Cholera is not a pretty disease. Characteristically, it can cause severe diarrhoea and may lead to death if severely affected and suffering from major water and electrolyte depletion.
Transmission is through the faecal-oral route. Generally, good water sanitation and hygiene practices do well to minimise the risk for disease, and there is even a vaccine available which has shown to be over 85% effective in outbreak settings, specific for the Serogroup 01. The responsible pathogen Vibrio cholerae can survive in aquatic environments for long periods – therefore providing a reservoir of infections in areas of weakened public health infrastructures – particularly in poorer areas of the developing world.
Cholera toxin comprises two subunits – that of A and B. Effectively, cyclic AMP is ‘turned on’ resulting in the efflux of water, bicarbonate and electrolytes. Treatment is through an initial rehydration phase followed by maintenance rehydration which has to be carefully thought out and considerate of the patient’s body weight.
Antimicrobials have been useful in treatment, although tetracycline resistance is frequently reported.
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