Cholera (patient information)

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 * Assistant Editor(s)-in-Chief: Meagan E. Doherty

Overview
Cholera is an acute, diarrheal illness caused by infection of the intestine with the bacterium Vibrio cholerae. The infection is often mild or without symptoms, but sometimes it can be severe. Approximately one in 20 infected persons has severe disease characterized by profuse watery diarrhea, vomiting, and leg cramps. In these persons, rapid loss of body fluids leads to dehydration and shock. Without treatment, death can occur within hours.

What are the symptoms of Cholera?
The following is a list of symptoms commonly associated with people who have developed cholera:
 * 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
 * Sunken "soft spots" (fontanelles) in infants
 * Unusual tiredness
 * Vomiting
 * Watery diarrhea that starts suddenly and has a "fishy" odor

What are the causes of Cholera?
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: 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.
 * Africa
 * Asia
 * India
 * Mexico
 * South and Central America

Who is at highest risk?
Risk factors include:
 * Exposure to contaminated or untreated drinking water
 * Living in or traveling to areas where there is cholera

Diagnosis
Tests that may be done include:
 * Blood culture
 * Stool culture

When to seek urgent medical care?
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

Treatment options
Cholera can be simply and successfully treated by immediate replacement of the fluid and salts lost through diarrhea. Patients can be treated with oral rehydration solution, a prepackaged mixture of sugar and salts to be mixed with water and drunk in large amounts. This solution is used throughout the world to treat diarrhea. Severe cases also require intravenous fluid replacement. With prompt rehydration, fewer than 1% of cholera patients die. Antibiotics shorten the course and diminish the severity of the illness, but they are not as important as rehydration. Persons who develop severe diarrhea and vomiting in countries where cholera occurs should seek medical attention promptly.

Diseases with similar symptoms

 * Viral gastroenteritis
 * Salmonellosis
 * Enterotoxigenic e. coli
 * Food poisoning

Where to find medical care for Cholera?
Directions to Hospitals Treating Cholera

What to expect (Outlook/Prognosis)?
Severe dehydration can cause death. Given adequate fluids, most people will make a full recovery.

Possible complications

 * Severe dehydration
 * Death

Prevention of Cholera
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. The risk for cholera is very low for U.S. travelers visiting areas with epidemic cholera. When simple precautions are observed, contracting the disease is unlikely. All travelers to areas where cholera has occurred should observe the following recommendations:
 * Drink only water that you have boiled or treated with chlorine or iodine. Other safe beverages include tea and coffee made with boiled water and carbonated, bottled beverages with no ice.
 * Eat only foods that have been thoroughly cooked and are still hot, or fruit that you have peeled yourself.
 * Avoid undercooked or raw fish or shellfish, including ceviche.
 * Make sure all vegetables are cooked avoid salads.
 * Avoid foods and beverages from street vendors.
 * Do not bring perishable seafood back to the United States.