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Cholera

Definition

Cholera is an infection of the small intestine that causes a large amount of watery diarrhea.

Causes

Cholera is caused by the bacterium Vibrio cholerae. These bacteria release a toxin that causes an increased amount of water to be released from cells that line the intestines. This increase in water produces severe diarrhea.

People get the infection from eating or drinking food or water that contains the cholera germ. Living in or traveling to areas where cholera is present raises the risk of getting it.

Cholera occurs in places with a lack of water treatment or sewage treatment, or crowding, war, and famine. Common locations for cholera include:

  • Africa
  • Some parts of Asia
  • India
  • Bangladesh
  • Mexico
  • South and Central America

Symptoms

Symptoms of cholera can be mild to severe. They include:

Exams and Tests

Tests that may be done include:

Treatment

The goal of treatment is to replace fluid and salts that are lost through diarrhea. Diarrhea and fluid loss can be fast and extreme. It can be hard to replace lost fluids.

Depending on your condition, you may be given fluids by mouth or through a vein (intravenous, or IV). Antibiotics may shorten the time you feel ill.

The World Health Organization (WHO) has developed packets of salts that are mixed with clean water to help restore fluids. These are cheaper and easier to use than the typical IV fluid. These packets are now being used around the world.

Outlook (Prognosis)

Severe dehydration can cause death. Most people will make a full recovery when they are given enough fluids.

Possible Complications

Complications may include:

  • Severe dehydration
  • Death

When to Contact a Medical Professional

Call your health care provider if you develop severe watery diarrhea. Also call if you have signs of dehydration, including:

  • Dry mouth
  • Dry skin
  • "Glassy" eyes
  • No tears
  • Rapid pulse
  • Reduced or no urine
  • Sunken eyes
  • Thirst
  • Unusual sleepiness or tiredness

Prevention

The U.S. Centers for Disease Control and Prevention does not recommend cholera vaccines for most travelers. (This vaccine is not available in the United States.)

Travelers should always be careful when eating food and drinking water, even if they are vaccinated.

When outbreaks of cholera occur, efforts should be made to establish clean water, food, and sanitation. Vaccination is not very effective in managing outbreaks.

References

DuPont HL. Approach to the patient with suspected enteric infection. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 283.

Haines CF, Sears CL. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger and Fordtran's Gastrointestinal and Liver Disease. 10th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 110.

Semrad CE. Approach to the patient with diarrhea and malabsorption. In: Goldman L, Schafer AI, eds. Goldman's Cecil Medicine. 25th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 140.

United Nations World Health Organization. WHO position paper on oral rehydration salts to reduce mortality from cholera. WHO 2016. www.who.int/cholera/technical/en/. Accessed March 18, 2016.

Review Date:3/13/2016
Reviewed By:Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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