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Introduction

            Cholera is an acute intestinal disease. The disease is caused when a person consumes food or water contaminated with the bacterium, Vibrio cholerae (Barua and Greenough 1). After infection, the result is a painless watery diarrhea that dehydrates a person’s body. Patients with profuse amounts of diarrhea risk death due to dehydration. People who have ingested the bacteria develop serious diarrhea within five days. Severe cases of the disease require immediate medical attention to control body fluids and receive the necessary treatment. Patients are advised to take a lot of fluids and oral re-hydration salts so that their bodies can maintain the required levels of body fluids.

The Disease

            Cholera is an uncommon disease in the United States of America and other well developed countries. People who are at high risk are those traveling abroad where the epidemic is very common and people who eat undercooked foods from questionable environments. Cholera germ is transmitted in the stools. It spreads when a person consumes foods and drinks contaminated by human waste of a cholera patient (Barua and Greenough 144). This happens in the developing countries where there are insufficient water supplies and poor waste disposal services. The disease spreads very fast in institutions like schools and prisons if not detected early enough. Doctors and medical professionals advise that immediate treatment and attention is necessary to avoid loss of lives. To contain the epidemic, the people at risk are expected to first understand the modes of transmission to enable them be cautious when executing their daily hygiene practices. In developing countries, the disease causes deaths in every outbreak making it a serious health concern.

 

Signs and Symptoms

            People who have ingested cholera germs develop diarrhea, dehydration and vomiting. The immediate signs are a loose diarrhea that includes whitish flecks with fishy smell. Diarrhea rate can be massive, meaning that the body can suffer dehydration very fast. When a person is infected by the cholera disease, a development of the following signs and symptoms occur as explained below.

            Vomiting coupled with nausea which is a symptom for an infection. Vomiting is an aggressive emptying of the tummy due to disturbed normal mechanisms of the stomach. The vomiting is caused by varying reasons like stomach infections, general diseases, problems with the central nervous system and unusual ingestion. Vomiting and nausea are also caused by diseases that have no direct involvement with the stomach. Side effects of medications cause vomiting.

            Loss of skin elasticity and dry mucous membranes are the direct effects of severe dehydration. Medical attention is extremely required in such conditions.

            Rapid heart rate is experienced. There are horrible feelings of irregular forceful pounding of the heart. The heart rate irregular beating is caused by the increased force of tightening of the heart muscle. Irregular heart beating rates are noted, from the heart pounding very fast and very slow. 

            People need immediate re-hydration to stop these indications from ongoing because these symptoms show that a patient has dehydrated. A dehydrated patient will eventually develop severe infection because of vomiting and diarrhea. Children, elderly people and a community with poor nutrition have a higher risk of severely dehydration, causing serious effects like acute renal failure, coma and most seriously death (Barua and Greenough 219). The severe dehydration mostly occurs during the first four to nine hour after the first watery stool and a person risks death if untreated for a period of one day to a few days. The cholera epidemic erupts in developing countries where sanitation is poor and there is a shortage of either medical assistance or medical supplies. The mortality rate can be as high as fifty percent or slightly higher.

Causes and Transmission

            Cholera is caused by a bacterium known as Vibrio cholerae. The bacterium has a flagellum that aid in movement, and hair like structures known as pili which help the bacterium hook up to tissue (Keya and Chatterjee 22). There are many types of the cholera germ that cause cholera symptoms. Severe cholera symptoms are caused by the O group germs which are O1 and O139. These cholera germs generate toxins. The bacterium uses the hair like structures to embed into human cells. Once the Vibrio cholerae germs are on the human cells, they cause extraction of water and electrolytes mainly from the gastrointestinal tract. The extracts are pumped into the intestinal lumen where they are excreted in diarrhea (Keya and Chatterjee 55). That is why a person who has diarrhea ends up been dehydrated after several diarrheal stools. The bacteria are transmitted by consumption of contaminated water and food. Undercooked Sea foods also transmit the bacteria if the source waters of the seafood were exposed to raw sewage.

History of cholera

            Cholera has been with human beings for various centuries. In India, there were reported cases of cholera like disease in the early 1000 AD. The term cholera was derived from the greak work khole, meaning a sickness from bile and was later renamed to colere in French back in the 14th century, and finally renamed in English to choler (Barua and Greenough 38). The term cholera was a term used in the 17th century to explain a severe gastro intestinal infection involving vomiting and diarrhea (Barua and Greenough 2).

            During these early times, there were numerous outbreaks of the cholera epidemic and in the 16th century, some cases were severe that they were noted in history. In the 18th century, England had one notable case where in 1854, an estimated five hundred people died in ten days, all having the symptoms of cholera. During this England case, one Dr. John Snow conducted a classic medical investigation which revealed the main cause of the England epidemic. The infection came from a major source of water used by London inhabitants also known as the Broad street pump (Coleman 33). In response to the deaths, the medical professionals decided to stop the flow of water to the residents and removed the pump handle. After this action, it was noted that the deaths and rate of new infections slowed down and stopped (Hamlin 182). The doctor did not ascertain the root cause of the cholera germ. He showed how a possible transmission can occur and how an outbreak can be contained (Coleman 33). The real scientific study of the cholera epidemic started then. Similar severe outbreaks happened in other parts of the world like in the United States of America between the eighteenth and the nineteenth century. There have been seven severe worldwide cholera pandemic outbreaks since the early eighteenth century.

            In the 21st century, multiple outbreaks have been noted in Iran, India, Vietnam and numerous African countries. In the last two years, severe outbreaks occurred in Nigeria and Haiti. From Dr. Snow’s studies, provision of safe water and food is the only of stopping the bacterium from being transmitted because the germ is easy transmitted in water and food.

Diagnosis

            Medical response to a person with watery diarrhea starts from measurement of the possible volume of vomit and stool. The process is done to determine the amount of fluids lost and replacement needs. In cases where severe there is a watery diarrhea and vomiting with signs of dehydration, recent travel to cholera prone environments and recent consumption of sea foods, a diagnosis of cholera bacteria is advised. Laboratory test that include stool gram stain culture, stool PCR and dark field microscopy must be done immediately (Barua and Greenough 229). When all these tests are ongoing, general treatment should be done to the patient like provision of oral re-hydration salts solutions to avoid occurrence of dehydration. Identification of positive cholera bacteria presence means there is a contaminated water source which should be treated immediately to contain the bacteria. 

            Preliminary analysis is done by a professional caregiver. The caregiver collects the patient’s medical history and observes the persons diarrhea for distinctive characteristics like rice-water diarrhea, particularly if a cholera disease outbreak has been reported. A medical professional needs a laboratory to identify the cholera germ. The bacterium is coma-shaped and thus distinctively identified. Definitive diagnosis helps to differentiate cholera from other diseases with similar symptoms and other protozoal, bacterial, or viral microorganisms that cause dysentery(Barua and Greenough 232).

Prognosis

            Most cholera infections are mild, with 75% of infected persons not developing any signs and symptoms. Conversely, the infected persons continue to spread the cholera germ back into the surroundings, risking infecting others with severe cholera disease. In such persons, the huge amounts of watery diarrhea help wipe out the germs, resulting to a reduced infection. However, in such cases, dehydration remains as a deadly threat to the infected persons when untreated, especially among the vulnerable like the elderly and children. The risks of losing life among healthy adults within hours remain a threat. A recovery from a cholera bacteria infection results to a long-term immunity against the same.

More Cholera Mysteries

            Cholera bacteria have been mysterious and scientists and medical professionals worked tirelessly to understand why the virulence of the germ was diverse in many strains (Coleman 67). A recorded number of strains failed to indicate illness. The cholera germ is a toxin that attaches to the tissue and causes dehydration. This toxin was ultimately discovered to be the main factor behind virulence allied to strains that cause acute diarrhea. 

            Rice water stool is an acute state caused by cholera toxin. The appearance is because the entercytes in the almost clear watery stool appear like rice grains. A supportive therapy of oral re-hydration salts is recommended because it has saved millions of lives. Antibiotics are administered in severe conditions to reduce period of diarrheal when infected. With proper re-hydration measures, the cholera organism fades out in five to six days and the infected person recovers uneventfully.    

            Studies conducted by marine scientists in the last decade have showed that open ocean is a favorable environment for the development of a wide range of viruses. The number of viral particles examined indicates that not all of the viruses are infectious because most of them are inactivated by ultra violent radiation in the ocean’s photic zone. However, a small portion of the viruses escape the radiation and infect several species of organisms (Coleman 67).

How Cholera Epidemics Start

            Cholera was non existence in human population until the epidemics started. Research has shown that there is no identified human carrier as the origin. The cholera organisms grow best at temperatures that are above 170 C, and in a broth of sodium chloride, well lower than that of open ocean, although above that of fresh water (Barua and Greenough 107). Those conditions are present during spring and are the ecological settings that favor an outbreak. 

            Modern intensive field and laboratory studies have led to a discovery that Vibrio cholerae is harbored in estuaries of zooplankton communities that have many species of copepods that consist of myriad assemblages. Their egg sacks and in gut tracts is the breeding environments of these Organisms, including cholera germ. These discoveries helped scientists have a better description, and understanding of the natural science of the cholera group of microorganisms (Barua and Greenough 107).     

Prevention

            Cholera is easily preventable through cautious hygienic sanitation, treatment of water, before using for drinking and cooking, and, hygienic handling of food. The Center for Disease Control and Prevention recommends boiling water and treatment with chlorine before use. Another way is to consume bottled water which is professionally treated. Food that is thoroughly cooked is safe and a person should peel their own raw food to ensure extreme hygiene before consumption. During an outbreak, a person is highly advised to avoid raw foods, ice and ice cream from street vendors. 

            Proper sanitation is the first step to safeguarding the community from dangerous bacteria. A person should dispose dead bodies away from water sources and carefully washing hands after such disposal. Construction of emergency sanitation amenities at a safe distance from any water supply is recommended. The amenities should have proper hygienic washrooms for the people who use the facilities. Food should be cooked thoroughly with safe water and consumed hot. Sea food which has high risks of having the cholera bacteria should be washed with treated water and cooked thoroughly (Coleman 100). Avoiding a mixture of cooked food and raw food is very important. Exclusion of infected persons from preparing food is important. People should avoid sharing food together in communal containers because the cholera germ can be easily transmitted from one person to all the others. Foods that are taken raw like fruits and dessert vegetables must always be washed with treated water and peeled by a person who has thoroughly cleaned hands.           

            There is a vaccine called Dukoral which is oral. The vaccine is available in some countries, but the Center for Disease Control and Prevention does not recommend it because it has incomplete defensive effects. Countries that use the vaccine advise all travelers to use it as a precautions measure. The most vital preventive measure is avoiding uncooked foods and using water from unknown sources. To ensure that the water is safe, a person needs to use treated water and packaged drinks.  

 

Ecological Awareness Aimed at Controlling of Cholera

            Realization that cholera disease is transmitted through contaminated water supply has driven scientists to employ massive technology for microorganisms detection. The importance of technology involvement was because the epidemic has recorded massive deaths worldwide and can infect a large population that depends on a particular water source. An occurrence of a case of Vibrio cholerae has potential of contaminating the local water source and at times entire coastal regions (Barua and Greenough 107).  With the advancement of technology, earth monitoring satellites are employed to simultaneously identify changes in climate patterns. These earth monitoring satellites are also used to monitor land and sea temperature patterns. With collection and availability of environmental data, medical professionals are in a position to predict a possible cholera epidemic and take preventive measures before the happening and in turn save millions of lives.

            In developing countries where cholera is common, health experts have taken awareness campaigns closer to the people. This is done by putting up warning billboards near open water bodies and in turn providing alternative water supply from a treated source to discourage unhygienic water usage. Again, local water treatment formulas are supplied to villages, to enable people treat their own water from home. Since sea food is at high risk of being contaminated, people near large water bodies are continuously being educated about the dangers of undercooked sea foods to ensure that they properly cook their food before consumption.

            Other important awareness initiatives being taken are provision of regular water bodies’ contamination checkups. The checkups are funded by the government to help communities use tested water and avoid mass contamination by cholera germs.  

 

Treatment

            Cholera bacteria are deadly because they dehydrate the body. The first treatment is through oral re-hydration therapy.  The person who is infected should take a lot of drinks. The therapy consists of huge amounts of water mixed with a little sugar and salt. Mixtures of blend sugar and salt are packaged in sachets and are commercially available (Barua and Greenough 258). Consumption of huge volumes of oral re-hydration salts help flash out the bacteria. Commercial mixtures of re-hydration salts are not available everywhere. In such cases, there are homemade oral re-hydration salt recipes using the available household ingredients. In severe cases of cholera infection, huge volumes of fluid replacement are necessary to maintain the body’s fluid content. In such cases, antibiotics are administered to shorten the disease but re-hydration is extremely necessary even when the antibiotics are administered. Food should be given to the patient as soon as the person can eat. The food should be coupled with more drinks to keep the intestines full.

            Re-hydration can be used to prevent and treat dehydration. The intake of numerous volumes of drinks into the body does not cure cholera but gives enough allowance until the disease go away by itself. Research has shown that infections of cholera fade away with time if an infected patient takes a lot of fluids to flash out the germ from the body. Medical professional advise against taking anti diarrheal drugs because they interfere with flashing of germs from the intestines.

Conclusion

            Cholera disease is a deadly disease that is transmitted through water contaminated with Vibrio cholerae bacteria. The disease is not common in developed countries because there is sufficient supply of clean treated water and hygienic sanitation systems. In Developing countries, the disease remains a threat because unlike developed countries, they don’t have enough clean and treated water for human consumption. Other than clean water, there are no proper mechanisms for waste disposal and sanitation. The governments of developing countries are unable to provide treated water to all people due to economic constrains. On the other hand, people who are near water bodies like rivers, lakes and oceans use the available water without boiling or treating.

            The other major reason why cholera epidemic infects masses is that an infected person will be unknowingly spread the germs back into the environment before noticing any signs and symptoms. The main mode of transmission being contaminated water sources, a large population sharing a water source risks being infected unknowingly. A healthy adult will have a mild infection in the first and second day of infection and will have spread the bacteria to many other people by the time the severe signs and symptoms develop. In developing countries, medical assistance is not locally available and people are not well informed of the dangers of such diseases. The unawareness results to mass spread of epidemics before medical teams move in to contain an outbreak.

            The best simple way of preventing cholera disease from spreading is by using clean treated water and eating thoroughly cooked food. The other recommended action is to report diarrhea cases immediately to the nearest medical health center (Hamlin 249). This is to ensure that a possible spread is contained and patients are treated early before a severe infection occurs.

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