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Cholera

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

Causes

Cholera is caused by the bacteria 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 develop 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:

  • Abdominal cramps
  • Dry mucous membranes or dry 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

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

There is a cholera vaccine available for adults ages 18 to 64 who are traveling to an area with an active cholera outbreak. The Centers for Disease Control and Prevention does not recommend the cholera vaccine for most travelers because most people do not travel to areas where cholera is present.

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

Centers for Disease Control and Prevention website. Cholera – Vibrio cholerae infection. www.cdc.gov/cholera/vaccines.html. Updated May 15, 2018. Accessed May 14, 2020.

Gotuzzo E, Seas C. Cholera and other vibrio infections. In: Goldman L, Schafer AI, eds. Goldman-Cecil Medicine. 26th ed. Philadelphia, PA: Elsevier; 2020:chap 286.

United Nations World Health Organization website. WHO position paper on oral rehydration salts to reduce mortality from cholera. www.who.int/cholera/technical/en. Accessed May 14, 2020.

Waldor MK, Ryan ET. Vibrio cholerae. In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 9th ed. Philadelphia, PA: Elsevier; 2020:chap 214.

  • Digestive system

    Digestive system - illustration

    The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

    Digestive system

    illustration

  • Digestive system organs

    Digestive system organs - illustration

    The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

    Digestive system organs

    illustration

  • Bacteria

    Bacteria - illustration

    Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.

    Bacteria

    illustration

    • Digestive system

      Digestive system - illustration

      The esophagus, stomach, large and small intestine, aided by the liver, gallbladder and pancreas convert the nutritive components of food into energy and break down the non-nutritive components into waste to be excreted.

      Digestive system

      illustration

    • Digestive system organs

      Digestive system organs - illustration

      The digestive system organs in the abdominal cavity include the liver, gallbladder, stomach, small intestine and large intestine.

      Digestive system organs

      illustration

    • Bacteria

      Bacteria - illustration

      Bacterial infections can lead to the formation of pus, or to the spread of the bacteria in the blood.

      Bacteria

      illustration

     

    Review Date: 3/4/2020

    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, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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