Cholera Alert: Battling the Invisible Enemy

Overview

Cholera is a bacterial disease spread through contaminated water, causing severe diarrhea and dehydration. Without treatment, it can be fatal within hours, even in healthy individuals.

Modern sewage and water treatment have nearly eradicated cholera in industrialized countries. However, cholera still exists in Africa, Southeast Asia, and Haiti. The risk of an epidemic is highest in areas where poverty, war, or natural disasters force people to live in crowded conditions without adequate sanitation.

Cholera is easily treated, and death from severe dehydration can be prevented with a simple and inexpensive rehydration solution.

Symptoms of Cholera

Most people exposed to the cholera bacterium (Vibrio cholerae) do not become ill and may not know they’ve been infected. However, they can still spread the bacteria through their stool for seven to 14 days, contaminating water supplies.

Symptoms of cholera infection can include:

• Diarrhea: Sudden onset, potentially causing significant fluid loss — up to a liter an hour. Cholera diarrhea often looks like rice water.
• Nausea and vomiting: Occurs mainly in the early stages and can last for hours.
• Dehydration: Can develop quickly, leading to severe dehydration marked by a loss of 10% or more of body weight.

Signs of cholera-related dehydration include irritability, fatigue, sunken eyes, dry mouth, extreme thirst, dry and shriveled skin, little or no urination, low blood pressure, and an irregular heartbeat.

Severe dehydration can lead to rapid loss of electrolytes, causing an imbalance that may result in:

• Muscle cramps: Due to rapid loss of salts like sodium, chloride, and potassium.
• Shock: One of the most serious complications, occurring when low blood volume causes a drop in blood pressure and oxygen levels. If untreated, severe hypovolemic shock can cause death in minutes.

When to See a Doctor

The risk of cholera is low in industrialized nations. However, if you develop severe diarrhea after visiting an area with active cholera, seek medical attention immediately. Severe dehydration is a medical emergency.

Causes

Cholera is caused by the bacterium Vibrio cholerae. The deadly effects result from a toxin produced in the small intestine, causing the body to secrete large amounts of water, leading to diarrhea and rapid loss of fluids and electrolytes.

The main sources of cholera infection include:

• Contaminated water supplies: Especially public wells in crowded areas without adequate sanitation.
• Seafood: Raw or undercooked, particularly shellfish from certain regions.
• Raw fruits and vegetables: Contaminated through fertilizers or irrigation water containing raw sewage.
• Grains: Such as rice and millet, contaminated after cooking and kept at room temperature for hours.

Risk Factors

While everyone is susceptible to cholera, certain factors increase vulnerability:

• Poor sanitary conditions: Common in refugee camps, impoverished countries, and disaster-stricken areas.
• Reduced stomach acid: People with low levels of stomach acid, including children, older adults, and those taking antacids, are at greater risk.
• Household exposure: Living with someone who has cholera increases risk.
• Type O blood: People with type O blood are twice as likely to develop cholera.
• Raw or undercooked shellfish: Increases risk, even in industrialized nations.

Complications

Cholera can quickly become fatal due to severe dehydration and shock. Other complications include:

• Low blood sugar (hypoglycemia): Dangerous for children, leading to seizures, unconsciousness, and death.
• Low potassium levels: Interferes with heart and nerve function, potentially life-threatening.
• Kidney failure: Accumulation of fluids and wastes in the body, often accompanying shock.

Prevention

To prevent cholera, especially when traveling to high-risk areas:

• Wash hands frequently with soap and water or use an alcohol-based hand sanitizer.
• Drink only safe water, including bottled or boiled water.
• Eat thoroughly cooked food and avoid street vendor food.
• Avoid raw or undercooked seafood and sushi.
• Stick to fruits and vegetables you can peel yourself.

Cholera Vaccine

Oral cholera vaccines are available in several countries. Consult your doctor or local health office for more information. Even with vaccination, continue practicing preventive measures.

For more information, visit the Mayo Clinic.