Cholera

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Introduction

What is cholera?

Cholera is an acute bacterial illness caused by infection of the intestinal tract with the bacterium Vibrio cholerae. Cholera may produce severe gastrointestinal symptoms, including profuse, watery diarrhea, as well as vomiting and dehydration.

Cholera is typically transmitted through water or foods that have been contaminated with fecal matter from a person who is infected with the disease. Cholera can spread rapidly, and epidemics may occur after fecal contamination of food or water supplies, but the infection is not transmitted by casual person-to-person contact. Most infections caused by current prevalent strains of the bacterium are asymptomatic and clear spontaneously. Clinical symptoms emerge in approximately 1 in 30 Vibrio cholerae infections.

Cholera is extremely rare in countries that have modern water and sewage treatment facilities. In fact, only about five cases of cholera are reported in the United States every year. Occasionally, scattered outbreaks have occurred in the United States, resulting from consumption of raw or undercooked shellfish from the Gulf of Mexico. However, cholera is a major cause of illness in the developing world, with approximately three to five million cases occurring worldwide each year. Most reported cases of cholera are in Africa. Travelers to affected countries should be cautious about food and water choices (Source: CDC).

Symptoms of cholera typically appear 24 to 48 hours after infection, but can appear anywhere from a few hours to five days after infection. Most patients have only very mild symptoms, or no symptoms at all. Only five percent of infected individuals develop severe symptoms. Fortunately, fluid replacement and antibiotic therapy are effective treatments for cholera infection and can prevent serious complications.

Left untreated, cholera can lead to potentially life-threatening complications. Severe dehydration and electrolyte imbalances can occur, resulting in shock, coma, and even death within a few hours. Seek prompt medical care if you develop diarrhea and vomiting or you think you may have been exposed to cholera. Seek immediate medical care (call 911) if you have symptoms of severe dehydration, such as confusion, lethargy, loss of consciousness, cold skin, sunken eyes, weak pulse, or reduced urine production.

Symptoms

What are the symptoms of cholera?

Common early symptoms of cholera

You may experience symptoms of cholera anytime from a few hours to five days after becoming infected. It is important to remember that similar symptoms occur in many different diseases and are unlikely to be associated with cholera unless you have recently traveled in developing countries. Early symptoms include:

  • Muscle cramps

  • Profuse, watery diarrhea that is typically painless. Stools are described as having a “rice-water” appearance.

  • Vomiting

Later symptoms of cholera

As dehydration progresses, further symptoms may develop as a result of fluid loss including:

  • Cold or cool skin

  • Dry skin and mucous membranes (such as dry mouth)

  • Excessive thirst

  • Loss of skin elasticity

  • Muscle cramps and weakness

  • Reduced urine output

  • Sunken eyes

  • Weak pulse

Serious symptoms that might indicate a life-threatening condition

In some cases, dehydration resulting from cholera infection is so severe that a life-threatening situation may develop within hours. Seek immediate medical care (call 911) if you, or someone you are with, have any of the following symptoms:

  • Change in level of consciousness or alertness, such as passing out or unresponsiveness

  • Change in mental status or sudden behavior change, such as confusion, delirium, lethargy, hallucinations and delusions

  • Fast heart rate (tachycardia)

  • Greatly reduced or no urine output

  • Rapid breathing rate (tachypnea)

  • Weak pulse

Causes

What causes cholera?

Cholera is a contagious disease caused by infection with the bacterium Vibrio cholerae. The infection is spread through food or water that has been contaminated with fecal matter from an infected person. In many cases, the infected person handled the food without proper hand washing. Casual contact does not spread the disease. Less commonly, you can become infected by eating shellfish taken from waters contaminated by raw sewage.

What are the risk factors for cholera?

A number of factors increase the risk of developing cholera. Not all people with risk factors will get cholera. Risk factors for cholera include:

  • Residence in a developing country with poor water and sewage treatment facilities or poor hygiene practices

  • Travel in affected areas of the world

Reducing your risk of cholera

When visiting affected areas of the world, you can reduce your risk of getting or transmitting cholera through the following actions:

  • Avoiding consumption of tap water, ice cubes, and fountain drinks (canned and bottled carbonated drinks are safe to drink)

  • Bathing and washing (yourself and your children) at least 100 feet away from drinking water sources

  • Being aware of the risks of cholera and understanding how it is spread

  • Drinking only boiled, bottled or purified water

  • Not eating raw or undercooked meats and seafood or unpeeled fruits and vegetables

  • Using purified water to wash dishes, prepare food, and brush your teeth

  • Washing your hands often with soap and water or an alcohol-based hand sanitizer

Cholera vaccines to protect indigenous people from contracting the disease are licensed in more than 60 countries, but the Centers for Disease Control does not recommend the vaccines for most travelers to parts of the world where cholera is prevalent. The vaccine is not available in the United States.

Treatments

How is cholera treated?

If you are experiencing symptoms and think you might have been exposed to cholera, contact your health care provider. The mainstay of cholera treatment is replenishment of fluids and electrolytes to prevent serious complications of dehydration. With proper rehydration treatment, less than 1% of people with cholera will die. Left untreated, however, cholera can produce life-threatening dehydration.

Your health care provider may also prescribe antibiotics, which can reduce the duration of infection and lessen the severity of your symptoms.

Replacement of fluids and salts

Replacement of lost fluids is the primary goal of treatment. Fluid replenishment must include replacement of electrolytes (salts). Either an oral rehydration solution (known as ORS) or intravenous fluids may be used. Intravenous fluids are the preferred treatment for severe cases.

Antibiotics for cholera

Antibiotics used to treat cholera include:

  • Azithromycin (Zithromax)
  • Doxycycline (for example, Bio-Tab, Adoxa, Avidoxy)
  • Erythromycin (for example, E-Mycin, E.E.S., Ery-Tab)
  • Tetracycline (for example, Brodspec, Emtet-500, Ala-Tet

What are the potential complications of cholera?

Severe cholera has the potential to cause life-threatening dehydration. Fortunately, such dehydration can be prevented by prompt treatment with rehydration and electrolyte replacement. Left untreated, cholera can cause serious complications including:

  • Acute renal (kidney) failure
  • Coma
  • Electrolyte disturbances (loss of sodium potassium, chloride, and bicarbonate)
  • Shock
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Medical Reviewer: William C. Lloyd III, MD, FACS
Last Review Date: 2019 Jan 4
  1. Cholera. Centers for Disease Control and Prevention. http://www.cdc.gov/cholera/general/
  2. Cholera. World Health Organization. http://www.who.int/mediacentre/factsheets/fs107/en/index.html
  3. Barzilay EJ, Schaad N, Magloire R, et al. Cholera surveillance during the Haiti epidemic--the first 2 years. N Engl J Med 2013; 368:599.
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