Cholera

By: feedmeee3

"When your stomach is a rolling, and your cleaning out your colon, diarrhea…diarrhea!"

While Americans are able to joke about experiencing diarrhea after consuming spicy or foreign food, diarrheal diseases remain to be the leading cause of preventable deaths for those in developing countries. Although diarrheal diseases are most common to children under the age of five in developing countries, anyone can be affected. Diarrheal diseases are prone to people in poverty since these diseases are associated with individuals who live in areas of inadequate sanitation and hygiene, no safe water treatment. During the 1800s, Cholera, a particular diarrheal illness was once prevalent in the United States, but was quickly resolved with our water and sewage system. While the United States was able to control and diminish this disease, Cholera epidemics occur all around the world today. Centers for Disease Control and Prevention (CDC) estimated 3-5 million cases and over 100,000 deaths that occur each year due to Cholera. Here we will discuss what exactly Cholera is, how an individual can obtain this diarrheal illness, the affects on the human body, and how the world plans on put an end to Cholera epidemics.

Cholera is an acute diarrheal illness caused by infection of the intestine with the comma shaped bacterium Vibrio cholera. It is transmitted by water or food that has been contaminated with the feces containing this bacterium, not by person-to-person contact. Once the bacterium is in the small intestine, it secretes a Cholera Toxin that causes the large intestine to secrete and lose large amounts of water and salt (Silva and Benitez et al. 2016). This leads to the symptoms of this disease, which include watery diarrhea, vomiting, cramping, abdominal pains and etc. If untreated, severe dehydration can rapidly lead to death in hours! Since Cholera symptoms are similar to symptoms of other bacterium, diagnosis and detection is based on a stool sample to see if the bacterium Vibrio cholera is present.

The reason why this bacterium, Vibrio cholera is still around today is due to evolution. Vibrio cholera evolved to effectively withstand diverse physical, chemical, and biological stresses such as extreme temperatures and pH levels and other harsh conditions in both aquatic environment and small intestine of humans (Silva and Benitez et al. 2016). Silva and Benitez et al. (2016) also propose that Vibrio cholera have the ability to switch from motile to non-motile allowing them to successfully survive and colonize in the small intestines of humans as well as in aquatic environments outside the human body. In other words, certain environmental cues will trigger Vibrio cholera to transition their mobility from being sessile (non-motile) to motile and vice versa. This could easily relate to migrating birds. Birds migrate to areas (environments) that supply them everything they need to survive, which would be sufficient amounts of food, water and good living conditions. When their environment no longer supplies these necessities, they migrate until they find another suitable area where they will then stay put, until they need to search for a new home. Since the intestinal gut provides a nutritious environment, it is thought that Vibrio Cholera would like to stay in the small intestine so they transition to non-motile form and cling to the walls of the small intestine. Why leave, when they have everything they need to survive and thrive!

Because nutritional balance is such an important necessity for growing infants, when infected by Cholera, infants are more prone to death. While diarrhea causes dehydration and loss of nutrition and electrolytes, the body loses the energy to grow and protect itself. According to the World Health Organization (WHO), Cholera is the leading cause of malnutrition in children in developing countries. Majority of Cholera deaths are children under the age of five, but Cholera can affect any individual in any age group. To prevent Cholera epidemics to those in developing countries, WHO Cholera groups as well as health experts in the area do their best to provide access to safe drinking water and food, as well as promoting better sanitation practices and hygiene. To resolve deaths of children under the age of five, mothers in developing countries are advised to breastfeed their children for till six months. Reason being, being breastfed allows infants to be 6.1 times less likely to die of diarrhea than infants who are not breastfed. Breast milk contains both immune (specific) and non-immune (nonspecific) antimicrobial factors as well as the necessary vitamins and minerals. In other words, mothers’ breast milk contains everything an infant needs to be a strong, healthy six month infant. According to WHO, by promoting exclusive breast feeding for the first six months through hospital policies, counseling, education, mass media, and mother support groups, this could decrease all-cause mortality in children under five by 13 percent! On top of being preventable, Cholera is also treatable. WHO also states that 80% of cases are be successfully treated with oral rehydration. There is also vaccines that help prevent Cholera, although does not guarantee 100% protection.

Every fifteen seconds, a child dies from bad water and sanitation.. According to WHO, 65% of infant deaths due to cholera and related illnesses in developing countries could be prevented with clean drinking water and sanitation. Hygiene education to create a locally sustainable solution to the global water and sanitation issue is another crucial aspect of the prevention of cholera. Even if we are not directly affected by it, Cholera is still a very active disease that is affecting the whole world.

Citations

Cholera. (2015, July). Retrieved February 12, 2016, from http://www.who.int/mediacentre/factsheets/fs107/en/

Cholera- Vibrio cholerae infection. (2014 October/November). Retrieved November/December, 2014, from http://www.cdc.gov/cholera/index.htm

Silva AJ, Benitez JA (2016) Vibrio cholerae Biofilms and Cholera Pathogenesis. PLoS Negl Trop Dis 10(2): e0004330. doi:10.1371/journal.pntd.0004330