Cholera
7591
225301372
2008-07-12T23:47:29Z
Stevenfruitsmaak
247845
[[WP:UNDO|Undid]] revision 225300993 by [[Special:Contributions/68.192.201.61|68.192.201.61]] ([[User talk:68.192.201.61|talk]]) testing
{{Infobox_Disease |
Name =Cholera |
Image =Vibrio cholerae.jpg |
Caption =[[Transmission electron microscope|TEM]] image of ''Vibrio cholerae'' |
Width =226 |
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ICD10 ={{ICD10|A|00||A|00}}, |
ICD9 =|
MedlinePlus =|
eMedicineSubj =|
eMedicineTopic= |
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[[Image:Cholera 395.1.jpg|thumb]]
[[Image:Distribution of the cholera.PNG|thumb|right|300 px|Distribution of cholera]]
'''Cholera''', sometimes known as Asiatic cholera or epidemic cholera, is an infectious [[gastroenteritis]] caused by the [[bacterium]] ''[[Vibrio cholerae]]''.<ref name= RyanKJ>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | pages = 376–7 |publisher = McGraw Hill | year = 2004 | isbn = 0838585299 }}</ref><ref name= FaruqueNair>{{cite book | author = Faruque SM; Nair GB (editors). | title = Vibrio cholerae: Genomics and Molecular Biology | publisher = Caister Academic Press | year = 2008 | id = [ISBN 978-1-904455-33-2]}}</ref> Transmission to humans occurs through ingesting contaminated water or food. The major reservoir for cholera was long assumed to be humans themselves, but considerable evidence exists that aquatic environments can serve as reservoirs of the bacteria.
''Vibrio cholerae'' is a [[Gram-negative]] bacterium that produces [[cholera toxin]], an [[enterotoxin]], whose action on the [[mucosa]]l [[epithelium]] lining of the [[small intestine]] is responsible for the characteristic massive [[diarrhoea]] of the disease.<ref name= RyanKJ>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | pages = 376–7 |publisher = McGraw Hill | year = 2004 | isbn = 0838585299 }}</ref> In its most severe forms, cholera is one of the most rapidly fatal illnesses known, and a healthy person may become [[hypotension|hypotensive]] within an hour of the onset of symptoms; infected patients may die within three hours if treatment is not provided.<ref name= RyanKJ>{{cite book | author = Ryan KJ, Ray CG (editors) | title = Sherris Medical Microbiology | edition = 4th ed. | pages = 376–7 |publisher = McGraw Hill | year = 2004 | isbn = 0838585299 }}</ref> In a common scenario, the disease progresses from the first liquid [[Human feces|stool]] to [[Shock (medical)|shock]] in 4 to 12 hours, with death following in 18 hours to several days without [[oral rehydration therapy]].<ref name=McLeod_2000>{{cite journal |author=McLeod K |title=Our sense of Snow: John Snow in medical geography |journal=Soc Sci Med |volume=50 |issue=7-8 |pages=923–35 |year=2000 |pmid = 10714917 |doi=10.1016/S0277-9536(99)00345-7}}</ref><ref>{{cite web|url=http://www.who.int/topics/cholera/control/en/index.html|title=Cholera: prevention and control| publisher=World Health Organization (WHO)|date=2007|accessdate=2008-01-03}}</ref>
==Symptoms==
The diarrhoea associated with cholera is [[acute (medicine)|acute]] and so severe that, unless [[oral rehydration therapy]] is started promptly, the diarrhoea may within hours result in severe [[dehydration]] (a [[medical emergency]]), or even [[death]].
According to novelist [[Susan Sontag]], cholera was more feared than some other deadly diseases because it dehumanized the victim. [[Diarrhea]] and dehydration were so severe the victim could literally shrink into a wizened caricature of his or her former self before death.<ref> Susan Sontag, ''AIDS and Its Metaphors'', 1988, Farra, Strauss and Giroux</ref>
Other symptoms include rapid dehydration, rapid pulse, dry skin, tiredness, abdominal cramps, nausea, and vomiting.
Traditionally, Cholera was widespread throughout third world countries, however more recently outbreaks have occurred in more rural parts of England and the United States' mid-west region.
==Treatment==
[[Image:Cholera rehydration nurses.jpg|thumb|right|Cholera patient being treated by medical staff in 1992.]]
Water and electrolyte replacement are essential treatments for cholera, as [[dehydration]] and electrolyte depletion occur rapidly. Prompt use of [[oral rehydration therapy]] is highly effective, safe, uncomplicated, and inexpensive.
The use of [[intravenous]] rehydration may be absolutely necessary in severe cases, under some conditions.
In addition, [[tetracycline]] is typically used as the primary antibiotic, although some strains of ''V. cholerae'' exist that have shown resistance. Other antibiotics that have been proven effective against ''V. cholerae'' include [[cotrimoxazole]], [[erythromycin]], [[doxycycline]], [[chloramphenicol]], and [[furazolidone]].<ref>{{cite web|url=http://sprojects.mmi.mcgill.ca/tropmed/disease/chol/treatment.htm|title=Cholera treatment|publisher=Molson Medical Informatics |date=2007|accessdate=2008-01-03}}</ref> [[Fluoroquinolone]]s such as [[norfloxacin]] also may be used, but resistance has been reported.<ref>.Recently [[Hemendra Yadav]] reported his findings at A.I.I.M.S.,New Delhi that Ampicillin resistance has again decreased in V.cholerae strains of Delhi{{cite journal | author=Krishna BVS, Patil AB, Chandrasekhar MR | title=Fluoroquinolone-resistant ''Vibrio cholerae'' isolated during a cholera outbreak in India | jounal=Trans R Soc Trop Med Hyg | year=2006 | volume=100 | issue=3 | pages=224–26 | doi=10.1016/j.rstmh.2005.07.007 | doi_brokendate=2008-06-24 }}</ref>
Rapid diagnostic assay methods are available for the identification of multidrug resistant ''V. cholerae''.<ref name=Mackay>{{cite book | author = Mackay IM (editor). | title = Real-Time PCR in Microbiology: From Diagnosis to Characterization | publisher = Caister Academic Press | year = 2007 | id = [ISBN 978-1-904455-18-9]}}</ref> New generation antimicrobials have been discovered which are effective against ''V. cholerae'' in ''in vitro'' studies.<ref name= Ramamurthy>{{cite book |author= Ramamurthy T|year=2008|chapter=Antibiotic Resistance in ''Vibrio cholerae''|title=Vibriocholerae: Genomics and Molecular Biology|publisher=Caister Academic Press|id=[ISBN 978-1-904455-33-2]}}</ref>
== Epidemiology ==
=== Prevention ===
Although cholera can be life-threatening, prevention of the disease is straightforward if proper sanitation practices are followed. In the [[first world]], due to advanced [[water treatment]] and sanitation systems, cholera is no longer a major health threat. The last major outbreak of cholera in the United States occurred in [[1911]]. Travelers should be aware of how the disease is transmitted and what can be done to prevent it. Good sanitation practices, if instituted in time, are usually sufficient to stop an epidemic. There are several points along the transmission path at which the spread may be halted:
[[Image:Cholera hospital in Dhaka.jpg|right|thumb|Cholera hospital in [[Dhaka]].]]
* Sterilization: Proper disposal and treatment of the germ infected fecal waste (and all clothing and bedding that come in contact with it) produced by cholera victims is of primary importance. All materials (such as clothing and bedding) that come in contact with cholera patients should be [[Sterilization (microbiology)|sterilized]] in hot water using chlorine bleach if possible. Hands that touch cholera patients or their clothing and bedding should be thoroughly cleaned and sterilized.
* Sewage: Treatment of general [[sewage]] before it enters the waterways or underground water supplies prevents undiagnosed patients from spreading the disease.
* Sources: Warnings about cholera contamination posted around contaminated water sources with directions on how to [[decontamination|decontaminate]] the water.
* Water purification: All water used for drinking, washing, or cooking should be sterilized by boiling or [[chlorination]] in any area where cholera may be present. Boiling, filtering, and chlorination of water kill the bacteria produced by cholera patients and prevent infections from spreading. [[Water filtration]], chlorination, and boiling are by far the most effective means of halting transmission. [[Cloth filter]]s, though very basic, have significantly reduced the occurrence of cholera when used in poor villages in [[Bangladesh]] that rely on untreated surface water. Public health education and appropriate sanitation practices can help prevent transmission.
A vaccine is available outside the US, but this [[prophylactic]] is short-lived in efficacy and not currently recommended by the [[Centers for Disease Control and Prevention|CDC]].<ref name=CDC_Vacc>{{cite web | title=Is a vaccine available to prevent cholera? | work=CDC Disease Info: Cholera | url=http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_g.htm#Is%20a%20vaccine%20available%20to%20prevent%20cholera | accessdate=2007-01-21}}</ref>
===Susceptibility===
Recent [[epidemiology|epidemiologic research]] suggests that an individual's susceptibility to cholera (and other [[diarrhoea]]l infections) is affected by their [[blood type]]: Those with [[type O blood]] are the most susceptible,<ref name=Swerdlow_1994>{{cite journal |author=Swerdlow D, Mintz E, Rodriguez M, Tejada E, Ocampo C, Espejo L, Barrett T, Petzelt J, Bean N, Seminario L |title=Severe life-threatening cholera associated with blood group O in Peru: implications for the Latin American epidemic |journal=J Infect Dis |volume=170 |issue=2 |pages=468–72 |year=1994 |pmid=8035040}}</ref><ref name=Harris_2005>{{cite journal |author=Harris J, Khan A, LaRocque R, Dorer D, Chowdhury F, Faruque A, Sack D, Ryan E, Qadri F, Calderwood S |title=Blood group, immunity, and risk of infection with ''Vibrio cholerae'' in an area of endemicity |journal=Infect Immun |volume=73 |issue=11 |pages=7422–7 |year=2005 |pmid=16239542 |doi=10.1128/IAI.73.11.7422-7427.2005}}</ref> while those with [[type AB]] are the most resistant. Between these two extremes are the A and B blood types, with type A being more resistant than type B.<ref>{{cite web|url=http://www.skypoint.com/members/waltzmn/Evolution.html|title=Genetics, Evolutionary Biology, and Evolutionary Variation|author=Waltz, Robert|date=2007|accessdate=2008-01-03}}</ref>
About one million ''V. cholerae'' bacteria must typically be ingested to cause cholera in normally healthy adults, although increased susceptibility may be observed in those with a weakened [[immune system]], individuals with decreased gastric acidity (as from the use of [[antacid]]s), or those who are [[malnutrition|malnourished]].
It has also been hypothesized that the [[cystic fibrosis]] genetic [[mutation]] has been maintained in humans due to a selective advantage: [[heterozygous]] carriers of the mutation (who are thus not affected by cystic fibrosis) are more resistant to ''V. cholerae'' infections.<ref name=Bertranpetit_1996>{{cite journal |author=Bertranpetit J, Calafell F |title=Genetic and geographical variability in cystic fibrosis: evolutionary considerations |journal=Ciba Found Symp |volume=197 |issue= |pages=97–114; discussion 114–8 |year=1996 |pmid=8827370}}</ref> In this model, the genetic deficiency in the [[cystic fibrosis transmembrane conductance regulator]] channel proteins interferes with bacteria binding to the [[gastrointestinal]] epithelium, thus reducing the effects of an infection.
=== Transmission ===
[[Image:Cholera.jpg|thumb|right|200px|[[Drawing]] of [[Death (personification)|Death]] bringing the cholera, in ''[[Le Petit Journal]]''.]]
Persons infected with cholera have massive diarrhoea. This highly-liquid [[diarrhoea]] is loaded with bacteria that can spread to infect water used by other people. Cholera is transmitted from person to person through ingestion of water contaminated with the cholera bacterium, usually from [[feces]] or other [[effluent]]. The source of the contamination is typically other cholera patients when their untreated diarrhoea discharge is allowed to get into waterways or into [[groundwater]] or drinking water supply. Any infected water and any foods washed in the water, as well as [[shellfish]] living in the affected [[waterway]], can cause an infection. Cholera is rarely spread directly from person to person. ''V. cholerae'' harbors naturally in the [[plankton]] of [[fresh water|fresh]], [[brackish water|brackish]], and [[Seawater|salt water]], attached primarily to [[copepod]]s in the [[zooplankton]]. Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a [[lysogenic]] [[bacteriophage]].<ref name=Archivist_1997>{{cite journal | author =''Archivist'' | title = Cholera phage discovery | journal =Arch Dis Child | year =1997 | volume =76 | pages = 274 | url=http://adc.bmj.com/cgi/content/full/76/3/274 }}</ref> Coastal cholera outbreaks typically follow [[algal bloom|zooplankton blooms]], thus making cholera a [[zoonosis|zoonotic]] disease.
===Laboratory diagnosis===
Stool and swab samples collected in the acute stage of the disease, before antibiotics have been administered, are the most useful specimens for laboratory diagnosis. A number of special media have been employed for the cultivation for cholera vibrios. They are classified as follows:
==== Holding or transport media ====
#''Venkataraman-ramakrishnan (VR) medium'': This medium has 20g Sea Salt Powder and 5g Peptone dissolved in 1L of distilled water.
#''Cary-Blair medium'': This the most widely-used carrying media. This is a buffered solution of sodium chloride, sodium thioglycollate, disodium phosphate and calcium chloride at pH 8.4.
# ''Autoclaved sea water'
==== Enrichment media ====
#''Alkaline peptone water'' at pH 8.6
#''Monsur's taurocholate tellurite peptone water'' at pH 9.2
==== Plating media ====
#''Alkaline bile salt agar (BSA)'': The colonies are very similar to those on [[agar|nutrient agar]].
#''Monsur's gelatin Tauro cholate trypticase tellurite agar (GTTA) medium'': Cholera vibrios produce small translucent colonies with a greyish black centre.
#''TCBS medium'': This the mostly widely used medium. This medium contains thiosulphate, citrate, bile salts and sucrose. Also in oysters and lobster in some cases. Cholera vibrios produce flat 2-3 mm in diameter, yellow nucleated colonies.
Direct [[microscopy]] of stool is not recommended as it is unreliable. Microscopy is preferred only after enrichment, as this process reveals the characteristic motility of ''Vibrios'' and its inhibition by appropriate [[antiserum]]. Diagnosis can be confirmed as well as serotyping done by [[agglutination]] with specific sera.
=== Biochemistry of the ''V. cholerae'' bacterium ===
Most of the ''V. cholerae'' bacteria in the contaminated water that a host drinks do not survive the very acidic conditions of the [[stomach|human stomach]].<ref name=Hartwell>Hartwell LH, Hood L, Goldberg ML, Reynolds AE, Silver LM, and Veres RC (2004). ''Genetics: From Genes to Genomes.'' Mc-Graw Hill, Boston: p. 551-552, 572-574 (using the turning off and turning on of [[gene expression]] to make toxin proteins in cholera bacteria as a "comprehensive example" of what is known about the mechanisms by which bacteria change the mix of proteins they manufacture to respond to the changing opportunities for surviving and thriving in different chemical environments).</ref> The few bacteria that do survive conserve their [[nutrient|energy and stored nutrients]] during the passage through the stomach by shutting down much protein production. When the surviving bacteria exit the stomach and reach the [[small intestine]], they need to propel themselves through the thick [[mucous membrane|mucus]] that lines the small intestine to get to the intestinal wall where they can thrive. ''V. cholerae'' bacteria start up production of the hollow cylindrical protein [[flagellin]] to make [[flagella]], the curly whip-like tails that they rotate to propel themselves through the mucous that lines the small intestine.
Once the cholera bacteria reach the intestinal wall, they do not need the flagella propellers to move themselves any longer. The bacteria stop producing the protein flagellin, thus again conserving energy and nutrients by changing the mix of proteins that they manufacture in response to the changed chemical surroundings. On reaching the intestinal wall, ''V. cholerae'' start producing the toxic proteins that give the infected person a watery [[diarrhoea]]. This carries the multiplying new generations of ''V. cholerae'' bacteria out into the drinking water of the next host—if proper sanitation measures are not in place.
[[Image:Cholera Toxin.png|thumb|Cholera Toxin. The delivery region (blue) binds membrane carbohydrates to get into cells. The toxic part (red) is activated inside the cell (PDB code: 1xtc)]]
Microbiologists have studied the [[gene expression|genetic mechanisms]] by which the ''V. cholerae'' bacteria turn off the production of some proteins and turn on the production of other proteins as they respond to the series of chemical environments they encounter, passing through the stomach, through the mucous layer of the small intestine, and on to the intestinal wall.<ref name= DiRita>{{cite journal |author=DiRita V, Parsot C, Jander G, Mekalanos J |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=Proc Natl Acad Sci U S A |volume=88 |issue=12 |pages=5403–7 |year=1991 | url=http://www.pnas.org/cgi/reprint/88/12/5403 |pmid=2052618 |doi=10.1073/pnas.88.12.5403}}</ref> Of particular interest have been the genetic mechanisms by which cholera bacteria turn on the protein production of the toxins that interact with host cell mechanisms to pump [[chloride]] ions into the small intestine, creating an ionic pressure which prevents sodium ions from entering the cell. The chloride and sodium ions create a salt water environment in the small intestines which through osmosis can pull up to six liters of water per day through the intestinal cells creating the massive amounts of diarrhoea.<ref>{{cite web|url=http://nursinggazette.blogspot.com/2007/11/cholera.html|title=Cholera | publisher=Nursing Gazette |date=2007-11-12 |accessdate=2008-01-02}}</ref>The host can become rapidly dehydrated if an appropriate mixture of dilute salt water and sugar is not taken to replace the blood's water and salts lost in the diarrhoea.
By inserting separately, successive sections of ''V. cholerae'' DNA into the DNA of other bacteria such as ''[[E. coli]]'' that would not naturally produce the protein toxins, researchers have investigated the mechanisms by which ''V. cholerae'' responds to the changing chemical environments of the stomach, mucous layers, and intestinal wall. Researchers have discovered that there is a complex cascade of regulatory proteins that control expression of ''V. cholerae'' virulence determinants. In responding to the chemical environment at the intestinal wall, the ''V. cholerae'' bacteria produce the TcpP/TcpH proteins, which, together with the ToxR/ToxS proteins, activate the expression of the ToxT regulatory protein. ToxT then directly activates expression of virulence genes that produce the toxins that cause diarrhoea in the infected person and that permit the bacteria to colonize the intestine.<ref name= DiRita>{{cite journal |author=DiRita V, Parsot C, Jander G, Mekalanos J |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=Proc Natl Acad Sci U S A |volume=88 |issue=12 |pages=5403–7 |year=1991 | url=http://www.pnas.org/cgi/reprint/88/12/5403 |pmid=2052618 |doi=10.1073/pnas.88.12.5403}}</ref> Current research aims at discovering "the signal that makes the cholera bacteria stop swimming and start to colonize (that is, adhere to the cells of) the small intestine."<ref name= DiRita>{{cite journal |author=DiRita V, Parsot C, Jander G, Mekalanos J |title=Regulatory cascade controls virulence in Vibrio cholerae |journal=Proc Natl Acad Sci U S A |volume=88 |issue=12 |pages=5403–7 |year=1991 | url=http://www.pnas.org/cgi/reprint/88/12/5403 |pmid=2052618 |doi=10.1073/pnas.88.12.5403}}</ref>
== History ==
===Origin and spread===
Cholera was originally [[endemic (epidemiology)|endemic]] to the Indian subcontinent, with the [[Ganges River]] likely serving as a contamination reservoir. The disease spread by trade routes (land and sea) to [[Russia]], then to [[Western Europe]], and from Europe to [[North America]]. Cholera is now no longer considered a pressing health threat in Europe and North America due to [[water filtration|filtering]] and [[chlorination]] of water supplies, but affects heavily the developing countries populations.
* 1816-1826 - '''[[First cholera pandemic]]''': Previously restricted, the pandemic began in [[Bengal]], and then spread across [[India]] by 1820. The cholera outbreak extended as far as [[China]] and the [[Caspian Sea]] before receding.
* 1829-1851 - '''[[Second cholera pandemic]]''' reached Europe, [[London]] and [[Paris]] in 1832. In London, the disease claimed 6,536 victims; in Paris, 20,000 succumbed (out of a population of 650,000) with about 100,000 deaths in all of France.<ref name="Rosenberg">{{cite book| title=The Cholera Years: The United States in 1832, 1849, and 1866| author=Charles E. Rosenberg|publiher=University of Chicago Press|date=1987}}</ref> The epidemic reached Russia (see [[Cholera Riots]]), [[Quebec, Canada|Quebec]], [[Ontario, Canada|Ontario]] and [[New York]] in the same year and the Pacific coast of North America by 1834. <ref>{{cite news |first= |last= |authorlink= |coauthors= |title=How Epidemics Helped Shape the Modern Metropolis. |url=http://www.nytimes.com/2008/04/15/science/15chol.html?8dpc |quote=On a Sunday in July 1832, a fearful and somber crowd of New Yorkers gathered in City Hall Park for more bad news. The epidemic of cholera, cause unknown and prognosis dire, had reached its peak. |publisher=[[New York Times]] |date= |accessdate=2008-04-15 }}</ref>
* 1849 - Second major outbreak in Paris. In London, it was the worst outbreak in the city's history, claiming 14,137 lives, over twice as many as the 1832 outbreak. In 1849 cholera claimed 5,308 lives in the port city of Liverpool, England, and 1,834 in Hull, England.<ref name="Rosenberg"/> An outbreak in North America took the life of former [[President of the United States|U.S. President]] [[James K. Polk]]. Cholera spread throughout the Mississippi river system killing over 4,500 in St. Louis<ref name="Rosenberg"/> and over 3,000 in New Orleans<ref name="Rosenberg"/> as well as thousands in New York.<ref name="Rosenberg"/> In 1849 cholera was spread along the California and Oregon trail as hundreds died on their way to the [[California Gold Rush]], [[Utah]] and [[Oregon]].<ref name="Rosenberg"/>
* 1852-1860 - '''[[Third cholera pandemic]]''' mainly affected Russia, with over a million deaths. In 1853-4, London's epidemic claimed 10,738 lives.
* 1854 - Outbreak of cholera in Chicago took the lives of 5.5% of the population (about 3,500 people).<ref name="Rosenberg"/> The [[Soho]] outbreak in London ended after removal of the handle of the [[Broad Street pump]] by a committee instigated to action by [[John Snow (physician)|John Snow]].<ref> {{cite book|title=On the Mode of Communication of Cholera| date=1855 |author=John Snow, M.D.| url=http://eee.uci.edu/clients/bjbecker/PlaguesandPeople/week8a.html}} </ref>
* 1863-1875 - '''[[Fourth cholera pandemic]]''' spread mostly in Europe and [[Africa]].
* 1866 - Outbreak in North America. <!-- taken from above paragraph. Not sure if this is separate from the 4th pandemic --> In London, a localized epidemic in the East End claimed 5,596 lives just as London was completing its major sewage and water treatment systems--the East End was not quite complete. [[William Farr]], using the work of [[John Snow (physician)|John Snow]] et al. as to contaminated drinking water being the likely source of the disease, was able to relatively quickly identify the East London Water Company as the source of the contaminated water. Quick action prevented further deaths.<ref name="Rosenberg"/> Also a minor outbreak at [[Ystalyfera]] in South Wales. Caused by the local water works using contaminated canal water, it was mainly its workers and their families who suffered. Only 119 died.
[[Image:Cholerabaracke-HH-1892.gif|thumb|1892 Cholera outbreak in [[Hamburg, Germany]], hospital ward]]
[[Image:Choleradesinfektin-1892.gif|thumb|1892 Cholera outbreak in [[Hamburg, Germany]], disinfection team]]
* 1881-1896 - '''[[Fifth cholera pandemic]] '''; The 1892 outbreak in [[Hamburg, Germany]] was the only major European outbreak; about 8,600 people died in Hamburg. Although generally held responsible for the virulence of the epidemic, the city government went largely unchanged. This was the last serious European cholera outbreak.
* 1899-1923 - '''[[Sixth cholera pandemic]]''' had little effect in Europe because of advances in public health, but major Russian cities were particularly hard hit by cholera deaths.
* 1961-1970s - '''[[Seventh cholera pandemic]]''' began in [[Indonesia]], called [[El Tor]] after the strain, and reached [[Bangladesh]] in 1963, India in 1964, and the USSR in 1966. From [[North Africa]] it spread into Italy by 1973. In the late 1970s, there were small outbreaks in Japan and in the South Pacific. There were also many reports of a cholera outbreak near [[Baku]] in 1972, but information about it was suppressed in the USSR.
* January 1991 to September 1994 - Outbreak in [[South America]], apparently initiated when a ship discharged ballast water. Beginning in [[Peru]] there were 1.04 million identified cases and almost 10,000 deaths. The causative agent was an O1, El Tor strain, with small differences from the seventh pandemic strain. In 1992 a new strain appeared in Asia, a non-O1, [[nonagglutinable vibrio]] (NAG) named O139 Bengal. It was first identified in [[Tamil Nadu]], India and for a while displaced El Tor in southern Asia before decreasing in prevalence from 1995 to around 10% of all cases. It is considered to be an intermediate between El Tor and the classic strain and occurs in a new [[serogroup]]. There is evidence of the emergence of wide-spectrum resistance to drugs such as [[trimethoprim]], [[sulfamethoxazole]] and [[streptomycin]].
=== Famous cholera victims ===
The pathos in the last movement of [[Pyotr Ilyich Tchaikovsky|Tchaikovsky's]] (c. 1840-1893) last symphony made people think that Tchaikovsky had a premonition of death. "A week after the premiere of his [[Symphony No. 6 (Tchaikovsky)|Sixth Symphony]], Tchaikovsky was dead--6 November 1893. The cause of this indisposition and stomach ache was suspected to be his intentionally infecting himself with cholera by drinking contaminated water. The day before, while having lunch with [[Modest Tchaikovsky|Modest]] (his brother and biographer), he is said to have poured tap water from a pitcher into his glass and drunk a few swallows. Since the water was not boiled and cholera was once again rampaging [[Saint Petersburg, Russia|St. Petersburg]], such a connection was quite plausible ...."<ref name=Neumayr>Meumayr A (1997). ''Music and Medicine: Chopin, Smetana, Tchaikovsky, Mahler: Notes on Their Lives, Works, and Medical Histories.'' Med-Ed Press: pp. 282-283 (summarizing various theories on what killed the composer [[Pyotr Ilyich Tchaikovsky|Tchaikovsky]], including his brother [[Modest Tchaikovsky|Modest's]] idea that Tchaikovksy drank cholera infested water the day before he became ill).</ref>
Other famous people who succumbed to the disease include:
<div style="-moz-column-count:2; column-count:2;">
* Major General [[Edward Hand]], Adjutant General of the Continental Army and congressman
* [[James K. Polk]], eleventh president of the United States
* [[Mary Abigail Fillmore]], daughter of U.S. president [[Millard Fillmore]]
* Elizabeth Jackson, mother of U.S. president [[Andrew Jackson]]
* Elliott Frost, son of American poet [[Robert Frost]]{{Fact|date=April 2008}}
* [[Nicolas Léonard Sadi Carnot]]
* [[Georg Wilhelm Friedrich Hegel]]
* Samuel Charles Stowe, son of [[Harriet Beecher Stowe]]
* [[Carl von Clausewitz]]
* [[George Bradshaw]]
* [[Adam Mickiewicz]]
* [[August von Gneisenau]]
* [[William Jenkins Worth]]
* [[John Blake Dillon]]
* Daniel Morgan Boone, founder of [[Kansas City, Missouri]], son of [[Daniel Boone]]
* [[James Clarence Mangan]]
* Mohammad Ali Mirza [[Dowlatshahi]] of [[Persia]]
* [[Ando Hiroshige]], Japanese ukiyo-e woodblock print artist.
* Juan de Veramendi, Mexican Governor of Texas, father-in-law of [[Jim Bowie]]
* [[Grand Duke Constantine Pavlovich of Russia]]
* William Shelley, son of [[Mary Shelley]]
* William Godwin, father of [[Mary Shelley]]
* Judge Daniel Stanton Bacon, father-in-law of [[George Armstrong Custer]]
* [[Inessa Armand]], mistress of [[Lenin]] and the mother of Andre, his son.
* [[Honinbo Shusaku]], famous go player.
* [[Henry Louis Vivian Derozio]], Eurasian Portuguese Poet and Teacher. Resided in India.
* [[Alexandre Dumas, père]], French author of [[The Three Musketeers]] and [[The Count of Monte Cristo]], also contracted cholera in the 1832 Paris epidemic and almost died, before he wrote these two novels.
* [[Charles X of France]]
</div>
=== Research ===
One of the major contributions to fighting cholera was made by physician and self-trained scientist [[John Snow (physician)|John Snow]] (1813-1858), who found the link between cholera and contaminated drinking water in [[1854]].<ref name="Rosenberg"/> In addition, Henry Whitehead, an Anglican minister, helped Snow track down and verify the source of the disease, which turned out to be an infected well in London. Their conclusions were widely distributed and firmly established for the first time a definite link between germs and disease. Clean water and good sewage treatment, despite their major engineering and financial cost, slowly became a priority throughout the major developed cities in the world from this time onward. [[Robert Koch]], 30 years later, identified ''V. cholerae'' with a microscope as the bacillus causing the disease in 1885. The bacterium had been originally isolated thirty years earlier (1855) by Italian anatomist [[Filippo Pacini]], but its exact nature and his results were not widely known around the world. The Spanish doctor [[Jaume Ferran i Clua]] developed the first cholera vaccine in [[1885]].
Cholera has been a laboratory for the study of evolution of virulence. The province of Bengal in [[British Raj|British India]] was partitioned into [[West Bengal]] and [[East Pakistan]] in 1947. Prior to partition, both regions had cholera pathogens with similar characteristics. After 1947, India made more progress on public health than East Pakistan (now [[Bangladesh]]). As a consequence, the strains of the pathogen that succeeded in India had a greater incentive in the longevity of the host and are less virulent than the strains prevailing in Bangladesh, which uninhibitedly draw upon the resources of the host population, thus rapidly killing many victims.
===False historical report of cholera===
A persistent myth states that [[Chicago 1885 cholera epidemic myth|90,000 people died in Chicago]] of cholera and [[typhoid fever]] in 1885, but this story has no factual basis.<ref>{{cite web|url=http://www.straightdope.com/columns/041112.html|title=Did 90,000 people die of typhoid fever and cholera in Chicago in 1885?|publisher= The Straight Dope|date=2004-11-12|accessdate=2008-01-03}}</ref> In 1885, there was a torrential rainstorm that flushed the Chicago river and its attendant pollutants into Lake Michigan far enough that the city's water supply was contaminated. However, because cholera was not present in the city, there were no cholera-related deaths, though the incident caused the city to become more serious about its sewage treatment.
===Cholera morbus===
The term ''cholera morbus'' was used in the 19th and early 20th centuries to describe both non-epidemic cholera and other gastrointestinal diseases (sometimes epidemic) that resembled cholera. The term is not in current use, but is found in many older references.<ref>{{cite web|url=http://www.antiquusmorbus.com/English/EnglishC.htm| title= Archaic Medical Terms| publisher=Antiquus Morbus| date=2007|accessdate=2008-01-03}}]</ref> The other diseases are now known collectively as [[gastroenteritis]].
=== Other historical information ===
In the past, people traveling in ships would hang a yellow flag if one or more of the crew members suffered from cholera. Boats with a yellow flag hung would not be allowed to disembark at any harbor for an extended period, typically 30 to 40 days.<ref>{{cite journal | author = Mackowiak PA | title = The Origin of Quarantine | journal = Clinical Infectious Diseases | year = 2002 | volume = 35 | pages = 1071–2 | doi = 10.1086/344062 }}</ref>
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== References ==
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== See also ==
*[[The Ghost Map|Johnson, S.(2006) The Ghost Map: a street, an epidemic and the two men who battled to save Victorian London Penguin]]
*[[The Painted Veil (2006 film)]], starring Naomi Watts and Edward Norton, in which the disease cholera is a prominent subject.
== External links ==
{{commonscat|Cholera}}
{{wiktionary|cholera}}
* [http://www.who.int/cholera Cholera] - [[World Health Organization]]
* [http://www.cdc.gov/ncidod/dbmd/diseaseinfo/cholera_g.htm What is Cholera?] - [[Centers for Disease Control and Prevention]]
* [http://www2.ncid.cdc.gov/travel/yb/utils/ybGet.asp?section=dis&obj=cholera.htm Cholera information for travelers] - Centers for Disease Control and Prevention
* Steven Shapin, [http://www.newyorker.com/printables/critics/061106crbo_books "Sick City: Maps and mortality in the time of cholera"], [[The New Yorker]] May 2006. A review of Steven Johnson, “The Ghost Map: The Story of London’s Most Terrifying Epidemic — and How It Changed Science, Cities, and the Modern World”
*[http://www.nytimes.com/2008/04/15/science/15chol.html? Cholera Epidemic in NYC in 1832] [[NYTimes]] [[April 15]] [[2008]]
{{Cholera}}
{{Bacterial diseases}}
[[Category:Gastroenterology]]
[[Category:Infectious diseases]]
[[Category:Neurotoxins]]
[[Category:Foodborne illnesses]]
[[Category:Bacterial diseases]]
[[Category:Water-borne diseases]]
[[Category:Pandemics]]
[[Category:Biological weapons]]
[[Category:Neglected diseases]]
[[Category:Microbiology]]
[[af:Cholera]]
[[ar:كوليرا]]
[[az:Xolera]]
[[bn:কলেরা]]
[[zh-min-nan:Làu-thò͘-soa]]
[[bs:Kolera]]
[[br:Kolera]]
[[bg:Холера]]
[[ca:Còlera]]
[[cs:Cholera]]
[[cy:Colera]]
[[da:Kolera]]
[[de:Cholera]]
[[et:Koolera]]
[[el:Χολέρα]]
[[es:Cólera]]
[[eo:Ĥolero]]
[[eu:Kolera]]
[[fa:وبا]]
[[fr:Choléra]]
[[ko:콜레라]]
[[hi:विसूचिका]]
[[hr:Kolera]]
[[id:Kolera]]
[[is:Kólera]]
[[it:Colera]]
[[he:כולרה]]
[[ku:Kolêra]]
[[la:Cholera]]
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[[ro:Holeră]]
[[qu:Q'icha unquy]]
[[ru:Холера]]
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[[scn:Culera]]
[[simple:Cholera]]
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[[sl:Kolera]]
[[sr:Колера]]
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[[te:కలరా]]
[[th:อหิวาตกโรค]]
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[[uk:Холера]]
[[zh:霍亂]]