The department of Health in Gauteng, South Africa has declared that there has been a cholera outbreak in Hammanskraal, which is North of Pretoria. Twenty-three people have already lost their lives due to this condition and this number is expected to rise as the number of cases are increasing in various provinces in South Africa.
Cholera is an acute diarrheal illness caused by infection of the intestine with Vibrio cholerae bacteria. People can get sick when they swallow food or water contaminated with cholera bacteria. The infection is often mild or without symptoms, but can sometimes be severe and life-threatening.
The risk of cholera transmission multiplies when people live in poor or overcrowded conditions and lack access to safe water, proper sanitation, and hygiene facilities. Other people more at risk of getting cholera are health care personnel attending to cholera patients, emergency response teams and travellers. A person can get cholera by drinking water or eating food contaminated with the cholera bacterium. Large epidemics are often related to faecal contamination of water supplies or street vended foods. The disease is occasionally spread through eating raw or undercooked shellfish that are naturally contaminated.
The hallmark of cholera is profuse watery diarrhoea, which forms stools that are often described as “rice water stools” because the colour and consistency often resembles that of water that has been used to cook or wash rice. The patients often have uncontrolled and frequent bowel movements. The severe diarrhoea can often lead to significant fluid loss and eventually result in dehydration, shock, renal failure and eventually death if left untreated. Other symptoms which may accompany diarrhoea include vomiting, thirst, general body malaise, abdominal cramps and restlessness.
The definitive diagnosis of cholera is made by microscopic examination of the stools and some special staining tests. When there is an outbreak of cholera treatment is often initiated based on clinical suspicion and confirmation is not necessary. The mainstay of treatment in those with a suspicion of the disease is fluid replenishment.
Oral rehydration solution which can be in the pre-packaged form made at home with salt and sugar is used as the initial therapy. Up to 100ml of fluid every five minutes until the patient stabilises is required. Large volumes of fluid are required in the first 4 hours, up to 5l in an average 70 kg man. Patients who have uncontrollable vomiting, who are unable to drink , in a coma or with severe dehydration should be urgently referred to a health care facility for intravenous fluids. Oral antibiotics are also administered in those with severe dehydration.
To prevent further spread when caring for people with cholera it is important that the stools are disposed in a safe manner. They must be meticulous hand washing to prevent spread. Clean drinking water is also needed. It is important for people with symptoms suggestive of cholera to seek help immediately. The death rate can be high, with 1 in 4 to up to half of patients with severe disease dying.
