Health talk

Cholera is a bacterial disease usually spread through contaminated water. Cholera causes severe diarrhea and dehydration. Left untreated, cholera can be fatal in a matter of hours, even in previously healthy people


Contaminated water supplies are the main source of cholera infection, although raw shellfish, uncooked fruits and vegetables, and other foods also can harbor V. cholerae.

Cholera bacteria have two distinct life cycles — one in the environment and one in humans.



Cholera-related diarrhea comes on suddenly and may quickly cause dangerous flu-id loss — as much as a quart (about 1 liter) an hour. Diarrhea due to cholera often has a pale, milky appearance that resembles water in which rice has been rinsed (rice-water stool).

Nausea and vomiting.

Occurring especially in the early stages of cholera, vomiting may per-sist for hours at a time.


Dehydration can develop within hours after the onset of cholera symptoms. De-pending on how many body fluids have been lost, dehydration can range from mild to severe. A loss of 10 percent or more of total body weight indicates severe dehydration.

Signs and symptoms of cholera dehydration include

irritability, lethargy, sunken eyes, a dry mouth, extreme thirst, dry and shriveled skin that's slow to bounce back when pinched into a fold, little or no urine output, low blood pressure, and an irregular heartbeat (arrhythmia).

Dehydration may lead to

a rapid loss of minerals in your blood (electrolytes) that maintain the balance of fluids in your body. This is called an electrolyte imbalance.

Risk Factors

  • Poor sanitary conditions. Cholera is more likely to flourish in situations where a sanitary environment — includ-ing a safe water supply — is difficult to maintain. Such conditions are common to refugee camps, impoverished coun-tries, and areas devastated by famine, war or natural disasters.
  • Reduced or nonexistent stomach acid (hypochlorhydria or achlorhydria). Chol-era bacteria can't survive in an acidic environment, and ordinary stomach ac-id often serves as a first-line defense against infection. But people with low levels of stomach acid — such as chil-dren, older adults, and people who take antacids, H-2 blockers or proton pump inhibitors — lack this protection, so they're at greater risk of cholera. Household exposure. You're at signifi-cantly increased risk of cholera if you live with someone who has the disease.
  • Type O blood. For reasons that aren't entirely clear, people with type O blood are twice as likely to develop cholera as are people with other blood types.
  • Raw or undercooked shellfish. Although large-scale cholera outbreaks no longer occur in industrialized nations, eating shellfish from waters known to harbor the bacteria greatly in-creases your risk.
  • Low blood sugar (hypoglycemia). Dangerously low levels of blood sugar (glucose) — the body's main energy source — may occur when people become too ill to eat. Children are at greatest risk of this complication, which can cause seizures, unconsciousness and even death.
  • Low potassium levels (hypokalemia). People with cholera lose large quantities of minerals, including potassium, in their stools. Very low potassium levels interfere with heart and nerve function and are life-threatening.
  • Kidney (renal) failure. When the kidneys lose their filtering ability, excess amounts of fluids, some electrolytes and wastes build up in your body — a potentially life-threatening condi-tion. In people with cholera, kidney failure often accompanies shock.
  • Wash hands with soap and water frequently, especially after using the toilet and before handling food.
  • Drink only safe water, including bottled water or water you've boiled or disinfected yourself.
  • Eat food that's completely cooked and hot and avoid street vendor food
  • Avoid sushi, as well as raw or improperly cooked fish and seafood of any kind. Stick to fruits and vegetables that you can peel yourself, such as bananas, oranges and avocados. Stay away from salads and fruits that can't be peeled, such as grapes and ber-ries.
  • Be wary of dairy foods, including ice cream, which is often contaminated, and unpasteur-ized milk.
  • Administration of Cholera vaccine
  • Rehydration. The goal is to replace lost fluids and electrolytes using a simple re-hydration solution, oral rehydration salts (ORS). The ORS solution is available as a powder that can be reconstituted in boiled or bottled water. Without rehydration, ap-proximately half the people with cholera die. With treatment, the number of fatali-ties drops to less than 1 percent. Intravenous fluids. During a cholera epi-demic, most people can be helped by oral rehydration alone, but severely dehydrat-ed people may also need intravenous flu-ids.
  • Antibiotics. While antibiotics are not a necessary part of cholera treatment, some of these drugs may reduce both the amount and duration of cholera-related diarrhea. A single dose of doxycycline (Monodox, Oracea, Vibramycin) or
  • Zinc supplements. Research has shown that zinc may decrease and shorten the duration of diarrhea in children with cholera.