CHOLERA AND ITS HOMOEOPATHIC

THERAPEUTICS
 Introduction
• Cholera is an acute diarrheal
infection caused by the
bacterium Vibrio cholerae,
characterized by severe, watery
diarrhea, vomiting, and
dehydration. If left untreated, it
can lead to death due to
dehydration and electrolyte
imbalances.
 Vibrio cholerae
Bacterium: Vibrio cholerae is a Gram-negative, comma-
shaped bacterium with a single flagellum.

Structure: The bacterium is facultatively anaerobic and

has a characteristic flagellated shape, which enables it to
move in the intestinal lumen.

Toxin: The bacterium produces cholera toxin (CT), which

is responsible for the hallmark symptoms of cholera.

O-antigen: Vibrio cholerae is classified into serogroups

based on the structure of its O-antigen; the two main
pathogenic serogroups are O1 and O139.
 Incidence
Global Prevalence: Cholera remains an important public
health concern, particularly in developing countries with
inadequate water, sanitation, and hygiene systems.

Endemic Regions: Cholera is endemic in parts of Africa,

Southeast Asia, and the Indian subcontinent.

Epidemics: Cholera outbreaks are often linked to

contaminated drinking water or food, particularly in
areas of rapid urbanization or during disasters like
floods.
 Risk Factors
• Poor Sanitation: Lack of clean drinking water, poor sewage disposal, and unhygienic food handling.

• Crowded Environments: Refugee camps, slums, or conflict zones where sanitation and water
supply are inadequate.

• Malnutrition: Malnourished individuals, especially children, are at higher risk.

• Immunocompromised Individuals : People with

weakened immune systems, such as those with
HIV/AIDS, are more susceptible.

• Travel History: Travelers to endemic regions,

especially without taking preventive measures like
hygiene maintainence or water purification, are at
higher risk.
 Etiology
• Bacterial Cause: Cholera is caused by infection
with Vibrio cholerae, usually ingested through
contaminated water or food.
 Pathophysiology
Ingestion of Contaminated water/food
↓
Survival in Stomach (Bacteria resist acidic environment)
↓
Colonization of Small Intestine
↓
Production of Cholera Toxin (A-B toxin binds to epithelial cells)
↓
Activation of Adenylate Cyclase (Increase in cyclic AMP levels)
↓
Excess Fluid and Electrolyte Secretion
↓
Watery Diarrhea (Rice-Water Stools) and Vomiting
↓
Dehydration and Electrolyte Imbalance (Loss of potassium, sodium)
↓
Hypovolemic Shock and Organ Failure (In severe cases)
 Clinical Features
• Incubation Period: 2–3 days post-exposure (sometimes as little as a few hours).

• Watery Diarrhea: Profuse, watery stools (resembling rice-water) are a key feature.

• Vomiting: Often present alongside diarrhea.

• Dehydration: Rapid fluid loss leading to :-

Thirst
Dry mouth
Sunken eyes
Decreased urine output
Weak pulse
Hypotension (low blood pressure)
Tachycardia (increased heart rate)

• Muscle Cramps: Due to electrolyte imbalance (primarily sodium and potassium).

• Shock: Severe dehydration can lead to hypovolemic shock, organ failure, and death.
 Investigations

Rapid Diagnostic Tests (RDTs): Antigen-based tests to detect Vibrio

cholerae in stool.

Stool Culture and Microscopy: To confirm the presence of Vibrio

cholerae.

Serum Electrolytes: To assess dehydration and imbalances (e.g.,

hyponatremia, hypokalemia).

Complete Blood Count (CBC): May show elevated white blood cells
due to the systemic response to infection.
 Differential Diagnosis

Acute Gastroenteritis: Caused by other bacterial (e.g., Salmonella,

Shigella), viral (e.g., Norovirus), or parasitic infections.

Giardiasis: Can cause similar gastrointestinal symptoms but typically

with a more prolonged course.

Inflammatory Bowel Disease (IBD): Although it may present with

diarrhea, it is usually chronic and associated with other systemic
signs.

Food Poisoning: Often from Staphylococcus aureus or Clostridium

perfringens; symptoms may overlap with cholera.
 Treatment
Rehydration:

Oral rehydration solution (ORS) is the first line of treatment.

In severe cases, intravenous fluids (Ringer’s lactate or normal saline) are necessary.

Antibiotics:

Doxycycline or Azithromycin can reduce the duration of symptoms and bacterial

shedding.

Ciprofloxacin may also be used, although resistance has been noted in some regions.

Zinc Supplementation: Especially in children, zinc has been shown to reduce the severity
and duration of diarrhea.
 General and Conservative
Management
Fluid Management: Ensure adequate hydration to prevent
dehydration and shock. Use ORS for mild cases, IV fluids for severe
cases.

Nutritional Support: Continue feeding and offer easily digestible

foods, as early refeeding can help recovery.

Antibiotic Stewardship: While antibiotics are effective, they are not

always necessary for mild cases; they should be reserved for severe
cases.

Monitoring : Closely monitor fluid balance, electrolytes, and vital

signs.
 Homoeopathic Therapeutics
Arsenicum album :
1. Profuse diarrhea: Watery, greenish, foul-smelling.
2. Vomiting: Violent, often projectile, with undigested food.
3. Thirst for small sips of cold water: The patient craves cold water but drinks in small amounts due to nausea.
4. Restlessness and anxiety: The person is anxious, fearful, and may fear death.
5. Extreme weakness, exhaustion & prostration

Key Note: Arsenicum album is one of the most frequently used remedies in cholera, particularly when there is
restlessness, anxiety, and intense thirst with exhaustion.

Veratrum album :
1. Profuse diarrhea and vomiting: The diarrhea is watery and often greenish, and the vomiting may be projectile.
The vomiting and diarrhea are simultaneous, often with an urgent need to pass stool.
2. Extreme coldness: The patient feels extremely cold even in warm environments and may have cold extremities
(hands, feet)
3. Cramps and spasms: Cramps in the abdomen and legs.
4. Intense weakness: The person is often delirious, confused, and exhausted.
5. Profuse perspiration: The patient sweats profusely, especially on the forehead.
6. Mental confusion present.

Key Note: Veratrum album is indicated for patients who feel cold, have profuse watery diarrhea and vomiting, and
are suffering from spasms and cramps with extreme weakness.
Cuprum metallicum :
1. Violent vomiting and diarrhea: Diarrhea is watery and may be accompanied by greenish stool. The patient may also
experience nausea with vomiting.
2. Cramps and spasms: There are violent abdominal cramps, muscular spasms, and violent leg cramps.
3. Cold sweat: especially on the face and extremities.
4. Extreme weakness.
5. Restlessness: There is an associated restlessness and anxiety.

Key Note: Cuprum metallicum is well-indicated for violent cramps, spasms, and profuse vomiting, particularly with cold,
clammy sweat.

Ipecacuanha
1. Nausea and vomiting: The vomiting is constant with nausea.
2. Profuse diarrhea: There is often watery diarrhea accompanying vomiting.
3. Pallor: The patient becomes very pale and weak, showing signs of exhaustion.
4. Tongue: The tongue may be clean and moist despite the vomiting.
5. Restlessness.

Key Note: Ipecacuanha is useful for constant vomiting, especially in the absence of relief, accompanied by profuse
diarrhea.

• Other indiacted remedies are lyco, podophyllum, china, etc.

 Conclusion
Cholera is a life-threatening diarrheal disease
that can be managed effectively through
rehydration, antibiotics, and proper nutrition.
Public health efforts to improve water quality
and sanitation are key to prevention.
Homeopathy may provide symptomatic relief
when used appropriately as a complementary
therapy.
 References
1. Jameson JL, Fauci AS, Kasper DL, Hauser SL, Longo DL, Loscalzo J, editors. Harrison’s
Principles of Internal Medicine. 20th ed. New York: McGraw-Hill Education; 2018.2.
2. Ralston SH, Penman ID, Strachan MWJ, Hobson RP, editors. Davidson’s Principles and
Practice of Medicine. 23rd ed. Edinburgh: Elsevier; 2018.
3. Boericke W. Boericke's Materia Medica. 9th ed. New Delhi: B. Jain Publishers; 2010.
4. Allen T. F. Allen’s Keynotes: Materia Medica. 8th ed. New York: Homoeopathic
Publishing Co.; 1999.
THANK YOU