Cholera

IF SYMPTOMS PERSIST 

“To conclude once again that the symptoms of love were the same as those of cholera.” — Gabriel Garcia Marquez (1927-2014), Colombian novelist, El Amor en los tiempos del cólera (1985)

My perverse fascination with pandemics has not run its course. This time I looked into how cholera has devastated the world. Last week, when 165 Filipino teachers arriving in Thailand were called by newspaper Thai Rath as coming from the “Land of COVID-19,” it drew both anger and sadness. Philippine Consul General to Bangkok Val Simon Roque says that the characterization was “inappropriate, insensitive, and unhelpful.” I agree that the headline was rather unbrotherly. And it would have even been undiplomatic to remind the Kingdom that we got cholera from them, by way of Indonesia, in 1820.

First Cholera Pandemic. Cholera is caused by the bacterium Vibrio cholerae that ingested, releases a toxin in the small bowel. Diarrhea and severe dehydration follow and if untreated can lead quickly to death. The first recorded pandemic started in the Ganges Delta in India, in 1817, from contaminated rice. While it did not spread as fast as the current coronavirus, it did make its way from present day Sri Lanka and to Myanmar. And yes by 1820, it had reached Thailand. Before infecting the Philippines, cholera killed 100,000 in the island of Java in Indonesia.

Risk Factors. As recently as September, 2018, Zimbabwe declared a cholera outbreak of 98 cases with 48 dead. Poverty is a risk factor such that cholera is not commonly seen in industrialized countries that have safe and treated water supply and modern sewage.  In June, 2017, UNICEF and the WHO recorded more than 200,000 cases (1,300 deaths) in Yemen due to cholera. The civil war caused “malnutrition, disrupted sanitation, and interrupted access to clean water.” For reasons still unknown, people with type O blood are twice as likely to get cholera compared with other blood types. Raw or uncooked shellfish harbor the bacteria. Raw fruits and vegetables as well as grains like rice and millet can be tainted with cholera bacteria.

Signs & Symptoms. Just like the asymptomatic COVID-19 carrier, cholera has its version of those being exposed and not knowing they are spreading the bacteria through contaminated water and food with their fecal material. An infected person can shed the bacteria in their stool for as long as 7 to 14 days. A severe infection will manifest as –

• Diarrhea – This isn’t your nuisance-type LBM punctuated by 4 or 5 trips to the toilet in a day; this is severe water loss of about 1 liter an hour with the watery stool resembling rinsed rice water (rice-water stool).
• Dehydration – This leads to muscle cramps; losing 10% or more of body weight is severe dehydration. Its most serious complication is shock that can lead to death if fluid replacement was not given hours before.
• Nausea and vomiting – These occur early in the cholera infection. Excessive vomiting may contribute to fluid and electrolyte loss and imbalance.

Diagnosis & Treatment. With stool culture, the bacteria can begrown and identified. Another option is the PCR (polymerase chain reaction) test. In remote areas, the dipstick method is used. It is a rapid test and is reliable enough in the field. The essential treatment of cholera is fluid replacement. In mild dehydration, oral replacement with rehydration formulas are mainstays. Severe volume depletion will require intravenous fluids. Antimicrobials started early have been shown to stop diarrhea in two days and reduce stool volume by 50%. They include doxycycline and ciprofloxacin for adults and azithromycin for pregnant women and children. Both oral and injectable cholera vaccines are available.

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