Alerts and Notices
SynopsisPer the US Centers for Disease Control and Prevention (CDC), cholera infections are rare and person-to-person transmission in the United States is unlikely; however, the CDC is urging providers to obtain a travel history when evaluating patients with acute-onset watery diarrhea. Further, the CDC recommends obtaining a stool sample for testing and starting aggressive treatment immediately while awaiting test results if cholera is suspected.
Cholera is an acute, potentially life-threatening diarrheal illness caused by the ingestion of water or food contaminated with the bacterium Vibrio cholerae. Symptoms may be mild or severe, with asymptomatic cases occurring frequently. Symptoms include abdominal cramping, severe watery gray-brown ("rice water") diarrhea, vomiting, leg cramping, malaise, and headache. Fever occurs infrequently. Fluid loss may approach 1 liter per hour, and dehydration secondary to the diarrhea can result in shock and circulatory collapse in some cases. Without treatment, the symptoms last from 1-7 days, with mortality rates as high as 50%.
Cholera's incubation period is 2 hours to 5 days, with an average of 2-3 days. While cholera exposure is commonly environmental, due to ingestion of contaminated food or water, person-to-person transmission is also thought to play a role, particularly in the rapid spread of cholera seen during epidemics. Cholera is 1 of 3 diseases with worldwide quarantine sanctions. (Yellow fever and plague are the others.)
An oral vaccine has been shown to be effective in conferring short-term protection during outbreaks, although food and water hygiene should remain the focus of prevention.
Cholera is endemic to countries with poor sewage and water treatment systems because it spreads rapidly through contaminated fecal contact. Few cases of cholera have ever been reported in the United States. Tourists to endemic areas are at higher risk for cholera.
Note: In an outbreak, appropriate disposal of feces, frequent hand washing, and efforts to maintain clean food and water supplies are imperative. Vibrio cholerae shedding in feces continues for 1-2 weeks after infection.
A00.9 – Cholera, unspecified
63650001 – Cholera
Differential Diagnosis & PitfallsClinically, the onset of cholera is often indistinguishable from other acute diarrheal illnesses.
Patient Information for Cholera
OverviewCholera is the name given to a diarrheal illness caused by the bacterium Vibrio cholerae. Vibrio cholerae is found in water or food contaminated by feces. Cholera causes profuse watery diarrhea and can lead to death by sudden dehydration because of the tremendous output of liquid stool. You can contract cholera by eating or drinking food or water contaminated with feces containing V. cholerae. This same bacterium is also present in raw seafood, particularly shellfish.
The best way to avoid getting cholera is to be careful about what you eat or drink. When traveling to countries without clean drinking water, a good way to remember what foods and beverages are safe is to think: If you can not boil it (to kill bacteria), peel it (to remove bacteria), or cook it (to kill bacteria), do not eat it. Also when traveling, remember to avoid ice cubes, which may be made with contaminated water, and to check the seal on all bottled water that you purchase (as the water bottle may have been refilled with unclean water). Some travelers drink only carbonated water in order to avoid this issue.
How do I get cholera?
- By eating foods contaminated with feces containing V. cholerae
- By drinking water contaminated with feces containing V. cholerae
- By eating raw shellfish contaminated with V. cholerae
Who’s At RiskCholera is very rare in the United States; it is usually seen in underdeveloped areas of the world where the sewage systems may be inadequate, such as parts of Latin America, Asia, and Africa. Travelers to these countries (particularly children and the elderly) are at risk for contracting cholera.
Although cholera can occur during travel to underdeveloped areas, cholera is not the classic "travelers' diarrhea." That diarrhea is caused by Escherichia coli (E. coli) species.
Signs & SymptomsThe hallmark of cholera is profuse watery grey-brown diarrhea; the diarrhea is sometimes described as "rice water diarrhea" because it can look like cloudy water with flecks of rice in it. The diarrhea begins hours to days after ingestion of the contaminated food or water and lasts 1-7 days. The affected person will complain of cramping abdominal pain; fatigue; and an overall weak, achy feeling (known as malaise). There is typically no blood in the diarrhea, and the affected person usually does not have a fever.
Symptoms of cholera include:
- Sudden onset of watery diarrhea
- Stool looks like water with flecks of rice in it
- Abdominal pain with cramps, nausea, and vomiting
- Dehydration with symptoms of dry mouth, sunken eyes, and rapid pulse (heart rate)
- Excessive thirst
- Decreased urine output
- In babies, sunken soft spots in the head (fontanelles)
Self-Care GuidelinesStay hydrated, preferably with a liquid that contains some sugar and electrolytes, such as a sports drink. A person with cholera can lose up to a liter of fluid an hour, so if the diarrhea is severe, drink at least half a liter an hour. If nausea and vomiting prevent drinking fluids, intravenous (IV) fluid replacement will be necessary.
Travelers to countries with cholera may want to pack a powdered electrolyte rehydration solution; be sure to use boiled water for reconstituting the solution. You may be tempted to take an anti-diarrheal drug such as loperamide, but if there is any blood in the diarrhea, check with your doctor first.
Drinking boiled skim milk is an old wives' tale and can potentially cause very serious illness (in the form of hyponatremia, or dangerously low levels of salt in the body).