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

Causes, incidence, and risk factors

Cholera is caused by the bacterium Vibrio cholerae. The bacteria releases a toxin that causes increased release of water from cells 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 and gram stain

Treatment

The goal 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, or IV). Antibiotics may shorten the time you feel ill. Antibiotics that may be used include tetracycline or doxycline.

The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical IV fluid. This solution 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. DuPont HL. Approach to the patient with suspected enteric infection. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed.Philadelphia, Pa: Saunders Elsevier; 2011:chap 291.
2. Semrad CE. Approach to the patient with diarrhea and malabsorption.In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, Pa:Saunders Elsevier; 2011:chap142.
3. Giannella RA. Infectious enteritis and proctocolitis and bacterial food poisoning. In: Feldman M, Friedman LS, Brandt LJ, eds. Sleisenger & Fordtran’s Gastrointestinal and Liver Disease. 9th ed. Philadelphia, Pa: Saunders Elsevier; 2010:chap 107.

Review Date: 5/30/2012.

Reviewed by: Linda J. Vorvick, MD, Medical Director and Director of Didactic Curriculum, MEDEX Northwest Division of Physician Assistant Studies, Department of Family Medicine, UW Medicine, School of Medicine, University of Washington. 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. Health Solutions, Ebix, Inc.