndrome. As many as 40% of Guillain-Barré syndrome cases in this country may be triggered by campylobacteriosis.
Transmission
A person may get cholera by drinking water or eating food contaminated with the cholera bacterium. In an epidemic, the source of the contamination is usually the feces of an infected person. The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The cholera bacterium may also live in the environment in brackish rivers and coastal waters. Shellfish eaten raw have been a source of cholera, and a few persons in the United States have contracted cholera after eating raw or undercooked shellfish from the Gulf of Mexico. The disease is not likely to spread directly from one person to another; therefore, casual contact with an infected person is not a risk for becoming ill.
Diagnosis
Cholera is diagnosed by isolating the bacteria from an infected person's stool (feces).
Treatment
Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die. Antibiotics, such as tetracycline, are also used to shorten the duration of diarrhea and shedding of the bacteria in the stool (feces).
Prevention
The single most important preventive measure is to avoid consuming uncooked foods in foreign countries where cholera occurs, unless they are known to be safe or have been properly treated. Tap water should be avoided, unless it has been chemically treated with chlorine or iodine, boiled, or filtered. At the present time, the manufacture and sale of the only licensed cholera vaccine in the United States (Wyeth-Ayerst) has been discontinued. It has not been recommended for travelers because of the brief and incomplete immunity if offers. No cholera vaccination requirements exist for entry or exit in any country. Two recently developed vaccines for cholera are licensed and available in other countries (Dukoral®, Biotec AB and Mutacol®, Berna). Both vaccines appear to provide a somewhat better immunity and fewer side-effects than the previously available vaccine. However, neither of these two vaccines is recommended for travelers nor are they available in the United States. Dukoral® Active Biotec AB (publ) Postal Address: P.O. Box 724, SE-220 07 Lund, Sweden Office address: Scheelevagen 22 Tel: +46 46 19 20 00 Fax +46 46 19 20 50 E-Mail: info@activebiotech.com Home page: http://www.activebiotech.com Mutacol® Berna, Switzerland Division P.O. Box CH-3001 Berne Domicile: Rehhagstrasse 79e CH-3018 Berne Tel. +41 31 981 22 11 Fax +41 31 981 20 66 E-mail: berna@berna.org Home page: http://www.berna.org
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