Research Proposal on Cholera Disease

Vibrio cholera O1, O139

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Cholera is caused by Vibrio cholera. The bacterium is comma shaped, although, under close observation, they may depict a rod-like structure. They are often described as Gram-negative with its natural habitat being salty water or the brackish. There exist various strains of the bacterium with some having pathogenic characteristics while other do not. The most common pathogenic strain is the O1 El Tor N16961, responsible for the infection of cholera disease (Burnett et al., 2016). O139 remain the most active, having been discovered in the early 1992 and has displayed strong resistance to medication and drugs.

Genome Structure

The bacterium is made up of two chromosomes with four million gene pairs. Serogroup O1 has no polysaccharide capsule. The genes can pass on cholera toxin from one gene to another in a horizontal transfer. The whole genome in many instances is sequenced, containing circular chromosomes, two in number (Burnett et al., 2016). Chromosome 1 is made up of approximately 3 million base pairs with about 3,000 ORF, while chromosome 2 has 1 million base pairs with 1,200 ORFs. Of the two, the largest is made up of critical genes with toxic substances and can regulate it. During the logarithmic stage, V. Cholerae has no cellular envelope shape, however, towards the end, characterized by internal swelling; it takes the form of the cell envelope. During anaerobic respiration, V. Cholerae is produced in significant number since the last part of the small intestine has an anaerobic environment with electron acceptors playing an active role during the metabolism process. Gene transfer is often responsible for the recombination of various bacterium genes allowing for different genes.

Ecology

The bacterium thrives best in particular surface water such as water bodies associated with aquatic plants, shellfish, and copepods. In regions with no water purification, the bacterium is very prevalent. The disease or bacterium is transmitted from one person to another through drinking of contaminated water or introduction to the bacterium from the stool of a sick, infected individual. Other prevalent ways through which it is transmitted include poorly cooked grains, shellfish, and contaminated fish.

Pathology

The bacterium makes entry into the human body through untreated and contaminated water or food. Once in the intestine, it attaches itself to the intestinal cells as it releases its toxin. The toxin is comprised of 5 B-subunits, components forming its a-subunits, made from the filamentous phage gene. The filamentous phage gene is also formed of another toxin known as the co-regulated pilus (TCP), acting as the receptive factor for CTX.10 (Cancedda et al., 2016)

Physiological sign and responses that come after the infectivity include stimulus of the mucosal lining that releases the fluids. The action triggers vomiting in addition to diarrhea characterized by rice water. At this moment, death can occur if a patient is left untreated and unattended at 50 to 70 percent of the duration (Cash et al., 2014). Treatment often includes replacement and rehydration of the lost electrolytes, vital ions, for example, potassium and sodium useful in biochemical processes that help the body remain alive. The motility of the vibrios is often brought to a stop by a particular antisemitic antibody, nonselective media, a culture of the feces, and TCBS samples (Nguyen et al., 2014). In specialized clinical laboratories, the polymerase chain reaction (PCR) and the genetically based fast methodologies are applied.

Host Defenses

In many cases, mucus secretion, gastric acid, and the intestines motility serve as the primary defense against the bacterium. Infants are often protected from the bacterium through and by breastfeeding. The ailment primarily characterized by the secretion of immunoglobulin in addition to IgG antibodies ( Lopez 2015). The antibodies fight against vibrios, outer membrane protein, enterotoxin, and somatic antigen. Significant signs and symptoms of the disease include; dehydration, muscle cramps, low blood pressure, rapid heart rate, dry throat, mucous membranes, eyelids, and nose. Lack of treatment at the earliest possible time often leads to death in a short while (Mengel et al., 2014).

Introduction

The incubation period of the bacterium is approximately between six to forty-eight hours and starts with watery diarrhea with the initial feces exceeding 1L in addition to many more liters secreted within a few hours later (Gibson 2015). Often, the original condition leads to hypovolemic shock. Accompanying the diarrhea is persistent vomiting together with muscle cramps as the body loses electrolytes and water from its tissues (George et al., 2016). Weak pulse, scaphoid, and loss of skin turgor are often a clear indicator of the key features of cholera. Depending on the loss of body fluids, the disease runs for a course period of two to seven days. If the electrolytes and water are sufficiently replaced, death may not occur. Often death occurs due to metabolic acidosis, uremia, often a result of acute tubular necrosis, and hypovolemic shock.

Prevention and Control

The prevention and control of the spread of the bacterium involve a multifaceted approach. It includes water sanitation, hygiene, and use of vaccines, social mobilization, and efficient treatment (Christian et al., 2013). Water sanitation involves the use of safe drinking water, use of piped water, and adequate sanitation at the production plant. Regular and household measures may include the use of latrines, sewage disposal, safe storage of water, enhancement of treatment facilities such as chlorination (Burnett et al., 2016). The above measures often require regular and up to date maintenance with proper interventions.

The treatment of the bacterium involves the use of oral rehydration solutions, commonly known as the ORS. The standard sachet is mixed and dissolved in clean water with adults requiring approximately 6 liters during the initial first day of treatment. Severely dehydrated persons who may be at risk of severe loss of body water may need up to seven liters of intravenous fluid in addition to the oral rehydration solution. The patients with the serious condition may also need appropriate antibodies aimed at diminishing diarrhea, shorten the duration of sickness and amount of water loss through feces (Cancedda et al., 2016). The World Health Organization and UNICEF do not recommend mass administration of the solution or antibodies. According to the organizations, the bacterium tends to develop antimicrobial resistance gradually during administration. Often quick access to treatment is the answer to containing the outbreak with ORS made available at the community level. With efficient and proper care, the fatality rate can be maintained below 1 percent.

Cholera in Sierra Leone

In the year 2012, Sierra Leone had its worst cholera outbreak. By 19th September, the country had over 19,000 cholera cases with 390 deaths. The last time Sierra Leone experienced a devastating cholera outbreak was in 1970 (Mengel et al., 2014). The country shares a reservoir with Guinea-Bissau, explaining the outbreak that occurred in 2012 sweeping across the two nations leaving behind many local dead, and a weak, fragile health system. A new outbreak later happened in the year 2013 leaving behind over 360 deaths. According to Mengel (2014), the WHO together with the Health and Sanitation department established a control center that became the response unit as the crisis became a national emergency. Cholera in Sierra Leona is prevalent during the rainy season, and when the outbreak occurred in February 2012, emergency signals were sent (Mengel et al., 2014). The Ministry of Health and Sanitation acknowledged that it was a rare occurrence given the high rate of infection and number of deaths that occurred in three districts that same month. Representatives of the world Health Organization established a task force that was mandated with looking into the outbreak, with the first challenge confirming the outbreak in several districts. During the first instances of the epidemic, medical practitioners realized a high prevalence of vomiting and diarrhea cases with the largest number of people above the age of five. Due to the limited laboratory capacity in the country, the little investigation was possible, and this delayed the response unit in tackling the outbreak in its initial stages (Mengel et al., 2014).

During the initial period of the outbreak, the WHO worked closely with the Health and Sanitation department, collaborating with UNICEF, in addition to the Medecins Sans Frontieres of Belgium (Mengel et al., 2014). Other international organizations that came in to help the situation included the Red Cross, Doctors Without Borders, Save the Children, Care International, The Finnish, the International Center for Diarrhoeal Disease Research, International Rescue Committee, and Concern. The World Vision partnered with the government of Sierra Leone to help prevent the spread of the disease in public places through garbage pills (Mengel et al., 2014). Doctors Without Borders launched emergency units to help treat and control the spread of the disease in slams such as Freetown, Kroo Bay, and Sema slum (Mengel et al., 2014). On the other hand, Care International took the initiative to create awareness in prone and rainy areas, an effort that saw many locals take up preventive water management such as heating and using clean water. The Finnish offered its doctors to help provide medical and clinical services to ravaged areas and densely populated regions in the slums. Other targeted areas by care International and the Finnish included Port Loko, Bombali, Kambia, and Tonkolili. The parts stood out as the most affected with new infections and deaths recorded every day for the period of April 2012 up to August 2012 (Nguyen et al., 2014). The organizations set out to detect, confirm, and seek for a way out for the locals in coming up with the medication. Between April and June, the situation was dire with a large number of infections turning up every day in health facilities. Deaths and casualties increased tremendously as the country declared the disease a national disaster. However, efforts by UNICEF, WHO, and Medecins Frontieres of Belgium together with the Ministry of health and Sanitation brought the situation under control. Fewer new infections and deaths were reported as the health department went back to tackling the secondary signs of the disease. Control efforts and strategies were implemented as the country acknowledged the need for water treatment and improvement of hygiene in public places together with households. Public awareness campaigns helped spread information on ways and means of controlling, preventing, and treating the disease locally (Nguyen et al., 2014).

The Command and Control Center

As the country's president declared the situation a national disaster in August, UNICEFthe WHO and health department established a Cholera Command and Control Center, a replica of the control measures that took place in Zimbabwe. The center coordinated the response and situation as other health partners came along to help control the high number of deaths and infections (Nguyen et al., 2014). The WHO brought in experts to carry out surveillance, training, and data management on the same. Additionally, the international body helped established a laboratory unit for testing and managing the bacterium. Additionally, the world bodies aided in the dissemination of information and critical materials to help curb, control, and inform the public on the spread. The efforts brought back normalcy in the health units and amongst the public as the infection rate reduced to a manageable level. World bodies such as the Global Po...