Cholera

Abstract

Cholera is specifically a human intestinal infection. It spreads by oral route as it is highly contagious—contamination and through fecal route by drinking water or contaminated food. It is caused by a Gram-negative bacterium that belongs to the 0:1 or 0:139 Vibrio cholerae serotypesand the pathogen bears an endotoxin responsible for acute digestive manifestations with abundant vomiting and diarrhea. Water loss is massive and leads to acute dehydration. If left untreated, cholera proves to be fatal in 25–30 % of cases. Treatment consisting of adequate rehydration and antibiotic therapy reduces the mortality to less than 1 %. Cholera came into picture five centuries ago and it spread out to the whole world during the seven pandemics. The seventh pandemic originated in 1961 and is still ongoing. It reached intertropical Africa in 1971, and it has since developed into epidemic proportion ravaging Africa. Large African cities represent a degraded environment favored by poor sanitation facilities, especially regarding water supply and treatment. The lipopolysaccharidic endotoxin is susceptible to provoke sleep–wake alterations through the release of proinflammatory cytokines, such as tumor necrosis factor-α (TNF-α), interferon-β (IFN-β), or interleukin-1 (IL-1). Furthermore, the massive dehydration may itself have an impact on sleep. However, due to the cataclysmic occurrence of the disease and its contagious potential, sleep studies have not been conducted in patients with cholera. We attempted to analyze the sleep–wake cycle in 36 cholera patients using a sleep diary. All patients with confirmed cholera showed a complete dysregulation of the circadian alternation of sleep and wake during the acute course of the disease.