The treatment of and cure for cholera

Factual Questions
1

Cholera dehydrates, and so one of the ways to “treat” cholera is to keep the victim hydrated, so that he doesn’t die. But it seems to me, with all my medical and scientific training (which is to say, nearly none) that simply keeping the victim hydrated would just “feed” the cholera so that it could continue to multiply (and get flushed out, and transfer to other people, and infect the whole city).

So, how does one treat cholera – hydration plus something to kill the cholera (what, antibiotics?)? And how would one treat cholera if one didn’t have access to modern medicine – i.e., how would, say, people in the middle of the cyclone’s destructive area in, say, Myanmar, treat cholera without access to all the international aid being held in abeyance or diverted to the junta?

(This thread brought to you by *The Ghost Map*, in which the author recounts the 1854 London cholera outbreak, including officials’ understanding of cholera. The predominant theory at the time apparently was that cholera was found in miasmic air, so was transmitted by the foul stench surrounding poor people (that’s why the poor got sick, and the rich didn’t), or it was God’s judgment on people’s sins (that’s why the poor got sick, and the rich didn’t), or other such stuff. Ghost Map (an interesting but flawed book) details the efforts undertaken by Dr. John Snow and Reverend Henry Whitehead to trace the origin of the cholera outbreak and take steps to prevent a recurrence.)

2

I’d argue that hydration doesn’t really actively treat the illness so much as keep you alive long enough for your own immune system to work. But for modern people. . .yeah, antibiotics. It’s caused by bacteria, so you’re going to want to get you some of those.

In areas where antibiotics aren’t available, the big things are going to be hydration and sanitation. In a disaster area with limited or no access to medical technology, prevention’s going to be an even bigger deal than treatment. Water MUST be boiled, for instance. Individuals who have the disease need to have their waste separated from the water supply. Even putting it in a large plastic (covered) bin’d be better than nothing, so long as the bin could be kept sealed until help arrived. Handwashing is a must if you have soap, alcohol, and bleach.

Of course, there’s only going to be so much you can do. Disaster areas are generally pretty desperate, and telling thirsty people, “hey, you can’t drink that until I boil it and it cools down!” rarely goes well.

3

Antibiotics don’t cure cholera.

They may shorten the duration of the diarrhea, but that’s not certain.

They do reduce bacterial shedding, so may make a person less contagious, or shorten the contagious phase.

But treatment is basically supportive, via fluid and electrolyte replacement, until the patient manages to recover.

4

Does the cholera just burn itself out eventually?

5

[QUOTE=Campion]
Does the cholera just burn itself out eventually?
[/QUOTE]

Yes, and with fluid hydration treatment (essentially sugar water) the recovery rate is extremely high (as in about 99%). I lecture about cholera in my micro class, but here is a cite from the WHO on cholera survival w/ and w/o treatment.

http://www.who.int/mediacentre/factsheets/fs107/en/index.html

6

[QUOTE=Angel of the Lord]
I’d argue that hydration doesn’t really actively treat the illness so much as keep you alive long enough for your own immune system to work. But for modern people. . .yeah, antibiotics. It’s caused by bacteria, so you’re going to want to get you some of those.

In areas where antibiotics aren’t available, the big things are going to be hydration and sanitation. In a disaster area with limited or no access to medical technology, prevention’s going to be an even bigger deal than treatment. Water MUST be boiled, for instance. Individuals who have the disease need to have their waste separated from the water supply. Even putting it in a large plastic (covered) bin’d be better than nothing, so long as the bin could be kept sealed until help arrived. Handwashing is a must if you have soap, alcohol, and bleach.

Of course, there’s only going to be so much you can do. Disaster areas are generally pretty desperate, and telling thirsty people, “hey, you can’t drink that until I boil it and it cools down!” rarely goes well.
[/QUOTE]

It’s true that in the end it is your immune system that wipes out the infection. This true for most infectious diseases, that’s why AIDS patients die from diseases that can, in healthy people, be cured with the aid of antibiotics.

The big thing, regardless of whether antibiotics are available or not, is rehydration. In an area with meager resources, one puts cholera patients supine on cots with a hole below their anus and a bucket under the hole then gives water (preferably containg a salt and sugar mixture such as prepackaged Oral Rehydration Salts or a home made solution of water, salt, and sugar prepared as directed by WHO) so that what goes in keeps up with what goes out.

Note, in a pinch the water need not be boiled. If you give them contaminated water, any cholera bacteria in it are inconsequential. The worst that can happen is that they can get some other waterborne disease (e.g., hepatitis A or E, giardia, typhoid, etc.). But those illnesses take a while to develop and are rarely fatal whereas someone with cholera can die in hours from dehydration.

I suppose a cholera epidemic and a disaster can occur at the same time in the same place but of the dozens of cholera epidemics I have heard of, none have been associated with an acute natural disaster and of the dozens of acute natural disasters I have heard of, none has been associated with a cholera outbreak. Can someone please tell us more about the the association of cholera and disasters?

7

Usually, cholera is spread through sewage. In natural disasters the sewage system breaks down. Floods, for instance, overflow septic systems. Earthquakes break pipes. The raw sewage gets into the water supply and cholera spreads.

8

[QUOTE=Campion]
Cholera dehydrates, and so one of the ways to “treat” cholera is to keep the victim hydrated, so that he doesn’t die. But it seems to me, with all my medical and scientific training (which is to say, nearly none) that simply keeping the victim hydrated would just “feed” the cholera so that it could continue to multiply (and get flushed out, and transfer to other people, and infect the whole city).
[/quote]
It’s my utterly uneducated understanding that the bacillus does multiply in the person’s gut and get flushed out, but it won’t stay in the gut in large quantities–fresh hydration does allow the victim to recover as long as the new fluid isn’t also contaminated with cholera too.

Apparently, most people can recover if they just drink enough to stay alive, even without antibiotics.

That was a really interesting book. By coincidence, I read a lot of it while sitting in the doctor’s office, waiting for treatment for a bacterial infection.

9

[QUOTE=IvoryTowerDenizen]
Yes, and with fluid hydration treatment (essentially sugar water) the recovery rate is extremely high (as in about 99%).
[/QUOTE]

That just seems so odd to me, that something as virulent as cholera can essentially be cured by drinking water.

Thanks, all!

(And dangermom, yeah, it was an interesting book, particularly the concept of mapping the disease – finding out why cholera skipped all the elderly widows in the neighborhood was fascinating!)

10

[QUOTE=dangermom]
It’s my utterly uneducated understanding that the bacillus does multiply in the person’s gut and get flushed out, but it won’t stay in the gut in large quantities–fresh hydration does allow the victim to recover as long as the new fluid isn’t also contaminated with cholera too..
[/QUOTE]

No. Contamination of the fluid with cholera makes no difference because the concentration of bacilli in the rehydration fluid, even if contaminated, will be so low compared with the concentration in the gut of the sick person until the person has nearly recovered at which point it makes no difference because the person has become immune to cholera bacilli.

11

[QUOTE=RealityChuck]
Usually, cholera is spread through sewage. In natural disasters the sewage system breaks down. Floods, for instance, overflow septic systems. Earthquakes break pipes. The raw sewage gets into the water supply and cholera spreads.
[/QUOTE]

OK. Makes sense. Please give examples of this actually happening.

12

[QUOTE=Campion]
That just seems so odd to me, that something as virulent as cholera can essentially be cured by drinking water.

Thanks, all!
[/QUOTE]

It’s an interesting concept, and one that I always vividly remembered after my Microbiology professor tried to explain it to us. Cholera is just like any other organism in that it has chosen a way to optimally spread its genes and try and spread itself. It’s method isn’t so much focusing on longterm survival, or trying to live inside it’s host by slowly decreasing the host’s defenses. So it’s methods simply work on trying to create the MOST likely scenario for another person getting sick as well in a 3rd world area (where we most likely see Cholera). It just increases its exit time from the body, and it’s very splashy- so there’s a good chance of another person getting into contact with those fluids (Vomit, diarrheas, etc), and then THEM getting sick.
Instead, it’s chosen to be a sprinter rather than a marathon runner- it goes for quantity of getting more hosts sick via its methods over quality of infection slowly bringing down the host (vs. say Malaria’s methods of infection, whose symptoms last for longer terms and are optimized for having the person be bitten by a mosquito and such).