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87-541: The Palais Longchamp was created to celebrate the construction of the Canal de Marseille , which was built to bring water from the river Durance to Marseille . Although the foundation stone was laid by the Duke of Orleans on 15 November 1839, the building took 30 years to complete, partly because of the enormous expense and partly because of difficulties with local regulations. Designed by the architect Henri-Jacques Espérandieu ,

174-436: A temperate bacteriophage called CTXφ . Microbiologists have studied the genetic mechanisms by which the V. cholerae bacteria turn off the production of some proteins and turn on the production of other proteins as they respond to the series of chemical environments they encounter, passing through the stomach, through the mucous layer of the small intestine, and on to the intestinal wall. Of particular interest have been

261-451: A 150-year-old plane tree and an oak and a Siberian elm that are both 120 years old. The area that was occupied by the 19th-century zoo still contains many of its picturesque buildings in fantastic styles, including oriental pavilions for the giraffe and elephant , cages ornamented with Turkish tiles, and bear cages and seal dens decorated with rocaille , or rock-work. The music video of Soprano 's single, "Ils Nous Connaissent Pas"

348-454: A century earlier, which had caused around 100,000 deaths. In July 1833, a gathering of 30,000 residents in the city centre protested the poor sanitary conditions. Maximin-Dominica Consolat, the city's mayor from 1832 to 1843, decided in 1834 to improve conditions "no matter what it costs." The decision was made to bring in water from the nearest large river, the Durance . However, the river

435-428: A day. Severe cholera, without treatment, kills about half of affected individuals. If the severe diarrhea is not treated, it can result in life-threatening dehydration and electrolyte imbalances. Estimates of the ratio of asymptomatic to symptomatic infections have ranged from 3 to 100. Cholera has been nicknamed the "blue death" because a person's skin may turn bluish-gray from extreme loss of fluids. Fever

522-428: A greatly reduced pathogen count—though it will not necessarily be perfectly safe, it is an improvement for poor people with limited options. In Bangladesh this practice was found to decrease rates of cholera by nearly half. It involves folding a sari four to eight times. Between uses the cloth should be rinsed in clean water and dried in the sun to kill any bacteria on it. A nylon cloth appears to work as well but

609-534: A massive inoculation program in British India . Persons who survive an episode of cholera have long-lasting immunity for at least 3 years (the period tested.) A number of safe and effective oral vaccines for cholera are available. The World Health Organization (WHO) has three prequalified oral cholera vaccines (OCVs): Dukoral, Sanchol, and Euvichol. Dukoral , an orally administered, inactivated whole-cell vaccine , has an overall efficacy of about 52% during

696-541: A non-toxic B-subunit of cholera toxin and providing protection against V. cholerae O1; and two vaccines developed using the same transfer of technology—ShanChol (Shantha Biotec) and Euvichol (EuBiologics Co.), which have bivalent O1 and O139 oral killed cholera vaccines. Oral cholera vaccination could be deployed in a diverse range of situations from cholera-endemic areas and locations of humanitarian crises, but no clear consensus exists. Developed for use in Bangladesh ,

783-408: A one-million fold increase in numbers of V. cholerae in the environment. The source of the contamination is typically other people with cholera when their untreated diarrheal discharge is allowed to get into waterways, groundwater or drinking water supplies. Drinking any contaminated water and eating any foods washed in the water, as well as shellfish living in the affected waterway , can cause

870-430: A person to contract an infection. Cholera is rarely spread directly from person to person . V. cholerae also exists outside the human body in natural water sources, either by itself or through interacting with phytoplankton , zooplankton , or biotic and abiotic detritus. Drinking such water can also result in the disease, even without prior contamination through fecal matter. Selective pressures exist however in

957-530: A result of transmission by food, while in developing countries it is more often water. Food transmission can occur when people harvest seafood such as oysters in waters infected with sewage , as Vibrio cholerae accumulates in planktonic crustaceans and the oysters eat the zooplankton . People infected with cholera often have diarrhea, and disease transmission may occur if this highly liquid stool, colloquially referred to as "rice-water", contaminates water used by others. A single diarrheal event can cause

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1044-566: A second, 5.5 km tunnel which heads southeast and emerges at La Sevine in the 15th arrondissement of Marseille. From here the canal heads south and begins to splinter into many smaller canals which feed the city. One branch of the canal works its way completely around the eastern side of Marseille, turning south then west and finally ending at the Mediterranean at Mont Rose in Montredon in the 8th arrondissement of Marseille. The canal

1131-555: A secondary basin, and then into an artificial pond. The water drains out of the pond into underground pipes, from which it emerges in a waterfall-like structure, and in twelve ornate bronze fountains lined alongside it, flowing into a second, larger pond. The central feature of the garden behind the palace is a classic garden à la française , which is known as the Jardin du plateau . The garden also includes an English landscape garden , with winding alleys and many notable trees, including

1218-421: A severe case if they become infected. Any individual, even a healthy adult in middle age, can undergo a severe case, and each person's case should be measured by the loss of fluids, preferably in consultation with a professional health care provider . The cystic fibrosis genetic mutation known as delta-F508 in humans has been said to maintain a selective heterozygous advantage : heterozygous carriers of

1305-442: A year (uncertainty range: 21,000–143,000) as of 2015 . This occurs mainly in the developing world. In the early 1980s, death rates are believed to have still been higher than three million a year. It is difficult to calculate exact numbers of cases, as many go unreported due to concerns that an outbreak may have a negative impact on the tourism of a country. As of 2004, cholera remained both epidemic and endemic in many areas of

1392-555: A year. To date, seven cholera pandemics have occurred, with the most recent beginning in 1961, and continuing today. The illness is rare in high-income countries , and affects children most severely. Cholera occurs as both outbreaks and chronically in certain areas . Areas with an ongoing risk of disease include Africa and Southeast Asia . The risk of death among those affected is usually less than 5%, given improved treatment, but may be as high as 50% without such access to treatment. Descriptions of cholera are found as early as

1479-530: A young mother and her baby were found dead in their apartment. The culprit was chlorine gas from the water supply that led to a citywide survey of the gasses in the system, but not before others were admitted to hospitals from all over the city. The canal was operated by the City of Marseille from 1849 to 1941. However, the destructive fire of the store "Nouvelles Galeries" in November 1938 in which 73 people died,

1566-596: Is endemic . If people are immunized broadly, herd immunity results, with a decrease in the amount of contamination in the environment. WHO recommends that oral cholera vaccination be considered in areas where the disease is endemic (with seasonal peaks), as part of the response to outbreaks, or in a humanitarian crisis during which the risk of cholera is high. Oral Cholera Vaccine (OCV) has been recognized as an adjunct tool for prevention and control of cholera. The World Health Organization (WHO) has prequalified three bivalent cholera vaccines—Dukoral (SBL Vaccines), containing

1653-547: Is oral rehydration salts (ORS), the replacement of fluids and electrolytes by using slightly sweet and salty solutions. Rice-based solutions are preferred. In children, zinc supplementation has also been found to improve outcomes. In severe cases, intravenous fluids , such as Ringer's lactate , may be required, and antibiotics may be beneficial. The choice of antibiotic is aided by antibiotic sensitivity testing . Cholera continues to affect an estimated 3–5 million people worldwide and causes 28,800–130,000 deaths

1740-422: Is a common problem. Stool and swab samples collected in the acute stage of the disease, before antibiotics have been administered, are the most useful specimens for laboratory diagnosis. If an epidemic of cholera is suspected, the most common causative agent is V. cholerae O1. If V. cholerae serogroup O1 is not isolated, the laboratory should test for V. cholerae O139. However, if neither of these organisms

1827-503: Is a common source. Humans are the only known host for the bacteria . Risk factors for the disease include poor sanitation , insufficient clean drinking water , and poverty . Cholera can be diagnosed by a stool test , or a rapid dipstick test , although the dipstick test is less accurate. Prevention methods against cholera include improved sanitation and access to clean water . Cholera vaccines that are given by mouth provide reasonable protection for about six months, and confer

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1914-442: Is available to determine the presence of V. cholerae . In those samples that test positive, further testing should be done to determine antibiotic resistance. In epidemic situations, a clinical diagnosis may be made by taking a patient history and doing a brief examination. Treatment via hydration and over-the-counter hydration solutions can be started without or before confirmation by laboratory analysis, especially where cholera

2001-513: Is crossed only by the irregular Huveaune River and its tributary, the Jarret River. The waters were canalised in the 14th century but gradually became an open sewer . Water quality continued to decline, and distribution suffered because of the lack of maintenance of the network. Since the river has only a small flow, droughts were devastating to the region. In 1834, the river nearly dried up completely, and only 1 litre (1 US qt)

2088-446: Is effective for adults aged 18–64 as a single dose. One injectable vaccine was found to be effective for two to three years. The protective efficacy was 28% lower in children less than five years old. However, as of 2010 , it has limited availability. Work is under way to investigate the role of mass vaccination. The WHO recommends immunization of high-risk groups, such as children and people with HIV , in countries where this disease

2175-416: Is increasing within cholera bacteria. In Bangladesh , for example, most cases are resistant to tetracycline , trimethoprim-sulfamethoxazole , and erythromycin . Rapid diagnostic assay methods are available for the identification of multi-drug resistant cases. New generation antimicrobials have been discovered which are effective against cholera bacteria in in vitro studies. A rapid dipstick test

2262-487: Is isolated, it is necessary to send stool specimens to a reference laboratory. Infection with V. cholerae O139 should be reported and handled in the same manner as that caused by V. cholerae O1. The associated diarrheal illness should be referred to as cholera and must be reported in the United States. The World Health Organization (WHO) recommends focusing on prevention, preparedness, and response to combat

2349-460: Is less in those with lowered gastric acidity (for instance those using proton pump inhibitors ). Children are also more susceptible, with two- to four-year-olds having the highest rates of infection. Individuals' susceptibility to cholera is also affected by their blood type , with those with type O blood being the most susceptible. Persons with lowered immunity , such as persons with AIDS or malnourished children, are more likely to develop

2436-754: Is maintained. The WHO only recommends antibiotics in those with severe dehydration. Doxycycline is typically used first line, although some strains of V. cholerae have shown resistance . Testing for resistance during an outbreak can help determine appropriate future choices. Other antibiotics proven to be effective include cotrimoxazole , erythromycin , tetracycline , chloramphenicol , and furazolidone . Fluoroquinolones , such as ciprofloxacin , also may be used, but resistance has been reported. Antibiotics improve outcomes in those who are both severely and not severely dehydrated. Azithromycin and tetracycline may work better than doxycycline or ciprofloxacin . In Bangladesh zinc supplementation reduced

2523-604: Is mostly concrete , but some portions are made of stone or brick . The canal's flow is 10 cubic metres (10 kL) per second, and the slope is 0.36 metres (1.2 ft) per 1 kilometre (0.62 mi). The width at the top is 9.4 metres (31 ft), and the width at the basin is 3 metres (10 ft). Water began flowing through the partly-finished canal on November 19, 1849 in Marseille. Between 1854 and 1869, 77 kilometres (48 mi) of pipes, tanks and basins were constructed, allowing access to water throughout Marseille and

2610-553: Is no longer the sole water source for Marseille. The Canal de Provence , almost completely underground, is a network of canals from the Verdon River built in the 1970s that now brings water to not only Marseille but also Aix-en-Provence and Toulon . Today, that water is approximately two thirds of the water brought into Marseille, the remaining third comes from the Verdon through Provence. Both sources are connected. The water

2697-469: Is not as affordable. Continued eating speeds the recovery of normal intestinal function. The WHO recommends this generally for cases of diarrhea no matter what the underlying cause. A CDC training manual specifically for cholera states: "Continue to breastfeed your baby if the baby has watery diarrhea, even when traveling to get treatment. Adults and older children should continue to eat frequently." The most common error in caring for patients with cholera

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2784-442: Is rapid and thready, and urine output decreases with time. Muscle cramping and weakness, altered consciousness, seizures , or even coma due to electrolyte imbalances are common, especially in children. Cholera bacteria have been found in shellfish and plankton . Transmission is usually through the fecal-oral route of contaminated food or water caused by poor sanitation . Most cholera cases in developed countries are

2871-412: Is rare and should raise suspicion for secondary infection. Patients can be lethargic and might have sunken eyes, dry mouth, cold clammy skin, or wrinkled hands and feet. Kussmaul breathing , a deep and labored breathing pattern, can occur because of acidosis from stool bicarbonate losses and lactic acidosis associated with poor perfusion . Blood pressure drops due to dehydration, peripheral pulse

2958-406: Is rare. For example, the last major outbreak of cholera in the United States occurred in 1910–1911. Cholera is mainly a risk in developing countries in those areas where access to WASH (water, sanitation and hygiene) infrastructure is still inadequate. Effective sanitation practices, if instituted and adhered to in time, are usually sufficient to stop an epidemic. There are several points along

3045-586: Is the preferred solution, often with added potassium. Large volumes and continued replacement until diarrhea has subsided may be needed. Ten percent of a person's body weight in fluid may need to be given in the first two to four hours. This method was first tried on a mass scale during the Bangladesh Liberation War , and was found to have much success. Despite widespread beliefs, fruit juices and commercial fizzy drinks like cola are not ideal for rehydration of people with serious infections of

3132-404: Is to underestimate the speed and volume of fluids required. In most cases, cholera can be successfully treated with oral rehydration therapy (ORT), which is highly effective, safe, and simple to administer. Rice-based solutions are preferred to glucose-based ones due to greater efficiency. In severe cases with significant dehydration, intravenous rehydration may be necessary. Ringer's lactate

3219-448: Is treated in two water treatment facilities, Sainte-Marthe and Saint-Barnabé. The main operations performed by the treatment facilities are pre- chlorination , clarification by flocculation with a coagulant, sand filtration and disinfection with ozone and chlorine . In 2006, the health authority of Marseille carried out a number of tests on the water quality, determining that the canal's water conformed to all required norms. In 2009,

3306-585: The Caspian and Volga in 1829. In 1830, the disease overtook Moscow and Poland and, in 1833, Hamburg . In March 1832, cholera reached Paris , and 18,000 died, and the eipedemic killed many people in Haute-Provence . In July 1833, the epidemic reached Marseille. By December 1834, the death toll was 865, and by 1835, it was 2,500. Fears were revived of the Great Plague of Marseille , just over

3393-681: The Durance was at the Pertuis Bridge in the Vaucluse at an elevation of 185 metres (607 ft) and 50 kilometres (31 mi) from Marseille. From there, the canal travelled west to Lew Puy-Sainte-Réparade and then northwest to Saint-Estève-Janson . This portion of the canal, now known as the Ancien Canal de Marseille , was abandoned when the Canal EDF de la Durance went into service in 1966. Since that time, water initially enters

3480-449: The Gs alpha subunit of the heterotrimeric G protein . This results in constitutive cAMP production, which in turn leads to the secretion of water, sodium, potassium, and bicarbonate into the lumen of the small intestine and rapid dehydration. The gene encoding the cholera toxin was introduced into V. cholerae by horizontal gene transfer . Virulent strains of V. cholerae carry a variant of

3567-406: The human stomach . The few surviving bacteria conserve their energy and stored nutrients during the passage through the stomach by shutting down protein production. When the surviving bacteria exit the stomach and reach the small intestine , they must propel themselves through the thick mucus that lines the small intestine to reach the intestinal walls where they can attach and thrive. Once

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3654-479: The potassium level may be normal, even though large losses have occurred. As the dehydration is corrected, potassium levels may decrease rapidly, and thus need to be replaced. This is best done by Oral Rehydration Solution (ORS). Antibiotic treatments for one to three days shorten the course of the disease and reduce the severity of the symptoms. Use of antibiotics also reduces fluid requirements. People will recover without them, however, if sufficient hydration

3741-455: The small intestine by some strains of the bacterium Vibrio cholerae . Symptoms may range from none, to mild, to severe. The classic symptom is large amounts of watery diarrhea lasting a few days. Vomiting and muscle cramps may also occur. Diarrhea can be so severe that it leads within hours to severe dehydration and electrolyte imbalance . This may result in sunken eyes , cold skin, decreased skin elasticity, and wrinkling of

3828-411: The "sari filter" is a simple and cost-effective appropriate technology method for reducing the contamination of drinking water. Used sari cloth is preferable but other types of used cloth can be used with some effect, though the effectiveness will vary significantly. Used cloth is more effective than new cloth, as the repeated washing reduces the space between the fibers. Water collected in this way has

3915-512: The 5th century BC in Sanskrit . In Europe, cholera was a term initially used to describe any kind of gastroenteritis, and was not used for this disease until the early 19th century. The study of cholera in England by John Snow between 1849 and 1854 led to significant advances in the field of epidemiology because of his insights about transmission via contaminated water, and a map of the same

4002-566: The added benefit of protecting against another type of diarrhea caused by E. coli . In 2017, the US Food and Drug Administration (FDA) approved a single-dose, live, oral cholera vaccine called Vaxchora for adults aged 18–64 who are travelling to an area of active cholera transmission. It offers limited protection to young children. People who survive an episode of cholera have long-lasting immunity for at least three years (the period tested). The primary treatment for affected individuals

4089-474: The aquatic environment that may reduce the virulence of V. cholerae . Specifically, animal models indicate that the transcriptional profile of the pathogen changes as it prepares to enter an aquatic environment. This transcriptional change results in a loss of ability of V. cholerae to be cultured on standard media, a phenotype referred to as ' viable but non-culturable ' (VBNC) or more conservatively ' active but non-culturable ' (ABNC). One study indicates that

4176-413: The area. The canal's offshoot irrigation ditches are controlled by the aygadiers , who have the right to cross private property ito assist in the repair and operation of the canal. The focus of SEEM and the aygadiers has recently been on centring the use of the canal on drinking water. Therefore, irrigation rights are not being renewed, and the city is providing pressurised water instead. Furthermore,

4263-490: The building was centered on the structure and elaborate fountain known as the château d'eau ("water tower"). The Palais Longchamp has three main parts: Longchamp Park was opened in 1869, at the same time as the palace; in addition, the art and natural-history collections, which had been housed elsewhere, moved into the palace at this time. The park also contained a zoo, which was run by the city from 1898 until 1987, when, because of public disaffection with traditional zoos, it

4350-574: The canal at the hydroelectric station just northwest of Saint-Estève-Janson. The canal then continues northwest to the southern end of the Cadenet bridge, where it feeds the Retenue d'eau de Saint-Christophe . The route then clings to the hills, passes above La Roque-d'Anthéron and Charleval , turns to the south and exits the Durance valley and EDF via a 3.7 km tunnel under the west end of

4437-404: The canal authority employs 15 chercheurs de fuite ( French : literally "searchers of leaks"), who are responsible for finding leaks in the distribution system. To help them, they use geophones , which amplify sound up to 400 times. Employees have allowed the efficiency of the canal to be raised to 85%. The canal outside Marseille is open to the air and can be followed along the road except for

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4524-406: The canal in his memoirs, Le Château de ma mère , and states that his father gave a key to enable him to enter the canal through private property and thus shorten his journey. However, the truth of that claim is doubted. 43°40′N 5°30′E  /  43.667°N 5.500°E  / 43.667; 5.500 Cholera Cholera ( / ˈ k ɒ l ər ə / ) is an infection of

4611-520: The canal took 15 years, from 1839 to 1854, and covered 80 kilometres (50 mi), of which 17 kilometres (11 mi) is underground. The canal also crosses 18 bridges. A major challenge was passing the canal over the valley of the Arc, which has an altitude of less than 100 metres (328 ft) between Aix-en-Provence and the Etang de Berre . The project's chief engineer, Franz Mayor de Montricher , rejected

4698-424: The canal's operation. Upon entering the treatment facility at Sainte-Marthe in the 14th arrondissement, the canal water is filtered at the bassin du Merlan before it exits the structure to enter the distribution network of Marseille. However, the canal is for more than sanitary purposes. Historically, the structure assisted in irrigating fields for farmers and gardeners and greatly boosted the growth of gardening in

4785-422: The cholera bacteria reach the intestinal wall, they no longer need the flagella to move. The bacteria stop producing the protein flagellin to conserve energy and nutrients by changing the mix of proteins that they express in response to the changed chemical surroundings. On reaching the intestinal wall, V. cholerae start producing the toxic proteins that give the infected person a watery diarrhea. This carries

4872-612: The cholera transmission path at which its spread may be halted: Handwashing with soap or ash after using a toilet and before handling food or eating is also recommended for cholera prevention by WHO Africa. Surveillance and prompt reporting allow for containing cholera epidemics rapidly. Cholera exists as a seasonal disease in many endemic countries, occurring annually mostly during rainy seasons . Surveillance systems can provide early alerts to outbreaks, therefore leading to coordinated response and assist in preparation of preparedness plans. Efficient surveillance systems can also improve

4959-572: The city government was put under trusteeship, and the operation of the canal was entrusted to the Société d’études des eaux de Marseille (SEEM) (English: Society for the study of the Marseille Water ) and Raoul Dautry, who had assisted in the creation of the SNCF and was named the first president. Since then, SEEM, owned equally by Veolia Environnement and Lyonnais des eaux , has controlled

5046-424: The culturability of V. cholerae drops 90% within 24 hours of entering the water, and furthermore that this loss in culturability is associated with a loss in virulence. Both toxic and non-toxic strains exist. Non-toxic strains can acquire toxicity through a temperate bacteriophage . About 100   million bacteria must typically be ingested to cause cholera in a normal healthy adult. This dose, however,

5133-433: The duration and severity of diarrhea in children with cholera when given with antibiotics and rehydration therapy as needed. It reduced the length of disease by eight hours and the amount of diarrhea stool by 10%. Supplementation appears to be also effective in both treating and preventing infectious diarrhea due to other causes among children in the developing world. If people with cholera are treated quickly and properly,

5220-489: The first to immunize humans against a bacterial disease. His vaccine and inoculation was rather controversial and was rejected by his peers and several investigation commissions but it ended up demonstrating its effectiveness and being recognized for it: out of the 30 thousand people he vaccinated only 54 died. Russian-Jewish bacteriologist Waldemar Haffkine also developed a human cholera vaccine in July 1892. He conducted

5307-480: The first year after being given and 62% in the second year, with minimal side effects. It is available in over 60 countries. However, it is not currently recommended by the Centers for Disease Control and Prevention (CDC) for most people traveling from the United States to endemic countries. The vaccine that the US Food and Drug Administration (FDA) recommends, Vaxchora , is an oral attenuated live vaccine , that

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5394-420: The genetic mechanisms by which cholera bacteria turn on the protein production of the toxins that interact with host cell mechanisms to pump chloride ions into the small intestine, creating an ionic pressure which prevents sodium ions from entering the cell. The chloride and sodium ions create a salt-water environment in the small intestines, which through osmosis can pull up to six liters of water per day through

5481-462: The genetic structure. Two clusters have been identified: Cluster I and Cluster II. For the most part, Cluster I consists of strains from the 1960s and 1970s, while Cluster II largely contains strains from the 1980s and 1990s, based on the change in the clone structure. This grouping of strains is best seen in the strains from the African continent. In many areas of the world, antibiotic resistance

5568-401: The hands and feet. Dehydration can cause the skin to turn bluish . Symptoms start two hours to five days after exposure. Cholera is caused by a number of types of Vibrio cholerae , with some types producing more severe disease than others. It is spread mostly by unsafe water and unsafe food that has been contaminated with human feces containing the bacteria. Undercooked shellfish

5655-673: The hills of the Chaîne des Côtes. The canal emerges from the tunnel to the west of Lambesc , whereupon the canal's path becomes more complex. Many bridges and tunnels are required to travel the valleys on its way to Coudoux . The canal travels around the hill of Ventabren and comes to the River Arc , where it enters the Roquefavour Aqueduct . Near this area, the Paris-Marseille high speed railway line passes it, and

5742-466: The intestinal cells, creating the massive amounts of diarrhea. The host can become rapidly dehydrated unless treated properly. By inserting separate, successive sections of V. cholerae DNA into the DNA of other bacteria, such as E. coli that would not naturally produce the protein toxins, researchers have investigated the mechanisms by which V. cholerae responds to the changing chemical environments of

5829-400: The intestines, and their excessive sugar content may even harm water uptake. If commercially produced oral rehydration solutions are too expensive or difficult to obtain, solutions can be made. One such recipe calls for 1 liter of boiled water, 1/2 teaspoon of salt, 6 teaspoons of sugar, and added mashed banana for potassium and to improve taste. As there frequently is initially acidosis ,

5916-505: The mortality rate is less than 1%; however, with untreated cholera, the mortality rate rises to 50–60%. For certain genetic strains of cholera, such as the one present during the 2010 epidemic in Haiti and the 2004 outbreak in India, death can occur within two hours of becoming ill. Cholera affects an estimated 2.8 million people worldwide, and causes approximately 95,000 deaths

6003-448: The multiplying new generations of V. cholerae bacteria out into the drinking water of the next host if proper sanitation measures are not in place. The cholera toxin (CTX or CT) is an oligomeric complex made up of six protein subunits : a single copy of the A subunit (part A), and five copies of the B subunit (part B), connected by a disulfide bond . The five B subunits form a five-membered ring that binds to GM1 gangliosides on

6090-400: The mutation (who are not affected by cystic fibrosis) are more resistant to V. cholerae infections. In this model, the genetic deficiency in the cystic fibrosis transmembrane conductance regulator channel proteins interferes with bacteria binding to the intestinal epithelium , thus reducing the effects of an infection. When consumed, most bacteria do not survive the acidic conditions of

6177-400: The neighboring communes of Plan-de-Cuques , Allauch and Aubagne . Although the population increased over the next 40 years, citizens of Marseille in 1876 had over 30 times more water per capita than they did before the canal opened: 370 litres (98 US gal) for domestic use and 660 litres (174 US gal) for industrial activities, daily. The initial intake of the canal from

6264-571: The proposal of a bridge trap and decided instead to build an aqueduct where the escarpments on both sides of the valley were closest, at 400 metres (1,312 ft). That would become the Roquefavour Aqueduct at Ventabren , inspired by the Roman architectural work Pont du Gard . Since then, the Roquefavour Aqueduct, 393 metres (1,289 ft) long, has been regarded as one of the main tourist attractions of Aix-en-Provence. The canal

6351-477: The railway bridge structure has been designed to harmonize with the aqueduct. From the aqueduct, the canal heads south, through many more tunnels, and feeds the Réservoir du Réaltor, a settling basin needed to clarify the Durance's silt-laden water. The canal then enters a 3.5 km tunnel south under Arbois plain, where it briefly emerges and passes thru a treatment plant at Les Giraudets. The canal then enters

6438-399: The risk assessment for potential cholera outbreaks. Understanding the seasonality and location of outbreaks provides guidance for improving cholera control activities for the most vulnerable. For prevention to be effective, it is important that cases be reported to national health authorities. Spanish physician Jaume Ferran i Clua developed the first successful cholera inoculation in 1885,

6525-406: The spread of cholera. They also stress the importance of an effective surveillance system. Governments can play a role in all of these areas. Although cholera may be life-threatening, prevention of the disease is normally straightforward if proper sanitation practices are followed. In developed countries , due to their nearly universal advanced water treatment and sanitation practices, cholera

6612-646: The stomach, mucous layers, and intestinal wall. Researchers have discovered a complex cascade of regulatory proteins controls expression of V. cholerae virulence determinants. In responding to the chemical environment at the intestinal wall, the V. cholerae bacteria produce the TcpP/TcpH proteins, which, together with the ToxR/ToxS proteins, activate the expression of the ToxT regulatory protein. ToxT then directly activates expression of virulence genes that produce

6699-613: The surface of the intestinal epithelium cells. The A1 portion of the A subunit is an enzyme that ADP-ribosylates G proteins , while the A2 chain fits into the central pore of the B subunit ring. Upon binding, the complex is taken into the cell via receptor-mediated endocytosis . Once inside the cell, the disulfide bond is reduced, and the A1 subunit is freed to bind with a human partner protein called ADP-ribosylation factor 6 (Arf6). Binding exposes its active site, allowing it to permanently ribosylate

6786-410: The toxins, causing diarrhea in the infected person and allowing the bacteria to colonize the intestine. Current research aims at discovering "the signal that makes the cholera bacteria stop swimming and start to colonize (that is, adhere to the cells of) the small intestine." Amplified fragment length polymorphism fingerprinting of the pandemic isolates of V. cholerae has revealed variation in

6873-568: The underground sections. However, within the city limits, efforts are being made to close up the canal, prompted by safety concerns over the unpredictable nature of the water's flow following valve openings and the steep and slippery walls. In addition, there are ongoing campaigns aimed at adding fences, lifelines and barriers and posting warning signs along the canal's route The canal passes through many picturesque regions of Provence and contains bicycle and walking paths along its route. Notable sites include: French novelist Marcel Pagnol refers to

6960-451: The world. Recent major outbreaks are the 2010s Haiti cholera outbreak and the 2016–2022 Yemen cholera outbreak . In October 2016, an outbreak of cholera began in war-ravaged Yemen . WHO called it "the worst cholera outbreak in the world". In 2019, 93% of the reported 923,037 cholera cases were from Yemen (with 1911 deaths reported). Between September 2019 and September 2020, a global total of over 450,000 cases and over 900 deaths

7047-465: Was available per person per day. In the 1830s, Marseille began to experience rapid population growth and an epidemic in 1832 to 1835 of cholera convinced the elected officials to act to restore health and to ensure enough water for the city. This cholera epidemic caused the death of 100,000 people throughout France. Originally from Asia, the disease spread along the Ganges Valley in 1826 and

7134-421: Was closed. At the summit of the fountain are sculptures of four large bulls and three women—a central figure representing the Durance flanked by one who represents grapes and one who represents wheat and fertility. Behind the women, within the central structure of the palace, is a manmade stone grotto decorated with carved stalactites and nymphs . From beneath the three women and from the bulls, water flows into

7221-431: Was directed by the engineer Franz Mayor de Montricher . The canal became functional on July 8, 1849. The canal was a significant achievement of 19th-century engineering, combining bridges, tunnels and reservoirs over mountainous terrain. Until 1970, it was almost the sole water source for Marseille, and it still provides two-thirds of the city's drinking water . Marseille is along the hilly Mediterranean seafront and

7308-402: Was far and separated from the city by mountains (chaîne des Côtes, plateau de l'Arbois, massif de l'Étoile ). The plan was to captured water from high up out of the Durance and gravity feed it over and through the terrain so that water would arrive in Marseille at the highest point of the city, Saint-Antoine (150 metres (492 ft)), thus allowing water to serve the whole city. The building of

7395-535: Was filmed at Palais Longchamp in 2014. 43°18′15″N 5°23′40″E  /  43.3043°N 5.3945°E  / 43.3043; 5.3945 Canal de Marseille The Canal de Marseille is a major source of drinking water for all of Marseille , the largest city in Provence , France . The canal , along its main artery, is 80 kilometres (50 mi) long and has additional 160 kilometres (99 mi) of minor arteries. Its construction lasted 15 years and

7482-629: Was reported; however, the accuracy of these numbers suffer from over-reporting from countries that report suspected cases (and not laboratory confirmed cases), as well as under-reporting from countries that do not report official cases (such as Bangladesh, India and Philippines). Although much is known about the mechanisms behind the spread of cholera, researchers still do not have a full understanding of what makes cholera outbreaks happen in some places and not others. Lack of treatment of human feces and lack of treatment of drinking water greatly facilitate its spread. Bodies of water have been found to serve as

7569-440: Was the first recorded incidence of epidemiological tracking. The primary symptoms of cholera are profuse diarrhea and vomiting of clear fluid. These symptoms usually start suddenly, half a day to five days after ingestion of the bacteria. The diarrhea is frequently described as "rice water" in nature and may have a fishy odor. An untreated person with cholera may produce 10 to 20 litres (3 to 5 US gal) of diarrhea

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