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Cholera

Cholera

Definition

Cholera is an acute infectious disease characterized by watery diarrhea that is caused by the bacterium Vibrio cholerae, first identified by Robert Koch in 1883 during a cholera outbreak in Egypt. The name of the disease comes from a Greek word meaning "flow of bile."

Cholera is spread by eating food or drinking water contaminated with the bacterium. Although cholera was a public health problem in the United States and Europe a hundred years ago, modern sanitation and the treatment of drinking water have virtually eliminated the disease in developed countries. Cholera outbreaks, however, still occur from time to time in less developed countries, particularly following such natural disasters as the tsunami that struck countries surrounding the Indian Ocean in December 2004. In these areas cholera is still the most feared epidemic diarrheal disease because people can die within hours of infection from dehydration due to the loss of water from the body through the bowels.

V. cholerae is a gram-negative aerobic bacillus, or rod-shaped bacterium. It has two major biotypes: classic and El Tor. El Tor is the biotype responsible for most of the cholera outbreaks reported from 1961 through the early 2000s.

Description

Cholera is spread by eating food or drinking water that has been contaminated with cholera bacteria. Contamination usually occurs when human feces from a person who has the disease seeps into a community water supply. Fruits and vegetables can also be contaminated in areas where crops are fertilized with human feces. Cholera bacteria also live in warm, brackish water and can infect persons who eat raw or undercooked seafood obtained from such waters. Cholera is rarely transmitted directly from one person to another.

Cholera often occurs in outbreaks or epidemics; seven pandemics (countrywide or worldwide epidemics) of cholera have been recorded between 1817 and 2003. The World Health Organization (WHO) estimates that during any cholera epidemic, approximately 0.2-1% of the local population will contract the disease. Anyone can get cholera, but infants, children, and the elderly are more likely to die from the disease because they become dehydrated faster than adults. There is no particular season in which cholera is more likely to occur.

Because of an extensive system of sewage and water treatment in the United States, Canada, Europe, Japan, and Australia, cholera is generally not a concern for visitors and residents of these countries. Between 1995 and 2000, 61 cases of cholera in American citizens were reported to the Centers for Disease Control and Prevention (CDC); only 24 represented infections acquired in the United States. People visiting or living in other parts of the world, particularly on the Indian subcontinent and in parts of Africa and South America, should be aware of the potential for contracting cholera and practice prevention. Fortunately, the disease is both preventable and treatable.

Causes and symptoms

Because V. cholerae is sensitive to acid, most cholera-causing bacteria die in the acidic environment of the stomach. However, when a person has ingested food or water containing large amounts of cholera bacteria, some will survive to infect the intestines. As would be expected, antacid usage or the use of any medication that blocks acid production in the stomach would allow more bacteria to survive and cause infection.

In the small intestine, the rapidly multiplying bacteria produce a toxin that causes a large volume of water and electrolytes to be secreted into the bowels and then to be abruptly eliminated in the form of watery diarrhea. Vomiting may also occur. Symptoms begin to appear between one and three days after the contaminated food or water has been ingested.

Most cases of cholera are mild, but about one in 20 patients experience severe, potentially life-threatening symptoms. In severe cases, fluids can be lost through diarrhea and vomiting at the rate of one quart per hour. This can produce a dangerous state of dehydration unless the lost fluids and electrolytes are rapidly replaced.

Signs of dehydration include intense thirst, little or no urine output, dry skin and mouth, an absence of tears, glassy or sunken eyes, muscle cramps, weakness, and rapid heart rate. The fontanelle (soft spot on an infant's head) will appear to be sunken or drawn in. Dehydration occurs most rapidly in the very young and the very old because they have fewer fluid reserves. A doctor should be consulted immediately any time signs of severe dehydration occur. Immediate replacement of the lost fluids and electrolytes is necessary to prevent kidney failure, coma, and death.

Some people are at greater risk of having a severe case of cholera if they become infected:

  • People taking proton pump inhibitors, histamine blockers, or antacids to control acid indigestion. As noted earlier, V. cholerae is sensitive to stomach acid.
  • People who have had chronic gastritis caused by infection with Helicobacter pylori.
  • People who have had a partial gastrectomy (surgical removal of a portion of the stomach).

Diagnosis

Rapid diagnosis of cholera can be made by examining a fresh stool sample under the microscope for the presence of V. cholerae bacteria. Cholera can also be diagnosed by culturing a stool sample in the laboratory to isolate the cholera-causing bacteria. In addition, a blood test may reveal the presence of antibodies against the cholera bacteria. In areas where cholera occurs often, however, patients are usually treated for diarrhea and vomiting symptoms as if they had cholera without laboratory confirmation.

Treatment

The key to treating cholera lies in preventing dehydration by replacing the fluids and electrolytes lost through diarrhea and vomiting. The discovery that rehydration can be accomplished orally revolutionized the treatment of cholera and other, similar diseases by making this simple, cost-effective treatment widely available throughout the world. The World Health Organization has developed an inexpensive oral replacement fluid containing appropriate amounts of water, sugar, and salts that is used worldwide. In cases of severe dehydration, replacement fluids must be given intravenously. Patients should be encouraged to drink when they can keep liquids down and eat when their appetite returns. Recovery generally takes three to six days.

Adults may be given the antibiotic tetracycline to shorten the duration of the illness and reduce fluid loss. The World Health Organization recommends this antibiotic treatment only in cases of severe dehydration. If antibiotics are overused, the cholera bacteria organism may become resistant to the drug, making the antibiotic ineffective in treating even severe cases of cholera. Tetracycline is not given to children whose permanent teeth have not come in because it can cause the teeth to become permanently discolored.

Other antibiotics that may be given to speed up the clearance of V. cholerae from the body include ciprofloxacin and erythromycin.

A possible complementary or alternative treatment for fluid loss caused by cholera is a plant-derived compound, an extract made from the tree bark of Croton lechleri, the Sangre de grado tree found in the South American rain forest. Researchers at a hospital research institute in California report that the extract appears to work by preventing the loss of chloride and other electrolytes from the body.

Prognosis

Today, cholera is a very treatable disease. Patients with milder cases of cholera usually recover on their own in three to six days without additional complications. They may eliminate the bacteria in their feces for up to two weeks. Chronic carriers of the disease are rare. With prompt fluid and electrolyte replacement, the death rate in patients with severe cholera is less than 1%. Untreated, the death rate can be greater than 50%. The difficulty in treating severe cholera does not lie in not knowing how to treat it but rather in getting medical care to the sick in underdeveloped areas of the world where medical resources are limited.

Prevention

The best form of cholera prevention is to establish good sanitation and waste treatment systems. In the absence of adequate sewage treatment, the following guidelines should be followed to reduce the possibility of infection:

  • Boil it. Drink and brush teeth only with water that has been boiled or treated with chlorine or iodine tablets. Safe drinks include coffee and tea made with boiling water or carbonated bottled water and carbonated soft drinks.
  • Cook it. Eat only thoroughly cooked foods, and eat them while they are still hot. Avoid eating food from street vendors.
  • Peel it. Eat only fruit or nuts with a thick intact skin or shell that is removed immediately before eating.
  • Forget it. Do not eat raw foods such as oysters or ceviche. Avoid salads and raw vegetables. Do not use untreated ice cubes in otherwise safe drinks.
  • Stay out of it. Do not swim or fish in polluted water.

Preventive measures following natural disasters include guaranteeing the purity of community drinking water, either by large-scale chlorination and boiling, or by bringing in bottled or purified water from the outside. Other important preventive measures at the community level include provision for the safe disposal of human feces and good food hygiene.

Because cholera is one of the few infectious diseases that can be spread by human remains (through fecal matter leaking from corpses into the water supply), emergency workers who handle human remains are at increased risk of infection. It is considered preferable to bury corpses rather than to cremate them, however, and to allow survivors time to conduct appropriate burial ceremonies or rituals. The remains should be disinfected prior to burial, and buried at least 90 feet (30 m) away from sources of drinking water.

A cholera vaccine exists that can be given to travelers and residents of areas where cholera is known to be active, but the vaccine is not highly effective. It provides only 25-50% immunity, and then only for a period of about six months. The vaccine is never given to infants under six months of age. The Centers for Disease Control and Prevention do not currently recommend cholera vaccination for travelers. Residents of cholera-plagued areas should discuss the value of the vaccine with their doctor.

A newer cholera vaccine known as Peru-15 underwent phase II trials in the summer of 2003. As of mid-2004, the manufacturer is planning phase III trials in a developing country and in travelers. Peru-15 is classified as a single-dose recombinant vaccine.

Resources

BOOKS

Beers, Mark H., MD, and Robert Berkow, MD, editors. "Bacterial Diseases." Section 13, Chapter 157. In The Merck Manual of Diagnosis and Therapy. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

PERIODICALS

Altman, Lawrence K., MD, and Denise Grady. "Water Is Key to Averting Epidemics Along Coasts." New York Times December 30, 2004.

Fischer, H., T. E. Machen, J. H. Widdicombe, et al. "A Novel Extract SB-300 from the Stem Bark Latex of Croton lechleri Inhibits CFTR-Mediated Chloride Secretion in Human Colonic Epithelial Cells." Journal of Ethnopharmacology 93 (August 2004): 351-357.

Handa, Sajeev. "Cholera." eMedicine. [cited March 21, 2003]. http://www.emedicine.com/med/topic351.htm.

Jones, T. "Peru-15 (AVANT)." Current Opinion in Investigational Drugs 5 (August 2004): 887-891.

ORGANIZATIONS

Centers for Disease Control and Prevention. 1600 Clifton Rd., NE, Atlanta, GA 30333. (800) 311-3435, (404) 639-3311. http://www.cdc.gov.

Infectious Diseases Society of America (IDSA). 66 Canal Center Plaza, Suite 600, Alexandria, VA 22314. (703) 299-0200. Fax: (703) 299-0204. http://www.idsociety.org.

World Health Organization (WHO). http://www.who.int/en/.

OTHER

World Health Organization Fact Sheet. "Cholera." Fact sheet No. 107, March 2000. http://www.who.int/mediacentre/factsheets/fs107/en/.

World Health Organization Fact Sheet. "Flooding and Communicable Diseases Fact Sheet: Risk Assessment and Preventive Measures." December 2004. http://www.who.int/hac/techguidance/ems/flood_cds/en/index.html.

KEY TERMS

Antibody A specific protein produced by the immune system in response to a specific foreign protein or particle called an antigen.

Bacillus A rod-shaped bacterium. The organism that causes cholera is a gram-negative bacillus.

Biotype A variant strain of a bacterial species with distinctive physiological characteristics.

Electrolytes Salts and minerals that ionize in body fluids. Common human electrolytes are sodium, chloride, potassium, and calcium. Electrolytes control the fluid balance of the body and are important in muscle contraction, energy generation, and almost all major biochemical reactions in the body.

Pandemic A widespread epidemic that affects whole countries or the entire world. There have been seven cholera pandemics since 1817.

Toxin A poison. In the case of cholera, a poison secreted as a byproduct of the growth of the cholera bacteria in the small intestine.

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Cholera

CHOLERA

Cholera is an acute diarrheal illness caused by a bacterium, Vibrio cholerae. There are several environmental strains of Vibrio cholerae, which are found mainly in brackish waters and marine environments, but only two strains are responsible for cholera epidemics in humans, serogroups O1 and O139.

The first described cholera pandemic was in Europe from 1817 to 1823. However, the disease was known in Asia prior to that, with the first possible descriptions dating back as far as 2,000 years ago in India and China. Since that first pandemic there have been a total of seven pandemics. The cholera outbreaks that occurred in London, England in 1849 and 1854 are important in the history of the disease. John Snow, a physician, recognized that cholera was spread via water contaminated with human waste when he identified the source of the London outbreak as the Broad Street water pump. This discovery stimulated the future development of adequate water and sewage systems, which led to the control of many infectious diseases.

The seventh pandemic started in Sulawesi, an island in Indonesia, in 1961 and then spread rapidly through Asia and the Middle East. In 1970, for the first time in over one hundred years, cholera was found in West Africa. In 1991, cholera appeared in Peru and quickly spread throughout the remainder of South and Central America. As was the case with Africa, cholera had not been seen in the western hemisphere for over one hundred years. As of 2001, the seventh cholera pandemic showed no signs of abating.

Cholera is acquired by ingestion of V. cholerae in water, seafood, or other foods that have been contaminated by human excrement. The incubation period can range from a few hours to five days, depending on the inoculum size and the underlying health of the person. Cholera can cause a spectrum of disease, from no clinical symptoms to a mild diarrheal illness or a severe fulminant illness resulting in death. The diarrhea is caused by an enterotoxin produced by the V. cholerae that stimulates the small intestine to secrete large volumes of fluid and electrolytes. Some factors that predispose to severe disease include having blood group O, low gastric acid levels, and malnutrition. The very young and the very old are at particular risk for severe disease. Persons living in endemic areas appear to develop some natural immunity to the infection.

In symptomatic infections, there is an abrupt onset of copious diarrhea, often accompanied by abdominal cramps and vomiting. The diarrhea is typically watery and clear with mucous flecks often described as "rice water stools." It is unusual for fever to develop. Uncomplicated cholera is a self-limited disease that resolves in three to six days. In more severe cases, fluid losses from diarrhea can amount to over 20 liters a day and can lead to profound dehydration that produces weakness, muscle cramping, loss of skin turgor, and sunken eyes and cheeks. If the fluid losses are not rapidly corrected, death results. The fatality rate can be over 50 percent in cases of severe cholera; however, with prompt and adequate rehydration the death rate may be as low as 1 to 2 percent.

The infection is diagnosed by identification of V. cholerae bacteria in stool. The organism can be grown in the laboratory on special alkaline culture media. It appears microscopically as curved, gramnegative rods. A clinical diagnosis can be made in severe cases if a patient presents with profuse, watery diarrhea in an endemic region. There are few other illness that cause such copious diarrhea.

The mainstay of treatment is fluid replacement, either intravenously or orally. In very severe cases, intravenous fluid replacement should be used. When fluids are administered by mouth, it is important to use an oral rehydration solution that contains the correct mix of sugars and electrolytes.

Antibiotics can be used to shorten the duration of illness by several days. Tetracycline, furazolidone, or doxycycline are all effective.

Prevention of cholera depends upon good sanitation and hygiene, including treatment of water supplies, adequate sewage control, and strict hygiene in food preparation. Good food preparation involves hand washing before contact with food, thorough cooking of food, eating food while it is still hot, and not allowing cooked food come into contact with raw foods or with water or ice.

There are several vaccines currently available to prevent cholera. The original cholera vaccine was a parenteral-killed preparation that provided about 50 to 60 percent protection and was only effective for a period of three to six months. This vaccine is no longer recommended for use. The World Heath Organization currently advocates the use of a killed whole cell V. cholerae O1 vaccine (WC/rBS), which is combined with one of the toxin subunits and is given in two doses one week apart. This newer vaccine has been shown to confer 85 to 90 percent protection for six months. The vaccine can be used to prevent a cholera outbreak in a population felt to be at high risk of an out-break, such as the inhabitants of refugee camps. It can also be offered to travelers going to high-risk regions. Another recently developed effective vaccine is the oral, single dose, live attenuated V. cholerae strain, devoid of the A toxin subunit (Mutachol), that provides from 62 to 100 percent protection for about six months. The level of protection varies for different cholera biotypes.

A concern about future cholera outbreaks is the possible emergence of new biotypes. Until 1992, the only strain of cholera identified as causing epidemics in humans was V. cholerae O1. That year a new serotype, O139, emerged in India. Neither previous exposure to O1 cholera, nor vaccination with current vaccines, confers protection against O139. Because V. cholerae exists naturally in brackish waters, and because of the possibility of new biotypes emerging, it is unlikely that cholera will ever be eradicated as a human pathogen. Good hygiene and sanitation are the best strategies we have for control of this disease.

Martha Fulford

Jay Keystone

(see also: Communicable Disease Control; Epidemics; Waterborne Diseases )

Bibliography

Raufman, J. P. (1997). "Cholera." American Journal of Medicine 104:386394.

Reeves, P. R., and Lan, R. (1998). "Cholera in the 1990s." British Medical Bulletin 54 (3):611623.

Ryan, E. T., and Calderwood, S. B. (2000). "Cholera Vaccines." Clinical Infectious Diseases 31:561565.

Sanchez, J. L., and Taylor, D. N. (1997). "Cholera." Lancet 349.

Scheld, W. M.; Craig, W. A.; and Hughes, J. M., eds. (1998). "Cholera and Vibrio Cholerae: New Challenges from a Once and Future Pathogen." In Emerging Infections 2. Washington, DC: ASM Press.

World Health Organization. Vaccines, Immunization and BiologicalsCholera. Available at http://www.who.int/vaccines/intermediate/cholera.htm.

(2000). Fact Sheet 107: Cholera. Geneva: WHO.

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Cholera

CHOLERA

CHOLERA. No epidemic disease to strike the United States has ever been so widely heralded as Asiatic cholera, an enteric disorder associated with crowding and poor sanitary conditions. Long known in the Far East, cholera spread westward in 1817, slowly advanced through Russia and eastern Europe, and reached the Atlantic by 1831. American newspapers, by closely following its destructive path across Europe, helped build a growing sense of public apprehension. In June 1832 Asiatic cholera reached North America and struck simultaneously at Quebec, New York, and Philadelphia. In New York City it killed more than 3,000 persons in July and August. It reached New Orleans in October, creating panic and confusion. Within three weeks 4,340 residents had died. Among America's major cities, only Boston and Charleston escaped this first onslaught. From the coastal cities, the disorder coursed along American waterways and land transportation routes, striking at towns and villages in a seemingly aimless fashion until it reached the western frontier. Minor flare-ups were reported in 1833, after which the disease virtually disappeared for fifteen years.

In December 1848 cholera again appeared in American port cities and, on this occasion, struck down more than 5,000 residents of New York City. From the ports it spread rapidly along rivers, canals, railways, and stagecoach routes, bringing death to even the remotest areas. The major attack of 1848–1849 was followed by a series of sporadic outbreaks that continued for the next six years. In New Orleans, for example, the annual number of deaths attributed to cholera from 1850 to 1855 ranged from 450 to 1,448.

The last major epidemic of cholera first threatened American ports late in 1865 and spread widely through the country. Prompt work by the newly organized Metropolitan Board of Health kept the death toll to about 600 in New York City, but other American towns and cities were not so fortunate. The medical profession, however, had learned that cholera was spread through fecal discharges of its victims and concluded that a mild supportive treatment was far better than the rigorous bleeding, purging, and vomiting of earlier days. Moreover,


a higher standard of living combined with an emphasis on sanitation helped to reduce both incidence and mortality. Cholera continued to flare up sporadically until 1868, disappeared for five years, and then returned briefly in 1873. In the succeeding years only sporadic cases of cholera were found aboard incoming vessels, leading to newspaper headlines and warning editorials.

BIBLIOGRAPHY

Crosby, Alfred. Germs, Seeds, and Animals: Studies in Ecological History. Armonk, N.Y.: Sharpe, 1993.

Duffy, John. Epidemics in Colonial America. Baton Rouge: Louisiana State University Press, 1971.

Rosenberg, Charles. The Cholera Years: The United States in 1832, 1849, and 1866. Chicago: University of Chicago Press, 1997.

JohnDuffy/h. s.

See alsoEpidemics and Public Health ; Influenza ; Sanitation, Environmental .

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cholera

cholera, an acute diarrhoeal disease transmitted by faecal contamination of water supplies and food, and long endemic in India, escaped from Bengal in 1817 to initiate the first of several world-wide pandemics. Asiatic cholera eventually appeared in England in October 1831 in the north-east port of Sunderland, supposedly imported from Hamburg; its presence was initially denied by those with mercantile interests, but it soon arose in Newcastle, Edinburgh, and London, before reaching France and then hurdling the Atlantic. Spreading capriciously, it caused some 31,000 estimated deaths in England and Scotland, and a further 20,000 in Ireland. A second outbreak commencing in London in 1848 was even more serious, despite a stream of regulations and recommendations, and affected all sections of the population rather than the ‘destitute and reckless class’ as before, with some 65,000 deaths in England, Wales, and Scotland and 30,000 in Ireland. The last two major outbreaks of 1853–4 and 1866 were milder. Mid-century attitudes of practical concern held by an enlightened minority (such as John Snow, who famously removed the handle of the Broad Street pump in 1854) spurred some sanitary reform, but there is disagreement amongst modern commentators about the impact of cholera on political, administrative, or social history. Despite its shock value, it was surpassed by tuberculosis and the fevers as a cause of death and debility, but local government reorganization facilitated progress in public health, and few cases occurred in Britain after 1893.

A. S. Hargreaves

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cholera

cholera (kŏl´ərə) or Asiatic cholera, acute infectious disease caused by strains of the bacterium Vibrio cholerae that have been infected by bacteriophages. The bacteria, which are found in fecal-contaminated food and water and in raw or undercooked seafood, produce a toxin that affects the intestines causing diarrhea, vomiting, and severe fluid and electrolyte loss. This overwhelming dehydration is the outstanding characteristic of the disease and is the main cause of death. Cholera has a short incubation period (two or three days) and runs a quick course. In untreated cases the death rate is high, averaging 50%, and as high as 90% in epidemics, but with effective treatment the death rate is less than 1%. The intravenous and oral replacement of body fluids and essential electrolytes and the restoration of kidney function are more important in therapy than the administration of antibacterial drugs. In regions of Asia, Africa, and South America where public sanitation is poor the disease is still endemic or epidemic; vaccination is recommended for people living in those areas. A theory of evolutionary biologists holds that the cystic fibrosis gene, a common but lethal recessive gene carried by approximately one in twenty Caucasians, affords those carriers partial protection against cholera.

See C. E. Rosenberg, The Cholera Years (1962).

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cholera

cholera (kol-er-ă) n. an acute infection of the small intestine by the bacterium Vibrio cholerae, which causes severe vomiting and diarrhoea (known as ricewater stools) leading to dehydration. The disease is contracted from contaminated food or drinking water and often occurs in epidemics. Initial treatment is concentrated on replacing the fluid loss by oral rehydration therapy; tetracycline eradicates the bacteria and hastens recovery. The mortality rate in untreated cases is over 50%. Vaccination against cholera is effective for only 6–9 months.

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Cholera

Cholera

What Is Cholera?

Is Cholera Common?

How Do People Contract Cholera?

What Happens to People Who Have Cholera?

How Can Cholera Be Prevented?

Resources

Cholera (KAH-luh-ruh) is an acute* infection of the small intestine* that can cause severe diarrhea (dye-uh-REE-uh).

*acute
describes an infection or other illness that comes on suddenly and usually does not last very long.
*small intestine
is the part of the intestinethe system of muscular tubes that food passes through during digestionthat directly receives the food after it passes through the stomach.

KEYWORDS

for searching the Internet and other reference sources

Dehydration

Diarrhea

Epidemics

Enteritis

Vibrio cholerae

What Is Cholera?

Cholera is an illness caused by the bacterium Vibrio cholerae, which is contracted by eating contaminated food or drinking contaminated water. The bacteria can cause serious diarrhea by producing a toxin that makes the intestines release more water and minerals than usual. The disease has a 1 to 5 day incubation period (the time between infection and when symptoms appear) and progresses very quickly. Most cases of cholera are mild, but in about 1 of 20 cases the disease is serious. If left untreated, severe cholera can lead to death from dehydration within hours. With treatment, the death rate is less than 1 percent.

Is Cholera Common?

Cholera has been rare in industrialized (or highly developed) countries such as the United States since the turn of the twentieth century, thanks to improved sanitation and water treatment. However, cholera is still common in other parts of the world, including India and southern Asia, parts of Africa, and Latin America.

In 1991, an epidemic* of cholera occurred in South America and some cases appeared in the United States shortly thereafter. Most cases of cholera reported in the United States can be traced to travel to an area where cholera is endemic*.

*epidemic
(eh-pih-DEH-mik) is an outbreak of disease, especially infectious disease, in which the number of cases suddenly becomes far greater than usual. Usually epidemics are outbreaks of diseases in specific regions, whereas worldwide epidemics are called pandemics.
*endemic
(en-DEH-mik) describes a disease or condition that is present in a population or geographic area at all times.

How Do People Contract Cholera?

Cholera is spread when people eat food or drink water that has been contaminated with feces (excreted waste) containing Vibrio cholerae. Risk factors for epidemics of cholera include unsanitary and crowded living conditions, war, famine (scarcity of food), and natural disaster. For example, following a natural disaster such as a hurricane or flood, supplies of drinking water can become contaminated. The disease is most frequently spread in areas with poor sanitation and water treatment facilities.

During outbreaks of the disease, cholera may spread by contact with the feces of an infected person; Vibrio cholerae can live in feces for up to 2 weeks. It also spreads when people use contaminated water for cleaning or waste disposal. Eating raw or undercooked shellfish can be another source of the illness because the bacteria can survive in slow-moving rivers and coastal waters. The few cases in the United States are typically caused by contaminated seafood from the Gulf of Mexico or seafood brought home by people who have traveled to other countries.

What Happens to People Who Have Cholera?

Signs and symptoms

The major symptom of cholera is diarrhea, which can be severe and cause up to a quart of fluid loss per hour from the body. Diarrhea caused by cholera is painless, with stools that are fishy smelling and watery, often with flecks of mucus* in them (these are sometimes called rice water stools, because they look like rice floating in water).

*mucus
(MYOO-kus) is a thick, slippery substance that lines the insides of many body parts.

Most cases of cholera are mild or moderate, and they can be difficult to distinguish from other causes of diarrhea. More serious cases can cause severe diarrhea, vomiting, and dehydration. Signs of dehydration include decreased urination, extreme tiredness, rapid heartbeat, dry skin, dry mouth and nose, thirstiness, and sunken eyes.

Concern Over Cholera

Until the late 1800s, cholera was a very real threat in the United States, and the numbers of cases often reached epidemic proportions. In 1849, the immigrant boat John Drew brought cholera to the city of Chicago, where 678 people died of the disease that year.

By 1870, cholera was no longer a major threat in the United States because of improved sanitation and water treatment. However, the disease continues to be a significant concern in other parts of the world. In 1961, a pandemic (an epidemic that occurs over a large geographic area) that began in Indonesia spread to Bangladesh, India, Iran, and Iraq by 1965. In 1970, cholera appeared in West Africa, where it had not been seen in 100 years. It eventually became endemic to most of the continent.

Eating raw or undercooked oysters, crabs, or shrimp that have come from polluted waters is one way to contract cholera. Outbreaks have been associated with seafood from the Gulf of Mexico. The disease associated with this type of cholera bacteria is less severe than that caused by types seen in Asia. U.S. Fish and Wildlife Service (Washington, D.C.)

Diagnosis

Because the symptoms of cholera are often identical to those of other illnesses that cause diarrhea, knowing that a person has traveled to a country where cholera is endemic is important in helping a doctor make the diagnosis. Blood and stool samples can be taken to look for signs of the bacteria.

Treatment

Treatment of cholera can be very simple and effective, especially if it is given soon after symptoms appear. Rehydration, or replenishing the body with fluids, is the most important part of treatment. This can be accomplished most effectively by drinking a mixture of sugar, salts, and clean water, known as an oral rehydration solution. The World Health Organization has an oral rehydration solution that is distributed worldwide through the efforts of the United Nations. In the United States, solutions can be bought or mixed at home. Such solutions replenish the fluid and salts lost by the body due to diarrhea and vomiting.

More serious cases of cholera may require intravenous (in-tra-VEE-nus) fluids, or fluids injected directly into a vein. Antibiotics, which are given in severe cases, can shorten the time that the symptoms last and help prevent spread of the disease to others.

Complications from cholera are usually the result of severe dehydration. Seizures*, abnormal heart rhythms, shock*, damage to the kidneys*, coma*, and death can occur. Children, especially infants, are more likely to develop complications than adults because they are more prone to developing severe dehydration and body mineral imbalances.

*seizures
(SEE-zhurs) are sudden bursts of disorganized electrical activity that interrupt the normal functioning of the brain, often leading to uncontrolled movements in the body and sometimes a temporary change in consciousness.
*shock
is a serious condition in which blood pressure is very low and not enough blood flows to the bodys organs and tissues. Untreated, shock may result in death.
*kidneys
are the pair of organs that filter blood and remove waste products and excess water from the body in the form of urine.
*coma
(KO-ma) is an unconscious state in which a person cannot be awakened and cannot move, see, speak, or hear.

How Can Cholera Be Prevented?

Steps people can take to prevent cholera when traveling or after a natural disaster include:

  • drinking only bottled water, water that has been boiled or treated with chlorine or iodine, or bottled, carbonated beverages
  • eating only food that has been thoroughly cooked and is still hot
  • not eating raw fruit or vegetables unless they have been peeled
  • avoiding food and drinks sold by street vendors
  • avoiding raw or undercooked seafood
  • not bringing seafood from abroad back to the United States.

Vaccines* for cholera exist, but their effectiveness is short lived and none are provided or recommended in the United States.

*vaccines
(vak-SEENS) are preparations of killed or weakened germs, or a part of a germ or product it produces, given to prevent or lessen the severity of the disease that can result if a person is exposed to the germ itself. Use of vaccines for this purpose is called immunization.

See also

Resources

Organizations

U.S. Centers for Disease Control and Prevention (CDC), 1600 Clifton Road, Atlanta, GA 30333. The CDC is the U.S. government authority for information about infectious and other diseases. It has a fact sheet about cholera at its website.

Telephone 800-311-3435 http://www.cdc.gov

World Health Organization (WHO), Avenue Appia 20, 1211 Geneva 27, Switzerland. WHOs communicable disease surveillance and response division posts a global cholera update at its website to report numbers of cholera cases and deaths worldwide.

Telephone 011-41-22-791-2111 http://www.who.int

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cholera

cholera Infectious disease caused by the bacterium Vibrio cholerae, transmitted in contaminated water. Cholera, prevalent in many tropical regions, produces almost continuous, watery diarrhoea often accompanied by vomiting and muscle cramps, and leads to severe dehydration. Untreated it can be fatal, but proper treatment, including fluid replacement and antibiotics, result in a high recovery rate. There is a vaccine.

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cholera

chol·er·a / ˈkälərə/ • n. an infectious and often fatal bacterial disease of the small intestine, caused by the bacterium Vibrio cholerae and typically contracted from infected water supplies.

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cholera

cholera †bile XIV; disorder attended with bilious diarrhoea, etc. XVII; disease endemic in India XIX. — L. — Gr. kholérā.

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cholera

choleraAltamira, chimera, clearer, Elvira, era, hearer, Hera, hetaera, interferer, lempira, lira, lire, Madeira, Megaera, monstera, rangatira, rearer, scorzonera, sera, shearer, smearer, sneerer, steerer, Thera, Utsire, Vera •acquirer, admirer, enquirer, firer, hirer, inquirer, requirer, wirer •devourer, flowerer, scourer •Angostura, Bonaventura, bravura, Bujumbura, caesura, camera obscura, coloratura, curer, Dürer, durra, Estremadura, figura, fioritura, Führer, insurer, Jura, juror, Madura, nomenklatura, procurer, sura, surah, tamboura, tempura, tourer •labourer (US laborer) • Canberra •Attenborough •Barbara, Scarborough •Marlborough • Farnborough •Deborah • rememberer •Gainsborough • Edinburgh •Aldeburgh • blubberer •Loughborough •lumberer, slumberer •Peterborough •Berbera, gerbera •manufacturer • capturer • lecturer •posturer • torturer • nurturer •philanderer • gerrymanderer •slanderer •renderer, tenderer •dodderer •squanderer, wanderer •borderer • launderer • flounderer •embroiderer • Kundera •blunderer, plunderer, thunderer, wonderer •murderer • amphora • pilferer •offerer • sufferer •staggerer, swaggerer •sniggerer •lingerer, malingerer •treasurer • usurer • injurer • conjuror •perjurer • lacquerer •Ankara, hankerer •bickerer, dickerer •tinkerer • conqueror • heuchera •cellarer • cholera •camera, stammerer •armourer (US armorer) •ephemera, remora •kumara • woomera • murmurer •Tanagra • genera • gunnera •Tampere, tamperer •Diaspora •emperor, Klemperer, tempera, temperer •caperer, paperer •whimperer • whisperer • opera •corpora • tessera • viscera • sorcerer •adventurer, venturer •batterer, chatterer, flatterer, natterer, scatterer, shatterer •banterer •barterer, charterer •plasterer • shelterer • pesterer •et cetera • caterer •titterer, twitterer •potterer, totterer •fosterer •slaughterer, waterer •falterer, palterer •saunterer • poulterer •bolsterer, upholsterer •loiterer • roisterer • fruiterer •flutterer, mutterer, splutterer, stutterer, utterer •adulterer • musterer • plethora •gatherer • ditherer • furtherer •favourer (US favorer), waverer •deliverer, shiverer •hoverer •manoeuvrer (US maneuverer) •discoverer, recoverer

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