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Cholera

Definition

Cholera is an infection of the intestines caused by bacteria called Vibrio cholerae. This infection results in large amounts of watery diarrhea, sometimes enough to cause life-threatening dehydration.

What is going on in the body?

A person can develop cholera by eating or drinking food or water that has been contaminated by cholera bacteria. Cholera occurs in most parts of the world.
In the U.S., most cases of cholera are seen either in:
  • travelers from other countries
  • people who have eaten food imported from another country
In some southern states in the U.S., an occasional cholera case occurs from eating raw shellfish. Cholera can cause severe dehydration, which may result in death if the person is not treated.

Risks

What are the causes and risks of the infection?

Cholera is caused by eating or drinking contaminated food or water that contains the bacteria.

Prevention

What can be done to prevent the infection?

Thorough cooking of food can usually prevent cholera. Boiling water or treating it with chlorine or iodine is another important way to prevent this infection. Cholera is common in underdeveloped countries that lack clean water supplies. A person who travels to this type of country should use care in the food and water consumed. Good hygiene, especially when preparing food, can help prevent the spread of infection through foods.

Diagnosed

How is the infection diagnosed?

The diagnosis of cholera begins with a complete medical history and physical examination. Sometimes, the doctor can see the bacteria in a stool sample through a microscope. In other cases, a stool culture is needed. Stool culture involves putting a sample of stool in a special container. This container has a solution in it that allows the bacteria to grow. If the organism grows, it can be identified, confirming the diagnosis.

Long Term Effects

What are the long-term effects of the infection?

All the serious effects of cholera occur because the body loses large amounts of water and salt through diarrhea. The person can develop life-threatening dehydration and salt imbalances, which in turn can result in low blood pressure and kidney damage. In severe cases, shock and death are possible. Death from cholera is very rare in the U.S but is more common in countries where access to medical care and clean water is limited.

Other Risks

What are the risks to others?

Cholera can be spread from one person to another. This is more likely to occur if the infected person does not have good personal hygiene. Any person with diarrhea from an infection should be careful to wash his or her hands thoroughly after using the toilet, and should not prepare food.

Treatments

What are the treatments for the infection?

A person who has cholera needs to replace what is lost due to the diarrhea. This includes both fluids and salts, also called electrolytes. Liquid salt solutions can be used if the person is able to drink. Otherwise, fluids and salt can be given through an intravenous line (IV).
An IV is a thin tube that is inserted through the skin and into a person's vein, usually in the hand or forearm. This is often the only treatment that is needed, because the diarrhea goes away in a few days.
Antibiotics such as doxycycline (i.e., Adoxa, Doryx, Oracea, Periostat, Vibramycin) and ciprofloxacin (i.e., Cipro, Proquin) can be used to treat cholera. Though antibiotics are not needed to cure the infection, they are commonly used in the U.S. to shorten the time it takes for symptoms to resolve. They also help clear the bacteria from the bowel, thereby reducing the chance of spreading the disease to others.
A recently developed oral vaccine may provide better immunity and have fewer adverse effects than the previously available vaccine. However, cholera vaccine is not generally recommended for most travelers. Prevention by avoiding unsafe food and water is considered more effective.

Side Effects

What are the side effects of the treatments?

All antibiotics have possible side effects, including allergic reactions and stomach upset.

After Treatment

What happens after treatment for the infection?

In most cholera cases in the U.S., the diarrhea goes away and the person starts to feel better within a few days. If treatment is delayed, dehydration can cause complications. These include:
  • kidney damage
  • severe salt imbalances
  • shock
In these cases, the person is usually treated and monitored in a hospital for a short time.

Monitor

How is the infection monitored?

Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

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