Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Mary D. Nettleman, MD, MS, MACP is the Chair of the Department of Medicine at Michigan State University. She is a graduate of Vanderbilt Medical School, and completed her residency in Internal Medicine and a fellowship in Infectious Diseases at Indiana University.
Again, a cholera epidemic strikes a human population. This time the cholera
epidemic is in Haiti, a small country that has undergone large disasters. On
Jan. 12, 2010, a huge earthquake killed over 300,000 people, leaving Haiti with
a huge homeless population and its main city, Port-au-Prince, devoid of most normal services
and sanitary conditions. Many city residents left, but the more rural areas were not any better at supplying people with sanitary conditions. Many Haitians simply turned to their largest river in the country for water to drink, bathe, wash clothes, and swim in. This is a perfect environment for the development and spread of cholera and other diseases. As of Oct. 26, 2010, at least 250 people have died from cholera in Haiti.
Cholera is an acute infectious disease caused by a
bacterium, Vibrio cholerae (V. cholerae), which results in a painless, watery
diarrhea in humans. Some affected individuals have copious amounts of diarrhea
and develop dehydration so severe it can lead to death. Most people who get the
disease ingest the organisms through food or water sources contaminated with V.
cholerae. Although symptoms may be mild, approximately 5%-10% of previously
healthy people will develop a copious diarrhea within about one to five days after
ingesting the bacteria. Severe disease requires prompt medical care. Hydration
(usually by IV for the very ill) of the patient is the key to surviving the
disease.
The term cholera has a long history (see history section below) and
has been assigned to several other diseases. For example, fowl or chicken
cholera is a disease that can rapidly kill chickens and other avian species
rapidly with a major symptom of diarrhea. However, the disease-causing agent in
fowl is Pasteurella multocida, a gram-negative bacterium. Similarly, pig cholera
(also termed hog or swine cholera) can cause rapid death (in about 15 days) in
pigs with symptoms of fever, skin lesions, and
seizures. This disease is caused
by a pestivirus termed CSFV (classical swine fever virus). Neither one of these
animal diseases are related to human cholera, but the terminology can be
confusing.
What are cholera symptoms and signs?
The symptoms and signs of cholera
are a watery diarrhea that often contains flecks of whitish material (mucus and
some epithelial cells) that are about the size of pieces of rice. The diarrhea
is termed "rice-water stool" (See Figure 1) and smells "fishy." The volume of
diarrhea can be enormous; high levels of diarrheal fluid such as 250 cc per kg
or about 10 to 18 liters over 24 hours for a 70 kg adult can occur. People may
go on to develop one or more of the following symptoms and signs:
restlessness or irritability (especially in children)
People require immediate hydration to prevent these symptoms from continuing
because these signs and symptoms indicate that the person is becoming or is
dehydrated and may go on to develop severe cholera. People with severe cholera
(about 5%-10% of previously healthy people; higher if a population is
compromised by poor nutrition or has a high percentage of very young or elderly
people) can develop severe dehydration, leading to
acute renal failure, severe
electrolyte imbalances (especially potassium an sodium), and coma. If untreated,
this severe dehydration can rapidly lead to shock and death. Severe dehydration
can often occur four to eight hours after the first liquid stool with death in about 18
hours to a few days in undertreated or untreated people. In epidemic outbreaks
in underdeveloped countries where little or no treatment is available, the
mortality (death) rate can be as high as 50%-60%.
Figure 1: Rice-water stool from a patient with cholera; note the flecks of
mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC
Figure 2: Washer woman hands (loss of skin elasticity) are a sign of cholera. SOURCE: CDC
Muscle cramps are involuntarily and forcibly contracted muscles that do not relax. Extremely common, any muscles that have voluntary control, including some organs, are subject to cramp. Since there is such variety in the types of muscle cramps that can occur, many causes and preventative medications are known. Stretching is the most common way to stop or prevent most muscle cramps.
Diarrhea is a change is the frequency and looseness of bowel movements. Cramping, abdominal pain, and the sensation of rectal urgency are all symptoms of diarrhea. Absorbents and anti-motility medications are used to treat diarrhea.
There are many causes of back pain. Pain in the low back can relate to the bony lumbar spine, discs between the vertebrae, ligaments around the spine and discs, spinal cord and nerves, muscles of the low back, internal organs of the pelvis and abdomen, and the skin covering the lumbar area.
Dehydration is the excessive loss of body water. There are a number of causes of dehydration including heat exposure, prolonged vigorous exercise, and some diseases of the gastrointestinal tract. The best way to treat dehydration is to prevent it from occurring.
Nausea is an uneasiness of the stomach that often precedes vomiting. Nausea and vomiting are not diseases, but they are symptoms of many conditions. The causes of vomiting differ according to age, and treatment depends upon the cause of nausea and vomiting.
Dry mouth is a common side effect of many prescription and non-prescription drugs. Symptoms of dry mouth include a sticky, dry feeling in the mouth, frequent thirst, sores in the mouth; sores or split skin at the corners of the mouth, cracked lips, a dry feeling in the throat, a b urning or tingling sensation in the mouth, and a dry, red, raw tongue.
Food poisoning is common, but can also be life threatening. The most common form of food poisoning is caused by bacteria and include symptoms such as fever, abdominal pain, diarrhea, nausea and vomiting.
Travelers' diarrhea is generally contracted by eating contaminated food or drinking contaminated water. Food is the primary source of travelers' diarrhea. Enterotoxigenic E. coli is the cause of up to 70% of all cases of travelers' diarrhea. There are five unique classes of E. coli that causes gastroenteritis. Other bacteria responsible for travelers' diarrhea include
Campylobacter, jejuni, shigella, and salmonella. Viruses such as rotavirus and Norwalk virus (norovirus) and giardia lamblia a parasite may cause travelers' diarrhea. Prevention is careful eating and drinking of water.
Travelers should prepare for their trip by visiting their physician to get the proper vaccinations and obtain the necessary medication if they have a medical condition or chronic disease. Diseases that travelers may pick up from contaminated water or food, insect or animal bites, or from other people include malaria, meningococcal meningitis, yellow fever, hepatitis A, typhoid fever, polio, and cholera.
Digestion is the complex process of turning food you eat into the energy you need to survive. The digestive process also involves creating waste to be eliminated, and is made of a series of muscles that coordinate the movement of food.
Bioterrorism is a form of terrorism where there is the intentional release of biological agents such as viruses, germs, or bacteria. Diseases caused by bioterrorism agents include anthrax, botulism, plague, smallpox, tularemia, brucellosis, food poisoning, Q fever, ricin toxin poisoning, cholera, epidemic typhus, viral encephalitis, XDR TB, and MDR TB.
There are several causes of dry mouth, also called xerostomia. These
include:
Side effect of certain medications. Dry mouth is a common side effect of
many prescription and nonprescription drugs, including drugs used to treat depression, anxiety, pain, allergies, and colds (antihistamines and decongestants), obesity, acne, epilepsy, hypertension (diuretics), diarrhea, nausea, psychotic disorders, urinary incontinence, asthma
(certain bronchodilators), and Parkinson's disease. Dry mouth
can also a side effect of muscle relaxants and sedatives.
Side effect of certain diseases and infections. Dry mouth can be a
side effect of medical conditions, including Sjögren's syndrome, HIV/AIDS, Alzheimer's disease, diabetes, anemia, cystic fibrosis, rheumatoid arthritis,
hypertension, Parkinson's disease, stroke, and mumps.
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