Cholera: Symptoms, Transmission & Treatment

Cholera is a bacterial intestinal disease spread through water or food contaminated with Vibrio cholerae. It can cause severe diarrhea, very watery stools, nausea, constant vomiting, fatigue, and dry mouth.

Cholera outbreaks happen more easily in places without treated running water or adequate sanitation. This includes areas without garbage collection or with open sewage.

Anyone experiencing cholera symptoms should seek immediate medical care, such as at an emergency room or urgent care center. A healthcare provider, such as a primary care provider or specialist, can then confirm the diagnosis and recommend appropriate treatment.

Cholera symptoms

The main symptoms of cholera are:

• Severe diarrhea occurring more than once per hour. This happens because bacterial toxins cause the intestinal lining to produce excess fluid.

• Watery, whitish stools that look like milk or rice water.

• Constant nausea and vomiting.

• No urine production.

• Excessive fatigue and weakness.

• Dehydration, with excessive thirst and dry mouth and skin.

• Increased heart rate and low blood pressure.

Cholera symptoms usually appear 2 to 5 days after contact with contaminated water or food.

These symptoms occur because of toxins produced by the bacteria, which cause inflammation in intestinal cells.

Anyone experiencing cholera symptoms should seek emergency medical care right away, as the infection can quickly lead to serious complications and become life-threatening.

Can cholera be life-threatening?

Cholera can be fatal in less than 24 hours if it is not identified and treated quickly.

This is because cholera can cause serious complications, such as severe dehydration, kidney necrosis, hypoglycemia, and hypovolemic shock.

Confirming a diagnosis

Cholera is diagnosed by an infectious disease specialist, gastroenterologist, primary care provider, or pediatrician based on symptoms and a history of travel to endemic areas or exposure to unsafe water or poor sanitation.

To confirm the diagnosis, the doctor may order a stool test to isolate and culture V. cholerae.

However, because of the risk of complications, treatment is started as soon as cholera is suspected, even before test results are available.

How it spreads

The main route of cholera transmission is fecal-oral, which can occur by:

• Drinking water or eating food contaminated with V. cholerae

• Eating contaminated freshwater fish, seafood, or shellfish

• Having direct contact with an infected person

• Not washing hands after using the bathroom, since V. cholerae remains in stool for 7 to 14 days

Vibrio cholerae can be shed through vomiting and diarrhea, which makes it easy to spread.

As a result, cholera is commonly transmitted among people in shared environments, such as those living in the same household or attending the same school or workplace.

Locally acquired cholera

According to the CDC, cholera is rare in the United States, and most cases are linked to international travel. Locally acquired cholera can occur without recent international travel and has rarely been associated with eating raw or undercooked shellfish from the Gulf of Mexico.

Risk factors

The main factors that can increase the risk of cholera are:

• Limited access to clean water and sanitation
• Difficulty accessing safe food storage or food preparation conditions
• Living in or traveling to areas with cholera outbreaks
• Living in crowded settings

V. cholerae is found in aquatic environments and, when present in stool, can multiply easily between 41°F and 104°F (5°C and 40°C). It is also resistant to freezing.

Therefore, contaminated rivers, reservoirs, and lakes can contribute to outbreaks in certain regions.

Treatment options

Cholera treatment should be guided by an infectious disease specialist, gastroenterologist, primary care provider, or pediatrician. It includes supportive care and antibiotics.

The main treatments for cholera are:

1. Increase hydration

Because cholera causes severe diarrhea, it is important to increase hydration by drinking plenty of fluids to prevent dehydration.

Oral rehydration solution, available at pharmacies, or homemade oral rehydration solution may also be recommended to prevent and treat dehydration by replacing fluids and electrolytes lost through diarrhea and vomiting.

2. Hospital admission

Hospitalization with IV fluids is indicated when severe dehydration and hypovolemic shock occur, with a loss of more than 10% of body weight.

In these cases, about 100 mL/kg of body weight of lactated Ringer’s solution is given during the first three hours.

3. Use of medications

Medications to stop diarrhea and vomiting are not recommended, as they may prevent toxins produced by V. cholerae from being eliminated.

If symptoms are severe, the doctor may prescribe medication to relieve nausea and pain, or probiotics to restore gut bacteria.

4. Antibiotics

Antibiotics for cholera may be prescribed by a doctor after 4 to 6 hours of adequate hydration and replacement of fluids and electrolytes.

The main antibiotics for cholera are:

Antibiotics for cholera can help shorten the infection and reduce the spread of V. cholerae.

The antibiotic used may vary depending on the strain of V. cholerae and its sensitivity to treatment. For this reason, antibiotics for cholera should only be used with medical guidance and, when available, stool test results.

Can cholera be cured?

Cholera can be cured when it is identified and treated quickly. Signs of improvement include less vomiting and diarrhea, better skin color, and reduced weakness.

Prevention measures

To help prevent cholera, especially when traveling to or living in areas where cholera is present, it is recommended to:

• Drink filtered water

• Boil tap water before drinking it

• Eat foods that are well cooked and served hot, avoiding raw foods such as salads or sushi

• Wash hands thoroughly before preparing food

• Soak fruits in water with a small amount of bleach solution to disinfect them.

It is also important to wash hands thoroughly with soap and water after using the bathroom and whenever vomiting or diarrhea is present.

Cholera vaccine

The cholera vaccine is mainly recommended for people in areas at high risk for cholera and for travelers or workers going to endemic regions.

According to the CDC, Vaxchora is the only cholera vaccine approved for use in the United States. It is a single-dose oral vaccine approved by the FDA for people 2 through 64 years of age who are traveling to areas where cholera is present.