UNDERSTAND CHOLERA

Cholera is an acute diarrheal disease which results when we ingest Vibrio cholerae bacteria. This bacteria is usually transmitted through foods and water contaminated by fecal matter. The bacteria produce potent toxins which binds to the walls of the small intestine and interfere with normal fluid movement across the wall of the intestine leading to excretion of large amount of fluid. Cases can occur in places where waste management systems have failed and food and water get contaminated. 

In Nairobi the disease has not been limited to overcrowded slum areas alone, even well established four star and five star hotels have been affected. The situation has been made worse by the ongoing nurses strike as the striking nurses play a big  role in public education on prevention measures, screening and prompt treatment of cases.

Signs and symptoms

Symptoms begin from a few hours to five days after ingesting the bacteria. Signs and symptoms will include,

• Rice watery stool which can lead to loss of about one liter of fluid per hour
•  Vomiting
• These will quickly lead to dehydration. Signs and symptoms of dehydration include, increased heart rate, dry mucous membranes, irritability, little or no urine, sunken fontanels in children, sunken eyes, low blood pressure, thirst. Loss of electrolytes can lead to shock and muscle cramps. If untreated,severe cases can quickly lead to coma and death in two to three hours.

Treatment

• The mainstay treatment for cholera is re-hydration with either oral fluids or intravenous fluids when condition is severe. 
• Antibiotics can also be administered to quicken recovery and also reduce amount of bacteria excreted by half.
• Zinc supplementation is also necessary to shorten duration of illness.

Complications

•  Hypokalemia this is low potassium in the blood. Potassium is necessary for the proper functioning of the heart and other skeletal muscles. Low potassium levels interferes with proper transmission of nerve impulses.
• Kidney failure – due to the severe dehydration, kidney failure can occur. Kidney failure will usually accompany shock.
• Hypoglycemia – his will result when patients are too sick to eat leading to reduced blood glucose levels. 

Diagnosis

•  Through signs and symptoms in cholera endemic areas
• By taking stool samples to identify bacteria in stool

Prevention

•   Avoiding consumption of raw uncooked food.
• Proper hand washing with soap and running water.
• Drinking safe water. Water can be treated through chlorination and adequate boiling for at least one minute. 
•  Vaccination   
• Treatment of raw sewer before discharging.