Cholera Classification and external resources
TEM image of Vibrio cholerae
ICD-10	A00.,

Distribution of cholera

Cholera, sometimes known as Asiatic cholera or epidemic cholera, is an infectious gastroenteritis caused by the bacterium Vibrio cholerae. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify Diseases The International Statistical Classification of Diseases and Related Health Problems 10th Revision ( ICD -10) is a coding of diseases and signs symptoms abnormal findings A00-A79 - Bacterial infections and other intestinal infectious diseases and STDs (A00-A09 Intestinal Infectious diseases ( Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the The Bacteria ( singular: bacterium) are a large group of unicellular Microorganisms Typically a few Micrometres in length bacteria have Vibrio cholerae (also Kommabacillus) is a Gram negative curved-rod shaped Bacterium with a polar Flagella that causes Cholera ^[1][2] Transmission to humans occurs through the process of 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 mucosal epithelium lining of the small intestine is responsible for the characteristic massive diarrhoea of the disease. Gram-negative bacteria are those Bacteria that do not retain Crystal violet dye in the Gram staining protocol Cholera toxin (sometimes abbreviated to CTX, Ctx, or CT) is a Protein complex secreted by the Bacterium Vibrio cholerae An enterotoxin (not to be confused with Endotoxin) is a Protein Toxin released by a Microorganism in the Intestine. The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in In biology and medicine epithelium is a tissue composed of cells that line the cavities and surfaces of structures throughout the body In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea ^[1] In its most severe forms, cholera is one of the most rapidly fatal illnesses known, and a healthy person may become hypotensive within an hour of the onset of symptoms; infected patients may die within three hours if treatment is not provided. In Physiology and Medicine, hypotension refers to an abnormally low Blood pressure. ^[1] In a common scenario, the disease progresses from the first liquid stool to shock in 4 to 12 hours, with death following in 18 hours to several days without oral rehydration therapy. Human Feces (also faeces &mdash see spelling differences) also known as stools, is the waste product of the human digestive system and varies significantly Oral rehydration therapy, (also called ORT, oral rehydration salts or solutions (ORS, oral electrolyte) is a simple cheap and effective ^[3][4]

Symptoms

The diarrhoea associated with cholera is 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. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea In Medicine, an acute disease is a disease with either or both of a rapid onset a short course (as opposed to a chronic course Oral rehydration therapy, (also called ORT, oral rehydration salts or solutions (ORS, oral electrolyte) is a simple cheap and effective Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object A medical emergency is an Injury or Illness that is acute and poses an immediate risk to a person's life or long term health Death is the termination of the biological functions that define living Organisms It refers both to a specific

According to novelist Susan Sontag, cholera was more feared than some other deadly diseases because it dehumanized the victim. Susan Sontag ( January 16, 1933 – December 28, 2004) was an American Literary theorist, Philosopher, Diarrhoea and dehydration were so severe the victim could literally shrink into a wizened caricature of his or her former self before death. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea ^[5]

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

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. Dehydration ( hypohydration) is the removal of Water ( hydro in ancient Greek) from an object Prompt use of oral rehydration therapy is highly effective, safe, uncomplicated, and inexpensive. Oral rehydration therapy, (also called ORT, oral rehydration salts or solutions (ORS, oral electrolyte) is a simple cheap and effective

The use of intravenous rehydration may be absolutely necessary in severe cases, under some conditions. Intravenous therapy or IV therapy is the giving of Liquid substances directly into a Vein.

In addition, tetracycline is typically used as the primary antibiotic, although some strains of V. This article deals with the specific antibiotic called tetracycline cholerae exist that have shown resistance. Other antibiotics that have been proven effective against V. cholerae include cotrimoxazole, erythromycin, doxycycline, chloramphenicol, and furazolidone. Co-trimoxazole (abbreviated SXT TMP-SMX TMP-SMZ or TMP-sulfa is an Sulphonamide, Antibacterial combination of Trimethoprim and Sulfamethoxazole Erythromycin is a Macrolide Antibiotic that has an antimicrobial spectrum similar to or slightly wider than that of Penicillin, and is often used for people Doxycycline ( INN) (ˌdɒksɪˈsaɪkliːn is a member of the Tetracycline antibiotics group and is commonly used to treat a variety of Infections Doxycycline Chloramphenicol is a Bacteriostatic Antimicrobial originally derived from the Bacterium Streptomyces venezuelae, isolated by Furazolidone is an Antibiotic used to treat Diarrhoea and Enteritis caused by Bacteria or Protozoan infections ^[6] Fluoroquinolones such as norfloxacin also may be used, but resistance has been reported. The quinolones are a family of synthetic Broad-spectrum antibiotics. Norfloxacin is an oral broad-spectrum Fluoroquinolone Antibacterial agent used in the treatment of Urinary tract infections It is also sometimes used to ^[7]

Rapid diagnostic assay methods are available for the identification of multidrug resistant V. cholerae. ^[8] New generation antimicrobials have been discovered which are effective against V. cholerae in in vitro studies. ^[9]

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 term " first world " refers to countries that are capitalist, which are technologically advanced and whose Water treatment describes those processes used to make water more acceptable for a desired end-use The last major outbreak of cholera in the United States occurred in 1911. Year 1911 ( MCMXI) was a Common year starting on Sunday (link will display the full calendar of the Gregorian calendar (or a Common year 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:

Cholera hospital in Dhaka. Dhaka (also known as Dacca ( Bangla: ঢাকা ɖʱaka is the Capital of Bangladesh and the principal city of Dhaka District.

• 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 sterilized in hot water using chlorine bleach if possible. Sterilization (or sterilisation, see spelling differences) refers to any process that effectively kills or eliminates transmissible agents (such as Fungi 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. Sewage is the mainly liquid Waste containing some solids produced by humans which typically consists of washing water Feces, Urine, laundry waste and other
• Sources: Warnings about cholera contamination posted around contaminated water sources with directions on how to 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. Chlorination is the process of adding the element Chlorine to Water as a method of Water purification to make it fit for human consumption as 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. Water purification is the process of removing contaminants and other harmful microorganisms from a raw water source Cloth filters, though very basic, have significantly reduced the occurrence of cholera when used in poor villages in Bangladesh that rely on untreated surface water. Developed for use in Bangladesh, the cloth filter is a simple and cost-effective Appropriate technology method for reducing the contamination of drinking water ( Bengali: বাংলাদেশ inc-Latn Bangladesh) officially 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 CDC. Prophylaxis ( Greek "προφυλάσσω" to guard or prevent beforehand) is any medical or Public health procedure whose purpose The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated ^[10]

Susceptibility

Recent epidemiologic research suggests that an individual's susceptibility to cholera (and other diarrhoeal infections) is affected by their blood type: Those with type O blood are the most susceptible,^[11][12] while those with type AB are the most resistant. Epidemiology is the study of factors affecting the Health and Illness of populations and serves as the foundation and Logic of interventions made in the In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea A blood type (also called a blood group) is a classification of Blood based on the presence or absence of inherited Antigenic substances on the Between these two extremes are the A and B blood types, with type A being more resistant than type B. ^[13]

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 antacids), or those who are malnourished. An immune system is a collection of mechanisms within an Organism that protects against Disease by identifying and killing Pathogens and Tumor An antacid is any substance generally a base or Basic salt, which counteracts stomach acidity. Malnutrition is a general term for a medical condition caused by an improper or insufficient diet.

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. Cystic fibrosis (also known as CF, mucoviscoidosis, or mucoviscidosis) is a hereditary disease affecting the exocrine (mucus glands of the lungs In biology mutations are changes to the Nucleotide sequence of the Genetic material of an organism Zygosity refers to the genetic condition of a Zygote. In genetics zygosity describes the similarity or dissimilarity of DNA between Homologous cholerae infections. ^[14] 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. Cystic fibrosis transmembrane conductance regulator ( CFTR) is an ABC transporter -class Protein and Ion channel that transports Chloride

Transmission

Drawing of Death bringing the cholera, in Le Petit Journal. Drawing is a Visual art that makes use of any number of drawing instruments to mark a two-dimensional medium In English Death is often given the name the " Grim Reaper " and shown as a skeletal figure carrying a large Scythe, and wearing a midnight black gown robe Le Petit Journal was a daily Parisian newspaper published from 1863 to 1944

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. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea Cholera is transmitted from person to person through ingestion of water contaminated with the cholera bacterium, usually from feces or other effluent. Feces, faeces, or fæces (see spelling differences) is a waste product from an animal's digestive tract expelled through the Anus Effluent is an outflowing of water from a natural body of water or from a man-made structure 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. Groundwater is Water located beneath the Ground surface in Soil pore spaces and in the Fractures of lithologic formations Any infected water and any foods washed in the water, as well as shellfish living in the affected waterway, can cause an infection. Shellfish is a Culinary and Fisheries term for those aquatic Invertebrate animals that are used as Food: various species of molluscs A waterway is any navigable Body of water. These include Rivers Lakes Seas Oceans and Canals In order for a waterway Cholera is rarely spread directly from person to person. V. cholerae harbors naturally in the plankton of fresh, brackish, and salt water, attached primarily to copepods in the zooplankton. Plankton consist of any drifting Organisms ( Animals Plants Archaea, or Bacteria) that inhabit the Pelagic zone of Freshwater is a word that refers to bodies of water such as Ponds lakes rivers and streams containing low concentrations of dissolved Salts and other Total dissolved Seawater is Water from a Sea or Ocean. On average seawater in the world's oceans has a Salinity of about 3 Copepods are a group of small Crustaceans found in the sea and nearly every freshwater habitat and they constitute the biggest source of protein in the oceans Zooplankton are the Heterotrophic (sometimes detritivorous) type of Plankton. Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a lysogenic bacteriophage. Lysogeny, or the lysogenic cycle, is one of two methods of viral reproduction (the Lytic cycle is the other This article is about a biological infectious particle for other uses see Phage (disambiguation. ^[15] Coastal cholera outbreaks typically follow zooplankton blooms, thus making cholera a zoonotic disease. An algal bloom is a rapid increase in the population of Algae in an aquatic system A zoonosis (ˌzoʊəˈnoʊsɨs or zoonose is any Infectious disease that is able to be transmitted (by a vector) from other Animals both wild and domestic

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

1. Venkataraman-ramakrishnan (VR) medium: This medium has 20g Sea Salt Powder and 5g Peptone dissolved in 1L of distilled water.
2. 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.
3. Autoclaved sea water'

Enrichment media

1. Alkaline peptone water at pH 8. 6
2. Monsur's taurocholate tellurite peptone water at pH 9. 2

Plating media

1. Alkaline bile salt agar (BSA): The colonies are very similar to those on nutrient agar. Agar or agar agar is a Gelatinous substance derived from Seaweed.
2. Monsur's gelatin Tauro cholate trypticase tellurite agar (GTTA) medium: Cholera vibrios produce small translucent colonies with a greyish black centre.
3. 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 the technical field of using microscopes to view samples or objects Microscopy is preferred only after enrichment, as this process reveals the characteristic motility of Vibrios and its inhibition by appropriate antiserum. This short article on antiserum deals exclusively with its applications Diagnosis can be confirmed as well as serotyping done by agglutination with specific sera. In Linguistics, agglutination is the morphological process ofadding Affixes to the base of a Word.

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 human stomach. In Human anatomy, the stomach is a J-shaped hollow muscular organ of the Gastrointestinal tract involved in the second phase of Digestion, following ^[16] The few bacteria that do survive conserve their energy and stored nutrients during the passage through the stomach by shutting down much protein production. A nutrient is food or chemicals that an organism needs to live and grow or a substance used in an organism's metabolism which must be taken in from its environment When the surviving bacteria exit the stomach and reach the small intestine, they need to propel themselves through the thick mucus that lines the small intestine to get to the intestinal wall where they can thrive. In Biology the small Intestine is the part of the Gastrointestinal tract (gut between the Stomach and the Large intestine, and comprises The mucous membranes (or mucosae; singular mucosa) are linings of mostly endodermal origin covered in Epithelium, which are involved in 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. Flagellin is a Protein that arranges itself in a hollow cylinder to form the filament in Bacterial Flagellum. A flagellum ( plural flagella) is a tail-like structure that projects from the Cell body of certain Prokaryotic and Eukaryotic cells and it

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. In Medicine, diarrhea, also spelled diarrhoea (see spelling differences) is frequent loose or liquid Bowel movements Acute diarrhea 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.

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 genetic mechanisms by which the V. Gene expression is the process by which inheritable information from a Gene, such as the DNA sequence, is made into a functional Gene product, such 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. ^[17] 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 Ion is formed when the element Chlorine picks up one Electron to form an Anion (negatively-charged ion Cl&minus 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. ^[18]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. ^[17] 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. "^[17]

History

Origin and spread

Cholera was originally endemic to the Indian subcontinent, with the Ganges River likely serving as a contamination reservoir. In Epidemiology, an Infection is said to be endemic (from Greek en- in or within + demos people in a Population when The Ganges (ˈgænʤiːz also Ganga, Devanāgarī: hi गंगा in most Indian languages) is the major river in the Indian subcontinent The disease spread by trade routes (land and sea) to Russia, then to Western Europe, and from Europe to North America. Russia (Россия Rossiya) or the Russian Federation ( Rossiyskaya Federatsiya) is a transcontinental Country extending Western Europe at its most general meaning means 'all the countries in the West of Europe ' Cholera is now no longer considered a pressing health threat in Europe and North America due to filtering and chlorination of water supplies, but affects heavily the developing countries populations. Water purification is the process of removing contaminants and other harmful microorganisms from a raw water source Chlorination is the process of adding the element Chlorine to Water as a method of Water purification to make it fit for human consumption as

• 1816-1826 - First cholera pandemic: Previously restricted, the pandemic began in Bengal, and then spread across India by 1820. The first cholera pandemic, also known as the first Asiatic cholera pandemic or Asiatic cholera, lasted from 1817 to 1824 Etymology and ethnology The exact origin of the word Bangla or Bengal is unknown though it is believed to be derived from the Dravidian-speaking tribe Bang India, officially the Republic of India (भारत गणराज्य inc-Latn Bhārat Gaṇarājya; see also other Indian languages) is a country The cholera outbreak extended as far as China and the Caspian Sea before receding. China ( Wade-Giles ( Mandarin) Chung¹kuo² is a cultural region, an ancient Civilization, and depending on perspective a National The Caspian Sea is the largest enclosed body of water on Earth by area variously classed as the world's largest lake or a full-fledged Sea.
• 1829-1851 - Second cholera pandemic reached Europe, London and Paris in 1832. The second cholera pandemic also known as the Asiatic Cholera Pandemic was a Cholera pandemic from 1829-1851 reached Europe London and Paris London ( ˈlʌndən is the capital and largest urban area in the United Kingdom. Paris (ˈpærɨs in English; in French) is the Capital of France and the country's largest city 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. ^[19] The epidemic reached Russia (see Cholera Riots), Quebec, Ontario and New York in the same year and the Pacific coast of North America by 1834. The Cholera Riots ( Холерные бунты in Russian) were the riots of the urban population Peasants and Soldiers in Russia Quebec (kwɨˈbɛk Ontario (ɒnˈtɛrioʊ is a province located in the central part of Canada, the largest by population and second largest after Quebec New York ( is a state in the Mid-Atlantic and Northeastern regions of the United States and is the nation's third most populous ^[20]
• 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. ^[19] An outbreak in North America took the life of former U.S. President James K. Polk. The President of the United States is the Head of state and Head of government of the United States and is the highest political official in United States by James Knox Polk ( November 2 1795&ndashJune 15 1849 was the eleventh President of the United States, serving from March 4 1845 to March 4 1849 Cholera spread throughout the Mississippi river system killing over 4,500 in St. Louis^[19] and over 3,000 in New Orleans^[19] as well as thousands in New York. ^[19] 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. The California Gold Rush (1848&ndash1855 began on January 24 1848 when Gold was discovered by James Marshall at Sutter's Mill in Coloma, California The State of Utah (ˈjuːtɔː or) is a western state of the United States. Oregon ( is a state in the Pacific Northwest region of the United States. ^[19]
• 1852-1860 - Third cholera pandemic mainly affected Russia, with over a million deaths. The third cholera pandemic was an outbreak of Cholera that occurred from 1852-1860 and 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). ^[19] 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. This article is about an area of Manhattan, New York City. For the area in London UK see Soho. This article is about an area of Manhattan, New York City. For the area in London UK see Soho. John Snow ( 15 March 1813 &ndash 16 June 1858) was a British physician and a leader in the adoption of Anaesthesia and medical ^[21]
• 1863-1875 - Fourth cholera pandemic spread mostly in Europe and Africa. The fourth cholera pandemic was the fourth major pandemic of Cholera that spread from 1863-1875 and was found mostly in Europe and Africa
• 1866 - Outbreak in North America. 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 et al. John Snow ( 15 March 1813 &ndash 16 June 1858) was a British physician and a leader in the adoption of Anaesthesia and medical 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. ^[19] Also a minor outbreak at Ystalyfera in South Wales. Ystalyfera is a former industrial Village situated on the River Tawe in the unitary authority of Neath Caused by the local water works using contaminated canal water, it was mainly its workers and their families who suffered. Only 119 died.

1892 Cholera outbreak in Hamburg, Germany, hospital ward

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. Hamburg (English, German: ˈhambʊɐk local pronunciation Low German / Low Saxon: Hamborg) is the second-largest city in Germany Hamburg (English, German: ˈhambʊɐk local pronunciation Low German / Low Saxon: Hamborg) is the second-largest city in Germany The fifth cholera pandemic was the fifth major outbreak of Cholera that occurred in the years 1881 - 1896. Hamburg (English, German: ˈhambʊɐk local pronunciation Low German / Low Saxon: Hamborg) is the second-largest city in Germany 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. Sixth cholera pandemic was a major outbreak of cholera from the years 1899 to 1923
• 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. The Seventh cholera pandemic was the seventh major outbreak of Cholera and occurred from the years 1961 to the 1970s The Republic of Indonesia ( (Republik Indonesia is a Country in Southeast Asia. El Tor is the name given to a particular strain of the bacterium Vibrio cholerae, the causative agent of Cholera. ( Bengali: বাংলাদেশ inc-Latn Bangladesh) officially From North Africa it spread into Italy by 1973. North Africa or Northern Africa is the Northernmost Region of the African Continent, separated by the Sahara from Sub-Saharan 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. Baku (Bakı sometimes known as Baqy, Baky, Baki or Bakü, is the capital the largest city and the largest port of Azerbaijan
• January 1991 to September 1994 - Outbreak in South America, apparently initiated when a ship discharged ballast water. South America is a Continent of the Americas, situated entirely in the Western Hemisphere and mostly in the Southern Hemisphere, with a Beginning in Peru there were 1. Peru (Perú Piruw Piruw officially the Republic of Peru ( reˈpuβlika del peˈɾu is a country in western South America. 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. Tamil Nadu ( Tamil:, Country of the Tamils, t̪ɐmɨɻ n̪aːɽɯ is one of the 28 states of India. It is considered to be an intermediate between El Tor and the classic strain and occurs in a new serogroup. A serovar or serotype is a group of Microorganisms or Viruses based on their cell surface Antigens Serovars allow the epidemiologic classification There is evidence of the emergence of wide-spectrum resistance to drugs such as trimethoprim, sulfamethoxazole and streptomycin. Trimethoprim ( INN) (traɪˈmɛθəprɪm is a bacteriostatic Antibiotic mainly used in the Prophylaxis and treatment of Urinary tract infections Sulfamethoxazole is a sulfonamide Bacteriostatic Antibiotic. It is most often used as part of a synergistic combination with Trimethoprim Streptomycin is an Antibiotic drug the first of a class of drugs called Aminoglycosides to be discovered and was the first antibiotic remedy for Tuberculosis

Famous cholera victims

The pathos in the last movement of Tchaikovsky's (c. 1840-1893) last symphony made people think that Tchaikovsky had a premonition of death. "A week after the premiere of his Sixth Symphony, Tchaikovsky was dead--6 November 1893. The Symphony No 6 in B minor, Pathétique, Op 74 is Pyotr Ilyich Tchaikovsky 's final Symphony, written between February 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 (his brother and biographer), he is said to have poured tap water from a pitcher into his glass and drunk a few swallows. Modest Ilyich Tchaikovsky ( Russian: Модест Ильич Чайковский, May 13 May 1 1850 Alapaevsk – January 15 January Since the water was not boiled and cholera was once again rampaging St. Petersburg, such a connection was quite plausible . Saint Petersburg ( tr: Sankt-Peterburg,) is a city and a federal subject of Russia located on the Neva River . . . "^[22]

Other famous people who succumbed to the disease include:

Research

One of the major contributions to fighting cholera was made by physician and self-trained scientist John Snow (1813-1858), who found the link between cholera and contaminated drinking water in 1854. Charles X (9 October 1757 – 6 November 1836 ruled as King of France and Navarre from 20 May 1824 until the French Revolution of 1830, when he abdicated John Snow ( 15 March 1813 &ndash 16 June 1858) was a British physician and a leader in the adoption of Anaesthesia and medical Year 1854 ( MDCCCLIV) was a Common year starting on Sunday (link will display the full calendar of the Gregorian Calendar (or a Common year ^[19] 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. Heinrich Hermann Robert Koch ( December 11 1843 – May 27 1910) was a German Physician. 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. Filippo Pacini ( May 25, 1812 – July 9, 1883) was an Italian Anatomist, posthumously famous for isolating the Cholera The Spanish doctor Jaume Ferran i Clua developed the first cholera vaccine in 1885. Jaume Ferran i Clua ( Corbera d'Ebre, 1851 - Barcelona 1929 was a Catalan Bacteriologist and sanitarian contemporary of Koch, and Year 1885 ( MDCCCLXXXV) was a Common year starting on Thursday (link will display the full calendar of the Gregorian calendar (or a Common

Cholera has been a laboratory for the study of evolution of virulence. The province of Bengal in British India was partitioned into West Bengal and East Pakistan in 1947. For usage see British rule in India British Raj ( rāj, lit "reign" in Hindustani) primarily refers to the British West Bengal ( Bengali: পশ্চিমবঙ্গ Poshchim Bônggo poʃtʃim bɔŋgo is a state in eastern India. East Pakistan ( Bengali: পূর্ব পাকিস্তান Purbo Pakistan, Urdu: مشرقی پاکستان Mashriqi Pakistan) was 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). ( Bengali: বাংলাদেশ inc-Latn Bangladesh) officially 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 90,000 people died in Chicago of cholera and typhoid fever in 1885, but this story has no factual basis. See also Chicago Sanitary and Ship Canal The Chicago 1885 cholera epidemic myth is a persistent Urban legend, stating that 90000 people in Chicago Typhoid fever, also known as enteric fever, bilious fever, Yellow Jack or commonly just typhoid, is an illness caused by the Bacterium ^[23] 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. ^[24] The other diseases are now known collectively as gastroenteritis. Gastroenteritis (also known as gastro, gastric flu, and stomach flu, although unrelated to Influenza) is Inflammation of the

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. ^[25]

References

See also

• 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. The Ghost Map The Story of London's Most Terrifying Epidemic - and How it Changed Science Cities and the Modern World is a book by Steven Berlin Johnson in The Painted Veil is a 2006 film directed by John Curran and stars Naomi Watts, Edward Norton, and Liev Schreiber.

External links

• Cholera - World Health Organization
• What is Cholera? - Centers for Disease Control and Prevention
• Cholera information for travelers - Centers for Disease Control and Prevention
• Steven Shapin, "Sick City: Maps and mortality in the time of cholera", The New Yorker May 2006. The Centers for Disease Control and Prevention (or CDC) is an agency of the United States Department of Health and Human Services based in unincorporated The New Yorker is an American Magazine that publishes reportage commentary criticism essays fiction satire cartoons and poetry 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”
• Cholera Epidemic in NYC in 1832 NYTimes April 15, 2008