As Nigeria continues to battle with a recent statewide surge in cholera infections, public health and internal medicine experts have warned that poorly treated cholera may lead to kidney failure, stroke and possible death.
They warned against the late presentation of cholera patients to the hospital, stating that it significantly increases the fatality rate and preventable complications.
The experts, in separate interviews with PUNCH Healthwise, urged relatives of individuals infected with cholera to seek immediate medical care in a hospital, warning that the condition can lead to death if properly managed.
Recently, the Lagos State Government attributed the number of recorded cholera deaths in the state to late hospital presentation.
Since, the outbreak of the disease earlier in the month, the death toll in the state has risen to 29, with 30 patients still undergoing treatment.
As of Monday, the Director General of the Nigeria Centre for Disease Control and Prevention, Dr Jide Idris, said that 1,528 suspected cases and 53 deaths have been recorded across 31 states and 107 Local Government Areas since the beginning of the year.
Cholera, although preventable, is an acute diarrhoeal infection caused by ingesting food or water contaminated with the bacterium Vibrio cholerae.
Cholera causes severe diarrhoea and leads to different levels of dehydration, leading to death if untreated.
The common indications are vomiting and stooling, while other symptoms include nausea, low blood pressure, rapid weight loss and muscle cramps.
PUNCH Healthwise had earlier reported several hygiene practices and preventive measures Nigerians, especially those living in the affected areas, should engage in.
The NCDC DG had also stated that dehydration was majorly responsible for the death of patients diagnosed with acute diarrhoeal infections.
According to the Mayo Clinic, dehydration is when the body loses more fluid than it is taken in, which results in inadequate fluids for normal activities.
Speaking on the implication of not managing the disease well, a professor of Community Medicine and Public Health at the College of Health Sciences, University of Port Harcourt, Rivers State, Best Ordinioha, said that poorly treated cholera could lead to an increased burden of kidney failures in the country.
He said, “If the person has gone into severe dehydration and has lost a lot of fluids, that residual capacity the body has will be lost such that the person can easily be tipped into organ failure.”
The don explained that cholera infection results in severe loss of body fluids, leading to a shutdown of body organs.
He added that persons with severe dehydration experience reduced blood flow, which can affect major organs in the body and lead to organ failure.
“Cholera usually results in a severe loss of body fluids and that severe loss of body fluids is almost like when you open a tap at full blast. So as the fluid is going out, the body system is shutting down. The body is supposed to operate with a certain amount of fluid volume. So when it gets to a certain point, then it will begin to affect some internal body organs like the kidneys. The kidneys can fail and so the person has renal failure.
“Since the patient will have lost a lot of fluids, the blood will become thick and begin to congeal. If it affects important parts of the body, like the brain, that can result in stroke. If it affects the arteries that supply blood to the heart, it can result in heart attack and that is dangerous,” he said.
The Consultant Community Physician warned that constant stooling should not be seen as usual diarrhoea that will stop after some time, as severe fluid loss could lead to death within hours.
He further noted that late hospital presentation makes it more difficult for the doctors to locate the veins needed to administer intravenous fluids.
“The only fortunate thing is if they go to a hospital where they have more experienced doctors that can do what is called cut down. That is, you cut into the body to locate a major vein that you can put the drip,” Ordinioha added.
The community medicine and public health expert further mentioned that the massive loss of body fluid causes a gradual shutdown of the body system, leading to the death of several cells.
“Usually, the body has excess capacity of different cells of the body. But with things like cholera affecting different parts of the body, it means that a lot of the cells would have died.
“If it affects the brain, it means that even if the patient survives, the mental capacity will be a little bit reduced. The person will not be as sharp or brilliant as before.
“Of course, the kidneys will be affected, which means that a lot of the kidney cells would have died and with a little thing, the person can go into renal failure.
“If the heart is also affected, it means that the cardiac capacity will also be affected. So it’s very dangerous. It’s almost like having a stroke all over the body because, with increased loss, the blood gets thicker and unable to flow through the blood vessels. If blood doesn’t flow, there won’t be any blood supply again to that area and that part of the body will now die,” the don said.
Also speaking with PUNCH Healthwise on the issue, an Internal Medicine Specialist, Dr Olusina Ajidahun, said that loss of body fluids, which are rich in electrolytes essential for body function, leads to dehydration.
He noted that late hospital presentation could lead to a drop in blood pressure, with patients experiencing hypovolemic shock, which is one of the leading causes of death in cholera patients.
“Also, electrolyte imbalance will happen because they are losing a lot of fluid, especially things like potassium and some other things that are found in the intestinal fluid, and since they are having diarrhoea and vomiting, they tend to lose a lot of that.
“If this continues, they can have what is called multi-organ dysfunction. A key organ in the body is the kidney and when the fluid loss is so much and the kidneys are not getting enough fluid, they have what is called acute kidney injury, which if not addressed can be deleterious to the kidney’s health and they might not recover from it,” Ajidahun warned.
The doctor further clarified that it is the loss of fluids and resulting complications, rather than the bacteria itself, that cause acute kidney injury and subsequent kidney failure.
He, however, noted that acute kidney injury is reversible if it is noticed and treated on time.
Furthermore, the internal medicine expert warned that delayed or no hospital presentation could increase the prevalence of kidney damage in the country.
He further said that untreated cholera could lead to increased morbidity and mortality rates, potential spread of the disease, and more incidences of organ damage.
“One of the things that are going to happen in the health sector as a whole is that it is going to affect our health indices because usually when there is an outbreak and it is not well controlled, it tells on the morbidity and mortality indices.
“Also, if this is not addressed on time, we are going to have more people turning to quacks. Due to the high inflation rate and the attitude of some Nigerians in going to the hospital, we may have more people turning to herbal concoctions, and this will further increase the risk of dangerous outcomes,” Ajidahun said.
He stressed that if cholera is well managed, fatalities could be avoided, while inadequate care and late hospital presentation will reduce the chances of survival.
The expert urged Nigerians to follow proper preventive measures and guidelines to reduce the spread of the infection.