Overview
Cholera is an acute diarrheal infection caused by the bacterium
Vibrio cholerae. The disease is transmitted via contaminated food or water. Individuals who become infected with cholera often have no symptoms and others experience very mild symptoms. Of those infected around 1 in 10 or 10% of individuals will develop a severe illness. The symptoms of cholera are not directly due to infection with the bacteria but rather by toxins that are produced by a bacteriophage (a virus that infects bacteria). Mortality rates of severe cases when left untreated can be upwards of 50%. However, with proper treatment only around 1% of cholera patients will die.
Transmission
How does Cholera spread?
Cholera bacteria are typically found in water or foods that have been contaminated with the feces of an infected individual. It is likely to spread in areas with inadequate water treatment, poor sanitation, and poor hygiene practices.
Cholera bacteria can also survive in brackish waters and coastal waters and has been known to occasionally spread through the consumption of raw or undercooked shellfish, including on rare occasions causing cases in the US through the consumption of raw shellfish from the Gulf
of Mexico.
​
Cholera is spread through fecal-oral transmission typically by contact with food or water that has been contaminated with the bacteria most often from the feces of an infected individual. The disease easily establishes itself and spreads rapidly through populations without basic sanitation and poor water quality and sewage treatment. Due to this it is typically known as a disease of poverty and mainly affects underdeveloped communities and camps for displaced refugees.
The disease can spread rapidly in areas with inadequate treatment of sewage and drinking water. The infection is not likely to spread directly from person to person, meaning casual contact with an infected person is not a risk factor for contracting the illness.
Symptoms
How can you identify Cholera?
Cholera is often a very mild infection or completely asymptomatic, however 1 in 10 cases will go on to be severe.
Symptoms of severe cases can include:
-
Severe watery diarrhea (unique to cholera and often known as “Rice Water Stool”
-
Leg cramps
-
Vomiting (Rare)
-
Extreme Dehydration caused by rapid loss of body fluids.
-
Shock (Due to rapid dehydration and loss of fluid if left untreated)
It typically takes 2-3 days for symptoms to present, however the onset of symptoms may range anywhere from 12 hours to 5 days after the initial infection. Severe cases, when left untreated can lead to death within a matter of hours.
An infected individual with a severe case of cholera can excrete more than a liter of fluid every hour and an individual gram of feces can contain up to a trillion bacteria. Even in mild cases people will shed up to about one million bacteria per gram of feces, and asymptomatic individuals will shed anywhere from 10-10,000 bacteria per gram of feces. Infected individuals will continue shedding bacteria in their poop for 1-10 days and in severe cases up to 2 weeks.
Treatment
How do we treat Cholera?
In cases of severe infection it is vital to get the infected person to medical attention as soon as possible after symptoms arise to greatly increase the chance of recovery. Seeing as complications of Cholera are greatly due to dehydration an oral rehydration solution (ORS), (mixture of water, salts, and sugars) should be administered as soon as possible. If you do not have access to premade ORS simple recipes for a solution can be found online.
Cholera is an incredibly treatable disease and treatment typically includes the use of large quantities of oral rehydration solution (up to six liters the first day), and in severe cases the use of intravenous fluids (IV). Antibiotics are rarely used in the treatment of cholera because they also kill healthy gut bacteria and can lead to antibiotic resistance, however, in very extreme cases they may be used to help shorten the course of the disease. In infant cases it is encouraged to continue breastfeeding.