Kwalara

**Kwalara** (/ ˈkɒlərə/) ta kasance wata nau'in cuta ce ta kananan hanji ta wasu nau'ikan ƙwayoyin cuta na Vibrio cholerae.Alamun na iya bambanta daga babu, zuwa mai laushi, zuwa mai tsanani.Alamar al'ada ita ce yawan gudawa ta ruwa mai yawan kwanaki[2]. Hakanan ana iya samun amai da ciwon tsoka[3]. Zawo na iya zama mai tsanani har ya kai cikin sa'o'i zuwa ga rashin ruwa mai tsanani da rashin daidaituwar electrolyte[2]. Wannan na iya haifar da dusar kankara idanu, sanyin fata, rage elasticity na fata, da murkushe hannaye da kafafu. Rashin ruwa na iya sa fata ta zama bluish[8]. Alamun suna farawa sa'o'i biyu zuwa kwana biyar bayan bayyanar su.[3]
Kwalara tana faruwa ne ta hanyar nau'ikan nau'ikan Vibrio cholerae, tare da wasu nau'ikan suna haifar da cututtuka mafi tsanani fiye da sauran. Ana yaduwa ta hanyar ruwa mara tsafta da abinci mara tsafta wanda aka gurbata da najasar dan Adam da ke dauke da kwayoyin cuta[2]. Kifin da ba a dafa shi ba shine tushen gama gari.[9] Mutane ne kadai aka san su ga kwayoyin cutar.[2]  Abubuwan da ke tattare da cutar sun hada da rashin tsafta, rashin isasshen ruwan sha, da talauci[2]. Ana iya gano cutar kwalara ta hanyar gwajin stool, [2] ko kuma gwajin saurin dipstick, kodayake gwajin dipstick ba shi da inganci.Hanyoyin rigakafin cutar kwalara sun hada da inganta tsafta da samun ruwa mai tsafta[5]. Alurar rigakafin cutar kwalara da ake bayarwa ta baki suna ba da kariya mai ma'ana na kimanin watanni shida, kuma suna ba da karin fa'idar kariya daga wani nau'in gudawa da E. coli ke haifarwa[2]. A cikin 2017 Hukumar Abinci da Magunguna ta Amurka (FDA) ta amince da allurar rigakafin kwalara mai rai-ɗaya, mai rai, na baka mai suna Vaxchora ga manya masu shekaru 18-64 waɗanda ke tafiya zuwa wani yanki na kamuwa da cutar kwalara[11].Yana ba da iyakataccen kariya ga yara kanana. Mutanen da suka tsira daga cutar kwalara suna da rigakafi na dindindin na akalla shekaru 3 (lokacin da aka gwada.)[12].
Babban magani ga mutanen da abin ya shafa shine salts rehydration na baka (ORS), maye gurbin ruwa da electrolytes ta hanyar amfani da mafita mai zaki da gishiri.[2]  An fi son mafita na tushen shinkafa.[2] A cikin yara, an kuma gano karin abubuwan da ke cikin Zinc don inganta sakamako.[6] A lokuta masu tsanani, ana iya bukatar ruwa mai ciki, irin su Ringer's lactate, kuma maganin rigakafi na iya zama da amfani[2]. Zabin maganin rigakafi yana taimakawa ta hanyar gwajin ji na kwayoyin cuta.[3]
Kwalara na ci gaba da shafar kimanin mutane miliyan 3-5 a duk duniya kuma yana haifar da mutuwar 28,800-130,000 a shekara.[2][7]  Ya zuwa yanzu dai an samu bullar cutar kwalara guda bakwai a cikin kasashe masu tasowa, wanda aka fara a baya-bayan nan a shekarar 1961, kuma ya ci gaba a yau.[13]  Cutar ba kasafai ake samunta ba a kasashe masu samun kudin shiga, kuma tana shafar yara sosai.[2][14]  Kwalara tana faruwa ne a matsayin barkewar duka biyu da kuma na dindindin a wasu wurare[2].Yankunan da ke da ci gaba da kamuwa da cutar sun hada da Afirka da kudu maso gabashin Asiya[2]. Haɗarin mutuwa tsakanin waɗanda abin ya shafa yawanci bai wuce kashi 5% ba, idan aka ba su ingantaccen magani, amma yana iya kaiwa kashi 50% ba tare da samun irin wannan damar ba[2]. Ana samun bayanin kwalara tun farkon karni na 5 BC a Sanskrit[5]. A Turai, cutar kwalara wata kalma ce da aka fara amfani da ita don bayyana kowace irin ciwon gastroenteritis, kuma ba a yi amfani da ita wajen wannan cutar ba sai a farkon karni na 19.[15]. Nazarin cutar kwalara a Ingila da John Snow ya yi tsakanin 1849 zuwa 1854 ya haifar da gagarumin ci gaba a fannin ilimin cututtuka saboda fahimtarsa game da watsa ta hanyar gurbataccen ruwa, kuma taswirar irin wannan ita ce karo na farko da aka rubuta game da bin diddigin cutar.[5].  [16]
## Alamomi
Alamomin farko na cutar kwalara sune yawan gudawa da amai na tsaftataccen ruwa.[17]  Wadannan alamomin suna farawa kwatsam, rabin yini zuwa kwana biyar bayan an sha kwayoyin cutar. Ana bayyana zawo akai-akai da “ruwa shinkafa” a yanayi kuma yana iya samun warin kifi.[17]  Mutumin da ba a yi masa magani ba yana iya samun gudawa daga lita 10 zuwa 20 ( gal 3 zuwa 5 US) a rana.[17]  Mummunan kwalara, ba tare da magani ba, yana kashe kusan rabin mutanen da abin ya shafa.  Idan ba a yi maganin gudawa mai tsanani ba, zai iya haifar da rashin ruwa mai hatsarin gaske da rashin daidaituwar electrolyte.[17]  Kididdiga na rabon asymptomatic zuwa cututtukan cututtuka sun kai daga 3 zuwa 100.[19].  Ana yi wa cutar kwalara lakabi da “mutuwar shudi”[20] domin fatar jikin mutum na iya yin shuɗi-toka saboda tsananin rashin ruwa.[21]
Zazzabi yana da wuya kuma ya kamata ya haifar da zato game da kamuwa da cuta na biyu.  Marasa lafiya na iya yin kasala kuma suna iya samun dusar kankara idanu, bushewar baki, sanyin fata, ko murkushe hannaye da kafafu. Kussmaul numfashi, yanayin numfashi mai zurfi da aiki, na iya faruwa saboda acidosis daga asarar bicarbonate na stool da lactic acidosis da ke hade da rashin jin dadi. Hawan jini yana raguwa saboda rashin ruwa, bugun jini na gefe yana sauri da zare, kuma fitar fitsari yana raguwa da lokaci. Makarkashiyar tsoka da rauni, canjin hayyacin hankali, kamawa, ko ma suma saboda rashin daidaituwar electrolyte ya zama ruwan dare musamman a yara.

## Dalilai

### Watsawa
An gano kwayoyin cutar kwalara a cikin kifi da kuma plankton.Yawaita yawanci ta hanyar najasa-baki na gurɓataccen abinci ko ruwa da rashin tsafta ke haifarwa.[2]  Galibin cutar kwalara a kasashen da suka ci gaba na faruwa ne sakamakon yaduwa ta hanyar abinci, yayin da a kasashe masu tasowa aka fi samun ruwa.[17]  Ana iya watsa abinci a lokacin da mutane suke girbi abincin teku kamar kawa a cikin ruwan da suka kamu da najasa, kamar yadda Vibrio cholerae ke taruwa a cikin crustaceans planktonic kuma kawa suna cin zooplankton.[22]
Mutanen da suka kamu da cutar kwalara sukan yi gudawa, kuma ana iya kamuwa da cututtuka idan wannan stool mai yawan gaske, wanda ake kira "ruwa shinkafa", yana gurbata ruwan da wasu ke amfani da shi.[23]  Cutar gudawa guda daya na iya haifar da karuwar adadin V. kwalara a cikin mahalli da ninki miliyan daya.[24]  Asalin kamuwa da cutar shine yawancin mutanen da ke fama da cutar kwalara lokacin da aka ba da izinin fitar da zawo da ba a kula da su ba ya shiga cikin ruwa, ruwan kasa ko ruwan sha.  Shan duk wani gurbataccen ruwa da cin duk wani abincin da aka wanke a cikin ruwa, da kuma kifin da ke zaune a magudanar ruwa, na iya sa mutum ya kamu da cutar.  Kwalara ba ta cika yaduwa kai tsaye daga mutum zuwa mutum ba.[25][bayanin kula 1]
V. cholerae kuma yana wanzuwa a wajen jikin mutum a cikin mabubbugar ruwa na halitta, ko dai ta kanta ko ta hanyar hulɗa da phytoplankton, zooplankton, ko biotic da abiotic detritus.[26]  Shan irin wannan ruwa kuma yana iya haifar da cutar, ko da ba tare da gurɓata ba a baya ta hanyar ƙwayar cuta.  Matsalolin zaɓaɓɓu sun kasance duk da haka a cikin yanayin ruwa wanda zai iya rage cutar V. cholerae.[26]  Musamman, kirar dabba suna nuna cewa bayanan da aka rubuta na kwayoyin cuta suna canzawa yayin da yake shirin shiga yanayin ruwa.[26]  Wannan canjin rubutun yana haifar da asarar ikon V. cholerae don haɓakawa akan daidaitattun hanyoyin sadarwa, nau'in halitta da ake magana da shi a matsayin 'mai yiwuwa amma ba al'ada ba' (VBNC) ko fiye da 'aiki mai aiki amma ba al'ada' (ABNC).  26]  Wani bincike ya nuna cewa al'adar V. cholerae tana raguwa da kashi 90 cikin 100 a cikin sa'o'i 24 da shiga cikin ruwa, haka nan kuma wannan hasarar da ake samu ta al'ada tana da alaka da hasarar kwayar cuta.[26][27]
Dukansu nau'ikan masu guba da marasa guba suna wanzu.  Nau'o'in da ba su da guba suna iya samun guba ta hanyar bacteriophage mai zafi.[28]
### Rashin Lafiya
Dole ne a sha kusan kwayoyin cuta miliyan 100 don haifar da kwalara a cikin babban koshin lafiya.[17]  Wannan kashi, duk da haka, yana da kasa a cikin wadanda ke da karancin acidity na ciki (misali wadanda ke amfani da inhibitors na proton pump).[17]  Yara kuma sun fi kamuwa da cutar, inda yara masu shekaru biyu zuwa hudu suka fi kamuwa da cutar.[17]  Hakanan nau'in jinin mutum yana shafar kamuwa da cutar kwalara, wanda masu dauke da jinin nau'in O ya fi kamuwa da cutar.[17]  Mutanen da ke da karancin rigakafi, kamar masu cutar kanjamau ko kuma yara masu fama da tamowa, suna iya kamuwa da cutar mai tsanani idan sun kamu da cutar.[29]  Kowane mutum, ko da babba mai lafiya a tsakiyar shekarun haihuwa, yana iya fuskantar matsala mai tsanani, kuma ya kamata a auna yanayin kowane mutum ta hanyar asarar ruwa, zai fi dacewa a tuntubar kwararrun ma'aikatan kiwon lafiya.
Maye gurbin kwayoyin halittar cystic fibrosis da aka sani da delta-F508 a cikin mutane an ce yana rike da zabin fa'idar heterozygous: masu daukar heterozygous na maye gurbi (wadanda cystic fibrosis ba ya shafa) sun fi jure kamuwa da cututtukan V. cholerae.[30]  A cikin wannan samfurin, karancin kwayoyin cuta a cikin kwayoyin cuta na kwayoyin cuta masu sarrafa kwayoyin cuta na kwayoyin cuta suna tsoma baki tare da kwayoyin cuta da ke daure zuwa epithelium na hanji, don haka rage tasirin kamuwa da cuta.

## Makanikai
Idan aka sha, yawancin kwayoyin cuta ba sa tsira daga yanayin acidic na cikin mutum[31].  Kadan daga cikin kwayoyin cuta masu rai suna adana kuzarinsu da adana abubuwan gina jiki yayin wucewa ta ciki ta hanyar rufe samar da furotin.  Lokacin da kwayoyin cutar da suka tsira suka fita daga ciki kuma suka isa karamar hanji, dole ne su fantsama cikin kauri mai kauri da ke layin karamar hanji don isa bangon hanji inda za su hade su yi girma[31].
Da zarar kwayoyin cutar kwalara sun isa bangon hanji, ba sa bukatar tuta ta motsa.  Kwayoyin suna daina samar da furotin flagellin don adana makamashi da abinci mai gina jiki ta hanyar canza haɗin sunadarai da suke bayyanawa don mayar da martani ga yanayin da aka canza.  Lokacin isa bangon hanji, V. cholerae ya fara samar da sunadarai masu guba waɗanda ke ba masu kamuwa da cutar.
mutum gudawa mai ruwa.  Wannan yana daukar sabbin tsararrun kwayoyin cuta na V. cholerae zuwa cikin ruwan sha na mai gida na gaba idan ba a samar da matakan tsaftar muhalli ba.[32]
Toxin kwalara (CTX ko CT) wani hadadden oligomeric ne da aka yi da sinadarai masu gina jiki guda shida: kwafi guda na rukunin A (bangaren A), da kwafi biyar na sashin B (bangaren B), wanda aka haɗa ta hanyar haɗin disulfide.  Rukunin B guda biyar suna samar da zobe mai membobi biyar wanda ke daure ga gangliosides GM1 akan saman sel epithelium na hanji.  Sashin A1 na rukunin A shine enzyme wanda ADP-ribosylates G sunadaran, yayin da sarkar A2 ta shiga tsakiyar rami na zoben subunit B.  Bayan daure, ana daukar hadaddun cikin tantanin halitta ta hanyar endocytosis mai matsakaicin mai karba.  Da zarar cikin tantanin halitta, hadin disulfide yana raguwa, kuma sashin A1 yana da 'yanci don ɗaure tare da furotin abokin tarayya wanda ake kira ADP-ribosylation factor 6 (Arf6).[33].  Daure yana fallasa rukunin yanar gizon sa, yana ba shi damar ribosylate subunit Gs alpha na furotin heterotrimeric G.  Wannan yana haifar da samar da cAMP mai kima, wanda hakan ke haifar da boyewar ruwa, sodium, potassium, da bicarbonate cikin lumen na kananan hanji da saurin bushewa.  An shigar da kwayar halittar kwayar cutar kwalara zuwa cikin V. cholerae ta hanyar canja wurin kwayoyin halitta a kwance.  Mummunan nau'in V. cholerae yana dauke da bambance-bambancen nau'in bacteriophage mai zafi da ake kira CTXφ.
Masana ilimin halittu sun yi nazari kan hanyoyin kwayoyin halitta da kwayoyin cutar V. cholerae ke kashe samar da wasu sunadaran da kuma kunna sauran sunadaran yayin da suke amsa jerin yanayin sinadarai da suke ci karo da su, suna wucewa ta ciki, ta hanyar mucosa Layer.  Kananan hanji, kuma zuwa bangon hanji[34].  Wani abin sha’awa shi ne tsarin kwayoyin halittar kwalara da kwayoyin cutar kwalara ke kunna furotin da ke samar da gubar da ke mu’amala da na’urorin da ke dauke da kwayar cutar don jefa ion chloride zuwa cikin karamar hanji, wanda ke haifar da matsin lamba na ionic wanda ke hana ion sodium shiga cikin tantanin halitta.  Chloride da ions sodium suna haifar da yanayin ruwan gishiri a cikin kananan hanji, wanda ta hanyar osmosis zai iya jawo ruwa har zuwa lita shida a kowace rana ta cikin kwayoyin hanji, yana haifar da zawo mai yawa.  Mai gida zai iya bushewa da sauri sai dai idan an kula da shi yadda ya kamata.[35]
Ta hanyar shigar da sassan daban-daban na V. cholerae DNA a cikin DNA na wasu kwayoyin cuta, kamar E. coli wanda ba zai haifar da gubar furotin ba a zahiri, masu bincike sun bincika hanyoyin da V. cholerae ke amsawa ga canjin yanayin sinadarai na  ciki, mucosa yadudduka, da bangon hanji.  Masu bincike sun gano wani hadadden tsari na sunadaran sunadaran da ke sarrafa maganganun V. cholerae virulence determinants.[36]  A cikin amsawa ga yanayin sinadarai a bangon hanji, kwayoyin cuta na V. cholerae suna samar da sunadaran TcpP / TcpH, wanda, tare da sunadaran ToxR / ToxS, suna kunna bayanin furotin na tsari na ToxT.  ToxT sai kai tsaye ya kunna bayyanar da kwayar cutar da ke haifar da guba, yana haifar da gudawa a cikin wanda ya kamu da cutar kuma yana ba da damar kwayoyin cuta su mamaye hanji.[34]  Binciken na yanzu[yaushe?] yana nufin gano "alamar da ke sa kwayoyin cutar kwalara su daina iyo su fara yin mulkin mallaka (wato, manne da kwayoyin halittar) kananan hanji."[34].
### Tsarin kwayoyin halitta
Kwararren tsayin gutsuttsura polymorphism zanen yatsan yatsa na keɓancewar cutar ta V. cholerae ya bayyana bambancin tsarin kwayoyin halitta.  An gano gungu biyu: Cluster I da Cluster II.  Ga mafi yawancin, Cluster I ya kunshi nau'o'i daga 1960s da 1970s, yayin da Cluster II ya kunshi nau'i daga 1980s da 1990s, dangane da canji a tsarin clone.  Wannan rukuni na iri shine mafi kyawun gani a cikin alamun daga Nahiyar Afirka. [37]
### Juriya na rigakafi
A wurare da dama na duniya, juriya na kwayoyin cuta na karuwa a cikin kwayoyin cutar kwalara.  A Bangladesh, alal misali, yawancin lokuta suna jure wa tetracycline, trimethoprim-sulfamethoxazole, da erythromycin.[38]  Ana samun hanyoyin tantancewa cikin gaggawa don gano cututtukan da ke jure magunguna da yawa.[39]  An gano sabbin magungunan kashe kwayoyin cuta masu amfani da kwayoyin cutar kwalara a cikin binciken vitro.[40]
## Bincike
Ana samun gwajin dipstick mai sauri don sanin kasancewar V. cholerae.[38]  A cikin wadannan samfuran da suka gwada inganci, yakamata a kara yin gwaji don sanin juriyar kwayoyin cuta.[38]  A cikin yanayi na annoba, ana iya yin ganewar asibiti ta hanyar daukar tarihin majiyyaci da yin dan gajeren gwaji.  Ana iya fara jiyya ta hanyar hydration da hydration na kan-da-counter ba tare da tabbatar da ko kafin bincike ta hanyar bincike ba, musamman inda cutar kwalara ta zama matsala ta gama gari.[41]
Samfurin stool da swab da aka tattara a cikin mummunan mataki na cutar, kafin a yi amfani da maganin rigakafi, sune samfurori mafi amfani don ganewar asibiti.  Idan ana zargin barkewar cutar kwalara, mafi yawan abin da ke haifar da cutar shine V. cholerae O1.  Idan V. cholerae serogroup O1 ba a keɓe ba, dakin gwaje-gwaje ya kamata a gwada V. cholerae O139.  Koyaya, idan dayan wadannan kwayoyin halitta ba su keɓanta ba, ya zama dole a aika samfuran stool zuwa dakin gwaje-gwaje.
Ya kamata a ba da rahoton kamuwa da cutar V. cholerae O139 kuma a kula da ita kamar yadda V. cholerae O1 ke haifarwa.  Ya kamata a kira cutar gudawa da ke da alaƙa da kwalara kuma dole ne a ba da rahoto a cikin Amurka.[42]
## Rigakafi
Hukumar Lafiya ta Duniya (WHO) ta ba da shawarar mayar da hankali kan rigakafi, shirye-shirye, da mayar da martani don yakar yaduwar cutar kwalara[35].  Suna kuma jaddada mahimmancin tsarin sa ido mai inganci[35].  Gwamnatoci na iya taka rawa a duk wadannan fagage.
### Ruwa, mai kyau da tsafta
Ko da yake kwalara na iya zama barazana ga rayuwa, rigakafin cutar yana da sauki idan aka bi hanyoyin tsaftar muhalli.  A cikin kasashen da suka ci gaba, saboda kusan ci gaban da ake da su na kula da ruwa da tsaftar muhalli, kwalara ba kasafai ba ne.  Misali, babba na karshe
barkewar cutar kwalara a Amurka ya faru a 1910-1911.[43][44]  Kwalara tana da haɗari a cikin kasashe masu tasowa a cikin wuraren da ba su da isasshen kayan aikin WASH (ruwa, tsafta da tsabta) har yanzu.
Ingantattun ayyukan tsafta, idan aka kafa kuma aka bi su cikin lokaci, yawanci sun isa don dakatar da annoba.  Akwai wurare da dama a kan hanyar yada cutar kwalara da za a iya dakatar da yaduwarta:[45]
Haifuwa: Yin zubar da kyau da kuma kula da duk wani abu da watakila ya taɓa saduwa da najasar wasu mutane masu cutar kwalara (misali, tufafi, kwanciya, da sauransu) suna da mahimmanci.  Ya kamata a tsabtace wadannan ta hanyar wankewa cikin ruwan zafi, ta amfani da bleach chlorine idan zai yiwu.  Hannun da suka taɓa masu cutar kwalara ko tufafinsu, kayan kwanciya da sauransu, yakamata a tsaftace su sosai kuma a shafe su da ruwan chlorinated ko wasu ingantattun magungunan kashe ƙwayoyin cuta.
Kula da sludge na najasa da najasa: A wuraren da cutar kwalara ta shafa, najasa da najasa suna bukatar kulawa da kuma kula da su a hankali don dakatar da yaduwar wannan cuta ta hanyar ɗan adam.  Samar da tsafta da tsafta muhimmin mataki ne na kariya.[35]  Bude bayan gida, fitar da najasa da ba a kula da su ba, ko zubar da sludge daga cikin ramummuka ko tankunan ruwa a cikin muhalli yana bukatar hanawa[46].  A yawancin yankunan da cutar kwalara ke fama da ita, ana samun karancin maganin najasa.[47][48]  Don haka aiwatar da busassun bayan gida da ba ya taimaka wajen gurbatar ruwa, kasancewar ba sa zubar da ruwa, yana iya zama wani zabi mai ban sha'awa na ban sha'awa.[49]
Madogarawa: Ya kamata a buga gargaɗi game da yiwuwar kamuwa da cutar kwalara a kusa da gurɓatattun hanyoyin ruwa tare da kwatance kan yadda za a ƙazantar da ruwan (tafasa, chlorination da sauransu) don yiwuwar amfani.
Tsarkakewar Ruwa: Duk ruwan da ake amfani da shi wajen sha, ko wanki, ko dafa abinci ya kamata a haifuwa ta hanyar tafasa, chlorination, maganin ruwa na ozone, haifuwar hasken ultraviolet (misali, ta hanyar lalata ruwan hasken rana), ko tacewa na rigakafi a kowane yanki da kwalara na iya kasancewa.  Chlorination da tafasa galibi sune mafi karancin tsada kuma mafi inganci hanyoyin dakatar da watsawa.  Tace-tufafi ko tace sari, duk da cewa tana da tushe sosai, sun rage bullar cutar kwalara sosai idan aka yi amfani da su a kauyuka marasa galihu a Bangladesh wadanda suka dogara da ruwan saman da ba a kula da su ba.  Ingantattun matatun rigakafin ƙwayoyin cuta, kamar wadanda ke cikin ci-gaban na'urorin tafiya na gyaran ruwa na mutum daya, sun fi tasiri.  Ilimin kiwon lafiyar jama'a da kuma bin hanyoyin tsaftar mahalli na da muhimmanci a farko don taimakawa rigakafin cutar kwalara da sauran cututtuka.
Wanke hannu da sabulu ko toka bayan bayan gida da kuma kafin sarrafa abinci ko cin abinci ana ba da shawarar rigakafin cutar kwalara ta WHO Afirka.[50]
### Sa ido
Sa ido da bayar da rahoto cikin gaggawa suna ba da damar daukar cututtukan kwalara cikin sauri.  Kwalara na wanzuwa a matsayin cuta na lokaci-lokaci a yawancin kasashe masu fama da cutar, yana faruwa kowace shekara galibi lokacin damina
yanayi.  Tsarin sa ido na iya ba da fadakarwa da wuri ga barkewar cutar, saboda haka yana haifar da hadakar amsawa da taimakawa cikin shirye-shiryen shirye-shiryen shirye-shiryen.  Ingantattun tsarin sa ido na iya inganta kimanta hadarin cutar kwalara.  Fahimtar yanayin yanayi da kuma wurin da ake samun bullar cutar yana ba da jagora don inganta ayyukan rigakafin kwalara ga masu rauni.[51]  Don rigakafin ya yi tasiri, yana da mahimmanci a kai rahoto ga hukumomin kiwon lafiya na kasa[17].
### Alurar riga kafi
Likita dan kasar Sipaniya Jaume Ferran i Clua ya yi allurar rigakafin kwalara a shekara ta 1885, wanda shi ne na farko da ya yi wa mutane rigakafi daga cutar kwayan cuta.[52]  Duk da haka, maganin alurar riga kafi da allurar sa ya kasance mai yawan cece-kuce kuma takwarorinsa da kwamitocin bincike da yawa sun ki su.[53][54][55]  Masanin kimiyyar kwayoyin cutar dan kasar Rasha-Yahudawa Waldemar Haffkine ya yi nasarar samar da rigakafin cutar kwalara na farko a watan Yulin 1892.[53][54][55][56]  Ya gudanar da gagarumin shirin rigakafin cutar a Indiya ta Burtaniya.[55][57]
Mutanen da suka tsira daga cutar kwalara suna da rigakafi na dindindin na akalla shekaru 3 (lokacin da aka gwada).  Hukumar Lafiya ta Duniya (WHO) tana da allurar rigakafin cutar kwalara guda uku (OCVs): Dukoral, Sanchol, da Euvichol.  Dukoral, maganin da aka yi ta baki, wanda ba a kunna allurar tantanin halitta gabadaya, yana da cikakken tasiri na kusan 52% a cikin shekarar farko bayan an ba shi da kashi 62% a cikin shekara ta biyu, tare da karancin sakamako.[58].  Ana samunsa a cikin kasashe sama da 60.  Duk da haka, ba a halin yanzu[yaushe?] Cibiyar Kula da Cututtuka (CDC) ta ba da shawarar ga yawancin mutanen da ke balaguro daga Amurka zuwa kasashe masu fama da cutar.[59]  Alurar rigakafin da Hukumar Abinci da Magunguna ta Amurka (FDA) ta ba da shawarar, Vaxchora, allurar rigakafi ce ta baka, wacce ke da tasiri ga manya masu shekaru 18-64 a matsayin kashi daya.[60]
An gano maganin allura guda daya yana aiki har tsawon shekaru biyu zuwa uku.  Tasirin kariyar ya kasance kasa da kashi 28% a cikin yara wadanda ba su wuce shekara biyar ba.[61]  Koyaya, ya zuwa 2010, yana da iyakacin samuwa.[2]  Ana ci gaba da aiki don bincikar rawar da yawan allurar rigakafi ke takawa.[62]  Hukumar ta WHO ta ba da shawarar yin allurar rigakafi ga kungiyoyi masu hadari, kamar yara da masu cutar HIV, a cikin kasashen da wannan cuta ta yadu.[2]  Idan aka yi wa mutane alluran rigakafi da yawa, rigakafin garken yana haifar da raguwar yawan gurbacewar muhalli.[38]
WHO ta ba da shawarar a yi la’akari da allurar rigakafin cutar kwalara a wuraren da cutar ke yaɗuwa (tare da kololuwar yanayi), a matsayin wani bangare na martani ga barkewar cutar, ko kuma a cikin rikicin jin kai wanda hadarin kwalara ya yi yawa.[63]  An gane maganin cutar kwalara na baka (OCV) a matsayin kayan aiki na gaba don rigakafi da sarrafa kwalara.  Hukumar Lafiya ta Duniya (WHO) ta riga ta ba da allurar rigakafin cutar kwalara guda uku - Dukoral (SBL Vaccines), wanda ke dauke da wani rukunin B-ba mai guba na toxin kwalara da kuma ba da kariya daga V. cholerae O1;  da alluran rigakafi guda biyu da aka haɓaka ta hanyar amfani da fasahar fasaha iri daya-ShanChol (Shantha Biotec) da Euvichol (EuBiologics Co.), waɗanda ke da bivalent O1 da O139 na baka sun kashe maganin kwalara.[64]  Ana iya tura allurar rigakafin cutar kwalara a cikin yanayi daban-daban daga yankunan kwalara da wuraren da ake fama da rikice-rikicen jin kai, amma babu wata yarjejeniya ta musamman.[65]

### Sari tacewa
An ƙirƙira don amfani a Bangladesh, "Sari filter" hanya ce mai saui kuma mai tsada mai dacewa don rage gurɓataccen ruwan sha.  Tufafin Sara da aka yi amfani da shi ya fi dacewa amma sauran nau'ikan zanen da aka yi amfani da su ana iya amfani da su tare da wani tasiri, kodayake tasirin zai bambanta sosai.  Tufafin da aka yi amfani da shi yana da tasiri fiye da sabon zane, saboda maimaita wankewar yana rage sarari tsakanin zaruruwa.  Ruwan da aka tara ta wannan hanya yana da raguwar adadin kwayoyin cuta-ko da yake ba lallai ba ne ya kasance lafiyayye, yana da kyau ga matalauta masu iyakacin zabi.[66]  A Bangladesh an gano wannan aikin na rage yawan kwalara da kusan rabi.[67]  Ya kunshi ninke sari sau hudu zuwa takwas[66].  Tsakanin amfani da rigar ya kamata a wanke shi da ruwa mai tsabta kuma a bushe a rana don kashe duk wani kwayoyin cuta a cikinsa[68].  Tufafin nailan yana bayyana yana aiki kuma amma ba shi da araha.[67]
## Magani
Ci gaba da cin abinci yana hanzarta dawo da aikin hanji na yau da kullun.  WHO ta ba da shawarar hakan gabadaya ga masu fama da gudawa ko da menene sanadin hakan[69].  Littafin koyarwa na CDC musamman game da cutar kwalara ya ce: "Ci gaba da shayar da jaririn ku nono idan jariri yana da gudawa na ruwa, ko da lokacin tafiya don neman magani. Ya kamata manya da yara masu girma su ci gaba da cin abinci akai-akai." [70].
### Ruwa
Kuskuren da ya fi dacewa wajen kula da masu fama da cutar kwalara shi ne rashin la’akari da saurin gudu da yawan ruwan da ake bukata.[71]  A mafi yawan lokuta, ana iya samun nasarar maganin cutar kwalara ta hanyar yin amfani da rehydration na baka (ORT), wanda yake da inganci, mai aminci, kuma mai sauƙin gudanarwa.[38]  Maganin tushen shinkafa an fi son na tushen glucose saboda mafi inganci.[38]  A cikin lokuta masu tsanani tare da rashin ruwa mai mahimmanci, sakewar ruwa na cikin jini na iya zama dole.  Ringer's lactate shine mafi kyawun bayani, sau da yawa tare da ƙara potassium.[17][69]  Ana iya bukatar girma mai girma da ci gaba da maye gurbin har sai gudawa ya ragu.[17]  Ana iya buƙatar kashi goma na nauyin jikin mutum a cikin ruwa a cikin sa'o'i biyu zuwa hudu na farko.[17]  An fara gwada wannan hanya da yawan jama'a a lokacin yakin 'yantar da Bangladesh, kuma an samu nasara sosai.[72]  Duk da yaɗuwar imani, ruwan 'ya'yan itace da abubuwan sha na kasuwanci kamar cola ba su dace da sake sanya ruwa ga mutanen da ke fama da cututtuka masu tsanani na hanji ba, kuma yawan sukarin da ke cikin su na iya cutar da shan ruwa.[73]
Idan hanyoyin samar da ruwa na baka na kasuwanci sun yi tsada sosai ko kuma da wahala a samu, ana iya yin mafita.  Daya daga cikin irin wannan girke-girke yana bukatar lita 1 na tafasasshen ruwa, teaspoon 1/2 na gishiri, cokali 6 na sukari, da kuma kara da ayaba da aka daskare don potassium da kuma inganta dandano.[74].
### Electrolytes
Kamar yadda yawancin acidosis ke farawa, matakin potassium na iya zama al'ada, ko da yake an sami babban hasara.[17]  Yayin da aka gyara rashin ruwa, matakan potassium na iya raguwa da sauri, don haka ana buƙatar maye gurbinsu.[17]  Ana iya yin hakan ta hanyar cin abinci mai yawan potassium, kamar ayaba ko ruwan kwakwa.[75]
### Magungunan rigakafi
Maganin kashe kwayoyin cuta na kwana daya zuwa uku yana rage tsawon lokacin cutar da rage tsananin alamun.[17]  Amfani da maganin rigakafi kuma yana rage buƙatun ruwa[76].  Mutane za su warke ba tare da su ba, duk da haka, idan an kiyaye isasshen ruwa[38].  WHO kawai tana ba da shawarar maganin rigakafi ga masu fama da rashin ruwa mai tsanani.[75]
Doxycycline yawanci ana amfani da layin farko, kodayake wasu nau'ikan V. cholerae sun nuna juriya.[17]  Gwajin juriya a lokacin fashewa na iya taimakawa wajen tantance zaɓin da suka dace a nan gaba.[17]  Sauran maganin rigakafi da aka tabbatar suna da tasiri sun haɗa da cotrimoxazole, erythromycin, tetracycline, chloramphenicol, da furazolidone.[77]  Ana iya amfani da Fluoroquinolones, irin su ciprofloxacin, amma an ba da rahoton juriya.[78]
Magungunan rigakafi suna inganta sakamako a cikin waɗanda suke da tsanani kuma ba su da ruwa sosai.[79]  Azithromycin da tetracycline na iya yin aiki fiye da doxycycline ko ciprofloxacin.[79]
### Karin sinadarin Zinc
A Bangladesh kari na zinc ya rage tsawon lokaci da tsananin gudawa a cikin yara masu fama da kwalara lokacin da aka ba su da maganin rigakafi da kuma sake dawo da ruwa kamar yadda ake bukata.  Ya rage tsawon cutar da sa'o'i takwas da kuma adadin stool da kashi 10%[80].  Kari ya bayyana yana da tasiri a duka biyun magani da kuma hana kamuwa da cutar gudawa saboda wasu dalilai na yara a kasashe masu tasowa.[80][81]
## Hasashen
Idan aka yi wa masu fama da cutar kwalara da sauri da kuma yadda ya kamata, yawan mace-macen bai kai kashi 1% ba;  duk da haka, tare da kwalara ba tare da magani ba, yawan mace-mace yana ƙaruwa zuwa 50-60%.[17][1]
Ga wasu nau'ikan kwayoyin cutar kwalara, kamar wanda aka samu a lokacin annoba ta 2010 a Haiti da barkewar 2004 a Indiya, mutuwa na iya faruwa cikin sa'o'i biyu da rashin lafiya.[82]

## Epidemiology
Kwalara na shafar kimanin mutane miliyan 2.8 a duk duniya, kuma yana haifar da mutuwar kusan 95,000 a shekara (rashin tabbas: 21,000-143,000) kamar na 2015.[83][84].  Wannan yana faruwa musamman a kasashe masu tasowa[85].
A farkon shekarun 1980, an yi imanin cewa adadin mace-macen ya haura miliyan uku a shekara.[17]  Yana da wahala a kididdige ainihin adadin lamurra, saboda da yawa ba a ba da rahoto ba saboda fargabar barkewar cutar na iya yin mummunan tasiri ga yawon bude ido na kasa.[38]  Ya zuwa shekara ta 2004, cutar kwalara ta kasance da annoba da ta zama annoba a wurare da dama na duniya.[17]
Barkewar kwanan nan shine barkewar kwalara na Haiti na 2010s da kuma barkewar cutar kwalara na Yemen na 2016-2022.  A watan Oktoban 2016 ne aka fara bullar cutar kwalara a Yaman da yaki ya daidaita.[86]  WHO ta kira shi "bullar cutar kwalara mafi muni a duniya"[87].  A cikin 2019, kashi 93% na rahoton bullar cutar kwalara 923,037 sun fito ne daga Yemen (tare da mutuwar 1911).[88]  Tsakanin Satumba na 2019 da Satumba 2020, an ba da rahoton adadin mutane sama da 450,000 a duniya kuma sama da 900 sun mutu;  duk da haka, daidaiton waɗannan lambobin suna fama da wuce gona da iri daga ƙasashen da ke ba da rahoton abubuwan da ake zargi (kuma ba a tabbatar da shari'o'in a cikin dakin gwaje-gwaje ba), da kuma ƙarancin rahoto daga kasashen da ba su ba da rahoton shari'o'in hukuma ba (kamar Bangladesh, Indiya da Philippines).  [88]
Ko da yake an san da yawa game da hanyoyin da ke haifar da yaduwar cutar kwalara, har yanzu masu binciken ba su da cikakkiyar fahimtar abin da ke haifar da barkewar cutar kwalara a wasu wurare ba wasu ba.  Rashin kula da najasar mutane da rashin kula da ruwan sha na saukaka yaduwarsa matuka.  An gano gawarwakin ruwa a matsayin tafki na kamuwa da cuta, kuma abincin teku da ake jigilar su daga nesa na iya yada cutar.
Kwalara ta bace daga nahiyar Amurka a mafi yawan karni na 20, amma ta sake bayyana a karshen wannan karni, inda ta fara da mummunar barkewar cutar a kasar Peru.[89]  Hakan ya biyo bayan barkewar kwalara na Haiti na 2010s[90] da kuma wani bullar cutar kwalara a Haiti a cikin rikicin Haiti na 2018-2023.[91]  Tun daga watan Agustan 2021 cutar tana yaduwa a Afirka da wasu yankuna na gabashi da yammacin Asiya (Bangladesh, Indiya da Yemen).[90]  Kwalara ba ta da yawa a Turai;  dukkan shari’o’in da aka ruwaito suna da tarihin tafiya zuwa wuraren da suka kamu da cutar.[90]
### Tarihin bullar cutar
Kalmar kwalara daga Girkanci: χολέρα kholera daga χολή kholē "bile".  Mai yiwuwa cutar kwalara ta samo asali ne a cikin yankin Indiya kamar yadda ake tabbatar da yaduwarta a yankin tsawon karni.[17]
Alamun cutar kwalara sun bayyana a cikin adabin Turai tun a shekara ta 1642, daga bayanin likitan Holland Jakob de Bondt a cikin De Medicina Indorum.[92]  (Lakabin "Indorum" yana nufin Indiyawan Gabas. Ya kuma ba da bayanin farko na Turai game da wasu cututtuka.) Amma a lokacin, kalmar "cholera" a tarihi likitocin Turai sun yi amfani da ita don yin nuni ga duk wani ciwon ciki da ke haifar da launin rawaya.  gudawa.  De Bondt don haka ya yi amfani da kalmar gama gari da aka riga aka yi amfani da ita akai-akai don bayyana sabuwar cutar.  Wannan al'ada ce ta yau da kullun.  Sai a shekarun 1830 ne sunan cutar zawo mai tsanani ya canza a turance daga "cholera" zuwa "cholera morbus" don bambanta shi da abin da ake kira "Asiatic cholera", ko kuma wanda ke da alaka da asali a Indiya da Gabas.
An yi imanin cewa farkon barkewar cutar a cikin yankin Indiya ya samo asali ne sakamakon cunkoson jama'a, rashin kyawun yanayin rayuwa, da kuma kasancewar tafkunan ruwan da babu ruwansu, dukkansu sun samar da yanayi mai kyau na kwalara.[93]  Cutar ta fara yaduwa ta hanyar matafiya ta hanyar kasuwanci (kasa da ruwa) zuwa Rasha a cikin 1817, daga baya zuwa sauran Turai, kuma daga Turai zuwa Arewacin Amurka da sauran duniya, [17] (saboda haka sunan "Asiatic cholera").  [1]).  Cutar kwalara bakwai ta faru tun farkon karni na 19;  na farko bai kai Amurka ba.  Annobar ta bakwai ta samo asali ne a Indonesia a cikin 1961.[94]
Cutar kwalara ta farko ta faru ne a yankin Bengal na Indiya, kusa da Calcutta tun daga 1817 zuwa 1824. Cutar ta bazu daga Indiya zuwa kudu maso gabashin Asiya, Gabas ta Tsakiya, Turai, da Gabashin Afirka.[95]  An yi imanin cewa zirga-zirgar jiragen ruwa da na sojojin ruwa na Burtaniya da na ruwa da ma'aikata sun ba da gudummawa ga yaduwar cutar, tun lokacin da jiragen suka yi jigilar mutanen da ke dauke da cutar zuwa gabar tekun Indiya, daga Afirka zuwa Indonesia, da arewa zuwa China da Japan.  [96]
Cutar ta biyu ta kasance daga 1826 zuwa 1837 kuma ta shafi Arewacin Amurka da Turai.  Ci gaban da aka samu a fannin sufuri da cinikayyar duniya, da kuma karuwar hijirar mutane, ciki har da sojoji, ya sa mutane da yawa ke dauke da cutar sosai.[97]
Annobar ta uku ta barke a shekara ta 1846, ta ci gaba har zuwa 1860, ta tsallaka zuwa Arewacin Afirka, kuma ta isa Arewa da Kudancin Amurka.  An gabatar da shi zuwa Arewacin Amurka a Quebec, Kanada, ta hanyar baki Irish daga Babban Yunwar.  A cikin wannan annoba, Brazil ta kamu da cutar a karon farko.
Cutar ta huɗu ta kasance daga 1863 zuwa 1875, ta bazu daga Indiya zuwa Naples da Spain, kuma ta isa Amurka a New Orleans, Louisiana a 1873. Ta bazu ko'ina cikin tsarin kogin Mississippi na nahiyar.
Annobar ta biyar ta kasance daga 1881 zuwa 1896. Ta fara a Indiya kuma ta yadu zuwa Turai, Asiya, da Kudancin Amurka.  Annobar ta shida ta fara ne daga 1899 zuwa 1923. Wadannan cututtukan sun yi kasa da adadin mace-mace domin likitoci da masu bincike sun fi fahimtar kwayoyin cuta kwalara.  Masar, yankin Larabawa, Farisa, Indiya, da Philippines sun fi fama da wannan annoba.  Sauran yankuna, irin su Jamus a cikin 1892 (musamman birnin Hamburg, inda sama da mutane 8.600 suka mutu)[98] da Naples daga 1910 zuwa 1911, suma sun sami mummunar barkewar cutar.
Annobar ta bakwai ta samo asali ne a shekarar 1961 a kasar Indonesiya kuma tana da alamar bullar wani sabon nau'i mai suna El Tor, wanda har yanzu yana ci gaba da wanzuwa (kamar 2018[99]) a kasashe masu tasowa.  Wannan annoba ta fara raguwa kusan 1975 kuma ana tsammanin ta kare, amma, kamar yadda aka gani, ta ci gaba.  An sami karuwa a lokuta a cikin 1990s kuma tun daga lokacin.
Kwalara ta yadu a karni na 19.[101]  Tun daga lokacin ta kashe dubunnan mutane[102].  A Rasha kadai, a tsakanin 1847 zuwa 1851, fiye da mutane miliyan daya ne suka mutu sakamakon cutar.[103]  Ya kashe Amurkawa 150,000 a lokacin annoba ta biyu.[104]  Tsakanin 1900 zuwa 1920, watakila mutane miliyan takwas ne suka mutu sakamakon cutar kwalara a Indiya.[105]  Kwalara a hukumance ta zama cuta ta farko da za a iya ba da rahoto a cikin Amurka saboda gagarumin tasirin da take da shi ga lafiya.[17]  John Snow, a Ingila, a shekara ta 1854 shine farkon wanda ya gano mahimmancin gurbataccen ruwa a matsayin tushen watsa shi.[17]  A yanzu ba a dauki cutar kwalara a matsayin wata barazana ta kiwon lafiya a Turai da Arewacin Amurka saboda tacewa da kuma sanya sinadarin chlorination na ruwa, amma har yanzu yana matukar shafar al'umma a kasashe masu tasowa.
A baya, jiragen ruwa suna tashi da tutar kebe masu launin rawaya idan wani ma'aikacin jirgin ko fasinjoji ya kamu da cutar kwalara.  Ba wanda ke cikin jirgin da ke dauke da tutar rawaya da za a bari a bakin teku na tsawon lokaci, yawanci kwanaki 30 zuwa 40.[106]
A tarihi da'awar magunguna daban-daban sun wanzu a cikin tatsuniyoyi.  Yawancin magungunan tsofaffi sun dogara ne akan ka'idar miasma, cewa cutar ta kamu da mummunan iska.  Wasu sun yi imanin cewa sanyin ciki yana sa mutum ya fi sauki, kuma an haɗa bel din flannel da kwalara a cikin kayan aikin soja.[107]  A cikin barkewar 1854-1855 a Naples, an yi amfani da camphor homeopathic bisa ga Hahnemann.[108]  TJ Ritter's Mother's Remedies Littafin ya lissafa ruwan tumatir a matsayin maganin gida daga Arewacin Amirka.  An ba da shawarar Elecampane a Burtaniya, a cewar William Thomas Fernie.[109]  An samar da maganin rigakafi na farko na dan adam a cikin 1885, kuma an samar da maganin rigakafi na farko a cikin 1948.
Cutar kwalara ba ta da yawa a kasashen da suka ci gaba inda gwamnatoci suka taimaka wajen kafa hanyoyin tsaftar ruwa da ingantattun magunguna.[110]  A cikin karni na 19, alal misali, Amurka, tana fama da matsalar kwalara mai tsanani irin ta wasu kasashe masu tasowa.  Tana da manyan bullar cutar kwalara guda uku a cikin 1800s, wanda za a iya danganta shi da yaduwar cutar kwalara ta Vibrio cholerae ta hanyoyin ruwa na cikin gida irin su Erie Canal da babban tsarin kwari na kogin Mississippi, da kuma manyan tashoshin jiragen ruwa tare da Gabashin Tekun Gabas da garuruwansu.  111]  Tsibirin Manhattan da ke birnin New York ya taba Tekun Atlantika, inda cutar kwalara da ake tarawa daga ruwan kogin da fitar ruwa a gabar tekun.  A wannan lokacin, birnin New York ba shi da tsarin tsaftar muhalli mai inganci kamar yadda aka samu a karni na 20, don haka cutar kwalara ta yadu ta hanyar samar da ruwan birnin.[112]
Kwalara morbus kalma ce ta tarihi da aka yi amfani da ita wajen yin nuni ga ciwon gastroenteritis maimakon na musamman ga abin da a yanzu ake ayyana cutar kwalara.[15]
## Bayanan kula
A cewar CDC, "Cutar [kwalara] ba zai iya yaduwa kai tsaye daga mutum daya zuwa wani ba; saboda haka, saduwa da mai cutar ta yau da kullun ba abu ne mai hadari don yin rashin lafiya ba."
## Manazarta