Abstract
Cholera is an acute diarrheal disease condition caused by toxigenic strains of Vibrio Cholerae and a major public health concern, particularly in such regions with inadequate sanitation and limited access for safe drinking water. Due to that Cholera continues to cause significant morbidity and mortality during outbreaks. Homoeopathy has historically been employed during Cholera epidemics, with classical literature describing individualised remedies based on characteristic symptomatology.
What is Cholera?
It is an acute condition of diarrhea caused by infection of small intestine by bacteria ‘Vibrio Cholerae’.
According to definition given by WHO, “Cholera is an acute diarrheal infection caused by ingestion of food or water contaminated with the bacterium Vibrio Cholerae”.
Epidemiology
Climate such as heavy rainfall, floods, cyclones are major factors driving seasonal Cholera outbreaks.
Chances are high in monsoon (June – September) is the peak season for cholera.
Cholera can affect all age group individual but, children younger than five years bear disproportionately high burden in endemic regions due to increased susceptibility to dehydration and lower level of acquired immunity.
During epidemics in previously unaffected populations, however, all age group may also be equally susceptible.
Etiology
Cholera is an acute enteric infection caused by the Gram-negative, comma-shaped bacterium Vibrio cholerae. More than 200 serogroups have been identified; however, serogroups O1 and O139 are responsible for epidemic and pandemic cholera.
The O1 serogroup is further classified into the Classical and El Tor biotypes, each comprising the Ogawa, Inaba, and rarely Hikojima serotypes. The El Tor biotype is currently responsible for most cholera outbreaks worldwide.
Pathogenesis
After ingestion, Vibrio cholerae survives gastric acidity and colonizes the mucosal surface of the small intestine using its flagellum and toxin-coregulated pili for motility and adherence. The organism does not invade the intestinal mucosa but produces cholera toxin (CT), the principal virulence factor responsible for the clinical manifestations.
Cholera toxin consists of one A subunit and five B subunits (AB₅ toxin). The B subunits bind to GM1 ganglioside receptors on intestinal epithelial cells, facilitating entry of the A subunit. Inside the cell, the A subunit activates adenylate cyclase through persistent stimulation of the Gs protein, resulting in a marked increase in intracellular cyclic adenosine monophosphate (cAMP).
The elevated cAMP concentration stimulates the CFTR chloride channels, leading to excessive secretion of chloride and bicarbonate ions into the intestinal lumen while simultaneously reducing sodium absorption. Water follows these electrolytes osmotically, producing the characteristic profuse “rice-water” diarrhea.
Common Symptoms of Cholera (Diagnosis)
•Profuse watery diarrhea (rice water stool)
•Vomiting
•Intense thirst
•Muscle cramps especially in legs
•Weakness and fatigue
Assessment of Dehydration
WHO classifies dehydration into three classes:
1) No dehydration
2) Some dehydration
3) Severe dehydration
On basis of,
•Level of consciousness
•Sunken eyes
•Thirst
•Skin turgor
•Pulse rate
•Blood pressure
•Urine output
Mode of Transmission
1. Contaminated drinking water
2. Contaminated food
3. Poor sanitation
4. Poor hand hygiene
5. Household transmission
Cholera not spread by air, coughing or sneezing as well as not by casual contact such as shaking hands or hugging.
Spread
In 2024, over 5,60,000 Cholera cases and more than 6000 deaths were reported globally.
According to surveillance data of year 2011 to 2020 the 45759 cases of Cholera reported out of which 263 lead to death and 565 outbreaks.
Precautions to avoid spread
1. Drinking safe water
2. Washing hands regularly
3. Practice good food hygiene
4. Improve sanitation
5. Maintain personal and environmental hygiene
6. Early detection and treatment
Transmission Cycle
Infected person -> feces contains Vibrio Cholerae -> contamination of food/water -> another person consumes contaminated food/water -> Infection …
Due to severe infection the diarrhea caused one to be dehydrated so the Infected person must be stay hydrated by any means to avoid extra complications.
Homoeopathic Medicinal Approach
- Camphora
Sudden collapse, marked coldness, early collapse-like state
- Characteristic features:
- Sudden onset
- Extreme coldness
- Collapse and prostration
- Weak or failing circulation
- Cold surface with serious constitutional disturbance
- Veratrum album
Profuse watery diarrhoea and vomiting, cold sweat, cramps, collapse
- Characteristic features:
- Profuse watery diarrhoea
- Severe vomiting with diarrhoea
- Marked weakness and collapse
- Cold sweat on the forehead
- Painful muscular cramps
- Intense thirst, often for cold water
- Cuprum metallicum
Severe painful muscular cramps with gastroenteric symptoms
- Characteristic features:
- Severe muscular cramps
- Cramps associated with gastroenteric disturbance
- Spasmodic vomiting
- Collapse and exhaustion
- Bluish or cyanotic appearance in severe states
- Arsenicum album
Restlessness, anxiety, prostration, burning sensations, vomiting and diarrhoea
- Characteristic features:
- Restlessness and anxiety
- Marked prostration
- Burning sensations
- Vomiting and diarrhoea
- Frequent thirst for small quantities
- Aggravation during the night
- Podophyllum
Profuse, watery, forceful and offensive diarrhoea
- Characteristic features:
- Profuse watery diarrhoea
- Sudden and forceful evacuation
- Offensive stool
- Marked weakness after stool
- Gastrointestinal symptoms with rapid exhaustion
- Jatropha curcas
Violent vomiting and diarrhoea with coldness and weakness
- Characteristic features:
- Simultaneous vomiting and diarrhoea
- Profuse watery evacuations
- Coldness and weakness
- Marked dehydration-like exhaustion
- Abdominal discomfort and cramps
- Elaterium
Sudden, profuse, watery or explosive diarrhoea
- Characteristic features:
- Sudden profuse watery diarrhoea
- Explosive evacuation
- Abdominal cramps
- Rapid weakness
- Helleborus niger
Stupor, dullness and profound prostration
- Characteristic features:
- Stupor and dullness
- Reduced responsiveness
- Severe weakness
- Collapse-like condition
- Opium
Marked drowsiness, stupor and diminished reaction
- Characteristic features:
- Profound drowsiness
- Stupor
- Reduced reaction to external stimuli
- Suppression or retention of secretions and excretions
- Laurocerasus
Collapse-like weakness, coldness and cyanotic tendencies
- Characteristic features:
- Extreme weakness
- Coldness
- Cyanotic tendency
- Weak circulation
- Collapse-like state
Life flows like a crystal stream,
Guard it well, fulfill the dream.
With clean water, care, hope each day,
We keep the threat of Cholera away.
Through knowledge, compassion and
Science united,
Health prevails, and lives are ignited.
Reference
• Allen’s keynote
• Boericke materia medica
• PubMed
• Kent, Clarke, Hering, Lilienthal for homoeopathic materia medica and therapeutic indications
• Harrison’s principles of internal medicine
• World Health Organization. Cholera fact sheets and technical guidance.
• Centers for Disease Control and Prevention. Cholera clinical guidance.
