Cholera

 

 

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

 

Causes, incidence, and risk factors

 

Cholera is caused by the bacterium Vibrio cholerae. The bacteria releases a toxin that causes increased release of water in the intestines, which produces severe diarrhea.
Cholera occurs in places with poor sanitation, crowding, war, and famine. Common locations for cholera include:

• Africa
• Asia
• India
• Mexico
• South and Central America

People get the infection by eating or drinking contaminated food or water.
A type of vibrio bacteria also has been associated with shellfish, especially raw oysters.
Risk factors include:

• Exposure to contaminated or untreated drinking water
• Living in or traveling to areas where there is cholera
  
  
  

  Symptoms

   

   

  • Abdominal cramps
  • Dry mucus membranes or mouth
  • Dry skin
  • Excessive thirst
  • Glassy or sunken eyes
  • Lack of tears
  • Lethargy
  • Low urine output
  • Nausea
  • Rapid dehydration
  • Rapid pulse (heart rate)
  • Sunken "soft spots" (fontanelles) in infants
  • Unusual sleepiness or tiredness
  • Vomiting
  • Watery diarrhea that starts suddenly and has a "fishy" odor
  Note: Symptoms can vary from mild to severe.
  
  
  
  
  

  Signs and tests

  Tests that may be done include:
  

  • Blood culture
  • Stool culture

  Treatment

  The objective of treatment is to replace fluid and electrolytes lost through diarrhea. Depending on your condition, you may be given fluids by mouth or through a vein (intravenous). Antibiotics may shorten the time you feel ill.
  The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally.

  Expectations (prognosis)

  Severe dehydration can cause death. Given adequate fluids, most people will make a full recovery.

  Complications

  • Severe dehydration
  • Death

  Calling your health care provider

  Call your health care provider if :
  

  • You develop severe watery diarrhea
  • You have signs of dehydration, including:
    
    • Dry mouth
    • Dry skin
    • "Glassy" eyes
    • Lethargy
    • 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. (Such a vaccine is not available in the United States.)
  Travelers should always take precautions with food and drinking water, even if vaccinated.
  When outbreaks of cholera occur, efforts should be directed toward establishing clean water, food, and sanitation, because vaccination is not very effective in managing outbreaks.

  References

  1. Seas C, Gotuzzo E. Vibrio cholera. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 7th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2009:chap 214.

  
  

  Review Date: 5/25/2010.

  Reviewed by: Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; 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. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.