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Cholera

Definition:

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



Alternative Names:

V. cholerae



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:

Note: Symptoms can vary from mild to severe.



Signs and tests:

Tests that may be done include:



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.



Support Groups:



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:

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.

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.

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.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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