Cholera

  • Medical Author:
    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

  • Medical Editor: Melissa Conrad Stöppler, MD
    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD

    Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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What is cholera?

Cholera is an acute infectious disease caused by a bacterium, Vibrio cholerae (V. cholerae), which usually results in a painless, watery diarrhea in humans. Some affected individuals have copious amounts of diarrhea and develop dehydration so severe it can lead to death. Most people who get the disease ingest the organisms through food or water sources contaminated with V. cholerae. Although symptoms may be mild, some previously healthy people will develop a copious diarrhea within about one to five days after ingesting the bacteria. Severe disease requires prompt medical care. Hydration (usually by IV for the very ill) of the patient, and antibiotics in some individuals, is the key to surviving the severe form of the disease.

The World Health Organization (WHO) has maps of current and past areas with cholera outbreaks (see WHO reference). It is estimated that about 1.4 million to 4.3 million people are infected worldwide each year, with approximately 28,000-142,000 deaths per year. Only about one in 10 people infected with cholera develop the typical signs and symptoms. Outbreaks of cholera in 2015 include South Sudan, United Republic of Tanzania, Kenya, and most recently, 121 people diagnosed with cholera in Iraq, their first outbreak since 2012.

The term cholera has a long history (see history section below) and has been assigned to several other diseases. For example, fowl or chicken cholera is a disease that can rapidly kill chickens and other avian species rapidly with a major symptom of diarrhea. However, the disease-causing agent in fowl is Pasteurella multocida, a gram-negative bacterium. Similarly, pig cholera (also termed hog or swine cholera) can cause rapid death (in about 15 days) in pigs with symptoms of fever, skin lesions, and seizures. This disease is caused by a pestivirus termed CSFV (classical swine fever virus). Neither one of these animal diseases are related to human cholera, but the terminology can be confusing.

What are cholera symptoms and signs?

The symptoms and signs of cholera are a watery diarrhea that often contains flecks of whitish material (mucus and some gastrointestinal lining [epithelial] cells) that are about the size of pieces of rice. The diarrhea is termed "rice-water stool" (See figure 1) and smells "fishy." The volume of diarrhea can be enormous; high levels of diarrheal fluid such as 250 cc per kg or about 10 to 18 liters over 24 hours for a 154-pound adult can occur. People may go on to develop one or more of the following symptoms and signs:

Other symptoms that may occur, especially with more severe disease, include the following:

Those infected require immediate hydration to prevent these symptoms from continuing because these signs and symptoms indicate that the person is becoming or is dehydrated and may go on to develop severe cholera. People with severe cholera (about 5%-10% of previously healthy people; higher if a population is compromised by poor nutrition or has a high percentage of very young or elderly people) can develop severe dehydration, leading to acute renal failure, severe electrolyte imbalances (especially potassium and sodium), and coma. If untreated, this severe dehydration can rapidly lead to shock and death. Severe dehydration can often occur four to eight hours after the first liquid stool, ending with death in about 18 hours to a few days in undertreated or untreated people. In epidemic outbreaks in underdeveloped countries where little or no treatment is available, the mortality (death) rate can be as high as 50%-60%.

Picture of rice-water stool from a patient with cholera
Figure 1: Rice-water stool from a patient with cholera; note the flecks of mucus precipitated at the bottom of the cup that resemble rice grains. SOURCE: CDC
Picture of patient with washer woman hands (loss of skin elasticity), a sign of cholera.
Figure 2: Washer woman hands (loss of skin elasticity) are a sign of the dehydration seen in cholera. SOURCE: CDC
Medically Reviewed by a Doctor on 11/18/2015

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