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CHOLERA: PATHOGENESIS AND MODERN TREATMENT APPROACHES
Tursunov Dilshodjon O'tkir o'g'li
Faculty of Medicine, International University of Asia, Uzbekistan.
https://doi.org/10.5281/zenodo.15383919
Abstract. Cholera is an acute diarrheal illness caused by ingestion of food or water
contaminated with the bacterium Vibrio cholerae. It is characterized by sudden onset of profuse
watery diarrhea, leading to severe dehydration and potentially death if not treated promptly.
While cholera is rare in developed countries, it remains a major public health concern in areas
with inadequate access to clean water, sanitation, and healthcare infrastructure.
Keywords: Cholera, G-protein, Euvichol-Plus, Vibrio, Dukoral.
Pathogenesis
1. Transmission and Colonization
Cholera is transmitted primarily through the fecal-oral route. Once Vibrio cholerae enters
the div, it passes through the acidic environment of the stomach and colonizes the small
intestine. The bacteria do not invade the intestinal mucosa but instead adhere to the epithelial
cells using specific pili and surface proteins.
2. Cholera Toxin Production
The key virulence factor of V. cholerae is the cholera toxin (CT), an AB₅-type exotoxin:
The B subunit binds to GM1 ganglioside receptors on the intestinal epithelial cells. The A
subunit is internalized and activates adenylate cyclase via G-protein signaling.
This results in elevated intracellular levels of cyclic AMP (cAMP), which triggers
massive secretion of chloride ions (Cl⁻) into the intestinal lumen. Sodium and water follow
osmotically, leading to copious, watery diarrhea known as “rice-water stools.”
3. Fluid and Electrolyte Loss
The rapid and profound loss of fluids and electrolytes can result in:
Hypovolemia
Hypotension
Hypokalemia
Metabolic acidosis
Acute renal failure
Shock and death in extreme cases
The entire process can progress rapidly, especially in children and immunocompromised
individuals.
Clinical Manifestations
Sudden, painless watery diarrhea (“rice-water stools”)
Vomiting
Rapid dehydration
Dry mucous membranes, sunken eyes
Muscle cramps
Decreased urine output
Weak pulse, hypotension, and in severe cases, unconsciousness
Without treatment, severe cholera can lead to death within hours due to fluid loss.
Modern Treatment Approaches
1. Rehydration Therapy (Primary Treatment)
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The cornerstone of cholera management is rapid fluid replacement.
Oral Rehydration Solution (ORS): For mild to moderate dehydration; contains glucose,
sodium, potassium, chloride, and bicarbonate or citrate.
Intravenous Fluids (IV): For patients with severe dehydration or those unable to drink;
Ringer’s lactate is preferred.
Prompt rehydration can reduce the case fatality rate to less than 1%.
2. Antibiotic Therapy
Antibiotics are not always necessary but can reduce the duration and severity of the
illness and decrease bacterial shedding.
Doxycycline (single dose) — commonly used for adults
Azithromycin — alternative, especially in children and pregnant women
Ciprofloxacin — another option in resistant cases
3. Zinc Supplementation
In children, zinc supplements (10–20 mg daily) help reduce the duration of diarrhea and
improve intestinal mucosal healing.
4. Nutritional Support
Continued feeding, including breastfeeding in infants, should be encouraged during and
after rehydration to support recovery and prevent malnutrition.
Prevention and Public Health Measures
1. Water, Sanitation, and Hygiene (WASH)
Use of clean drinking water
Proper disposal of human waste
Regular handwashing with soap
Safe food handling practices
2. Cholera Vaccination
Oral cholera vaccines (OCVs) are effective preventive tools, especially in high-risk areas
or during outbreaks:
Dukoral (inactivated vaccine with recombinant B subunit)
Shanchol and Euvichol-Plus (killed whole-cell vaccines)
These vaccines provide immunity for 2–3 years and are included in the World Health
Organization (WHO) recommendations for outbreak and endemic settings.
3. Surveillance and Rapid Response
Early detection of outbreaks, community education, and immediate intervention are
critical to limit transmission.
Conclusion
Cholera remains a life-threatening disease, especially in resource-limited settings, but it is
entirely preventable and treatable. The pathogenesis of cholera revolves around toxin-mediated
fluid loss in the intestine, leading to severe dehydration. Modern treatment strategies, particularly
rehydration therapy, combined with antibiotics, nutritional support, and public health
interventions such as vaccination and improved sanitation, have significantly reduced mortality.
Continued global efforts are essential to eliminate cholera as a public health threat.
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