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The term "pandemic" is likely a concept you're well-acquainted with. The COVID-19 pandemic serves as a recent and vivid illustration of this phenomenon. When a disease is deemed pandemic, it signifies its widespread occurrence, encompassing regions as vast as continents or even spanning the entire globe. The ebb and flow of pandemics typically follow a pattern, beginning with an initial surge in cases due to person-to-person transmission, often lacking an immediate cure. Subsequently, these outbreaks tend to taper off, and in some cases, the disease may even recede over time. While this general trend holds true for many pandemics, the story of cholera offers a notable exception.


![675px-Suspected_Source_of_Cholera-_Waste_Water_-_Nigeria_(16436898133).jpg](https://images.hive.blog/DQmXDPAt5UA4p4BJPyESxT7UjiJyVfX8ZcDazdtJLNLXrjk/675px-Suspected_Source_of_Cholera-_Waste_Water_-_Nigeria_(16436898133).jpg)</div>
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An intestinal disease categorized by severe diarrhea, Cholera is one disease that has been for over 140 years and almost every country in the world has about 5 pandemics. This disease occurs as a result of a person ingesting the bacteria *Vibrio cholerae* which is a gram-negative bacteria. It can be contacted via drinking contaminated water, as well as eating contaminated food, especially seafood.

Cholera colonizes in the small intestine and is released to the environment via feces into land, sewages, and water which could then reach food. In places of high population density, poor drainage systems, and sanitation, the sewage can find its way to water bodies, thereby contaminating the water bodies where people would get water from thereby spreading the bacteria.


![Patients_lie_in_bed_at_a_cholera_treatmen_centre_in_the_Budiriro_District,_that_was_badly_affected_by_cholera,_in_Harare,_Zimbabwe_on_the_21st_April,_2009._Photo-_Kate_Holt_-_AusAID_(10712704546).jpg](https://images.hive.blog/DQmd2TDXWVWrmDxaxZTrEiswzvbEvYLnEsU2fmBeyVWLW6y/Patients_lie_in_bed_at_a_cholera_treatmen_centre_in_the_Budiriro_District,_that_was_badly_affected_by_cholera,_in_Harare,_Zimbabwe_on_the_21st_April,_2009._Photo-_Kate_Holt_-_AusAID_(10712704546).jpg)
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While most bacteria consumed are destroyed by HCL in the stomach, Vibrio cholera is able to scale through because they propagate in large numbers and create biofilms which they use to protect themselves. These biofilms protect the bacteria from heat, protein, acid, and bases, and with this, the acidic condition of the stomach does not destroy the bacteria even in extreme cases where the biofilms are destroyed.

Another mechanism by which the bacteria survive the harsh environment of the stomach by increasing the pH of the stomach thereby making it less acidic using lysine decarboxylase to convert Lysine amino acid to cadaverine which in turn reduces the stomach acidity which allows them to pass through the stomach unharmed.


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Upon reaching the small intestine, Vibrio cholerae adheres to the intestinal wall and initiates rapid multiplication. Simultaneously, it releases cholera toxin, which attaches to the intestinal surface, triggering the engulfment of bacterial cells by host cells. This event catalyzes the activation of G-proteins, which in turn prompts the production of protein kinase enzymes. These enzymes signal the intestinal cells to release sodium and chloride ions into the intestine, resulting in an osmotic imbalance that draws an excessive amount of water into the intestine. The culmination of these processes manifests as purgative diarrhea, causing the afflicted individual to expel water-studded stool in quantities surpassing normal daily intake.

The host start to release water in stool far more than the required amount to be taken into the body in a day. In the early 90s, treatments were not available for diarrhea, but science have done a good job to identify that replacement of fluid, nutrients and antibiotics is enough to tackle the bacteria and give nutrient back to the patient. Curretly, cholera is an endemic in certain regions including Africa, Yemen, and western Asia and this is as a result of poor sanition but also studies are continuously ongoing, and vaccines have been created to fight this bacteria.


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#### <center><sup>Reference</sup></center>
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<sup><sup>https://www.who.int/news-room/fact-sheets/detail/cholera
https://www.who.int/health-topics/cholera#tab=tab_1
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3761070/
https://www.ncbi.nlm.nih.gov/books/NBK26912
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3310593</sup>