Cholera

Written by Bree Normandin | Published on June 4, 2012
Medically Reviewed by George Krucik, MD

Cholera

Cholera is a serious bacterial disease that can cause severe diarrhea and dehydration. The disease is usually spread through contaminated water. Immediate treatment is necessary because death can occur within hours if you have a severe case of cholera, even if you were healthy before you caught it.

Modern sewage and water treatment have effectively eliminated cholera in most countries. However, cholera is still a problem in countries in Asia, Latin America, Africa, India, and the Middle East. Countries affected by war, poverty, and natural disasters have the greatest risk for a cholera outbreak because these conditions tend to force people to live in crowded situations without proper sanitation.

Causes of Cholera

Cholera is caused by bacteria called Vibrio cholerae. The disease’s deadly effects are the result of a strong toxin known as CTX that is produced by these bacteria in your small intestine. CTX interferes with the normal flow of sodium and chloride when it binds to your intestinal walls. When the bacteria attaches to the small intestine’s walls, your body begins to secrete large amounts of water that leads to diarrhea and rapid loss of fluids and salts.

Dirty water supplies are the primary source of cholera infection. Uncooked fruits, vegetables, and other foods can also contain the bacteria that cause cholera.

Cholera is not usually passed from person to person through casual contact.

Are You at Risk?

Anyone can become sick with cholera. However, a few factors may make you more likely to catch cholera and more likely to have a more severe case. These risk factors include:

  • unclean conditions (such as poor sanitation and contaminated water)
  • low levels of stomach acid (cholera bacteria cannot live in highly acidic environments)
  • sick household members
  • type O blood (it’s not clear why this is true, but more people with this blood type seem to be at risk for cholera)
  • eating raw shellfish (if the shellfish live in dirty waters where the cholera bacteria live, there is greater risk of becoming ill)

Symptoms of Cholera

The majority of people exposed to cholera never become ill. In fact, in most cases, you may never know you have been exposed. However, once you are infected, you will continue to shed cholera bacteria in your waste from 7 to 14 days. Cholera usually causes mild to moderate diarrhea, like other illnesses.

One in 10 people who are infected will develop signs that are typical of cholera within two to three days after infection.

Common symptoms of cholera can include:

  • sudden onset of diarrhea
  • nausea
  • vomiting
  • mild to severe dehydration

The dehydration caused by cholera is usually severe and can cause tiredness, moodiness, sunken eyes, dry mouth, shriveled skin, extreme thirst, reduced urine output, irregular heartbeat, and low blood pressure.

Dehydration may lead to loss of minerals in your blood. This can lead to an electrolyte imbalance. The first sign of an electrolyte imbalance is severe muscle cramps. An electrolyte imbalance can eventually lead to shock.

Children usually have the same cholera symptoms as adults. However, children may experience:

  • severe drowsiness
  • fever
  • convulsions
  • coma

Cholera rarely occurs in first-world nations. If you follow proper food safety practices, even in affected areas, the risk of infection is minor. Still, cholera continues to occur worldwide. If you develop severe diarrhea after visiting an area with a high rate of cholera, you should see a doctor.

Diagnosing and Treating Cholera

If you have symptoms of cholera, you should contact your doctor. A doctor can confirm that you have cholera by identifying bacteria in a stool sample.

Common methods for treating cholera include:

  • oral rehydration salts
  • IV fluids
  • antibiotics
  • zinc supplements

These treatments add to the liquid in the body and rehydrate it. They also help reduce the length of time you have diarrhea.

Cholera Complications

Cholera can be fatal. In severe cases, rapid loss of fluids and electrolytes can cause death in as little as two or three hours. Even in typical cases, if cholera is left untreated, people can die of dehydration and shock in as little as 18 hours.

Shock and severe diarrhea are the most serious complications of cholera. However, other problems may occur, such as:

  • low blood sugar
  • low potassium levels
  • kidney failure

Preventing Cholera Infection

If you are traveling to an area where cholera is common, your chances of catching the disease are still low if you:

  • wash your hands
  • drink only bottled or boiled water
  • avoid raw food and shellfish
  • avoid dairy foods
  • eat raw fruits and vegetables that you can peel yourself

Because cholera vaccines do not work very well and most people have a slim chance of catching cholera, your doctor is not likely to provide you with a vaccination. However, if you have had the vaccine and are going to be in a country where cholera is a threat, you may need a second dose or booster of the vaccine.

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